Abdominal and Pelvic Radiology Practice Questions

Q: What is the investigation of choice for testicular swelling?

Ultrasonography (USG). **Explanation:** **Ultrasonography (USG)**, specifically high-frequency scrotal ultrasound with **Color Doppler**, is the gold standard and initial investigation of choice for any testicular swelling. Its high sensitivity (nearly 100%) allows for the differentiation between intra-testicular and extra-testicular lesions, which is the most critical step in diagnosis. Intra-testicular masses are highly suspicious for malignancy, whereas extra-testicular masses are usually benign (e.g., hydrocele, epididymal cyst). **Why other options are incorrect:** * **FNAC:** It is generally **contraindicated** in suspected testicular tumors due to the risk of **scrotal seeding** (disrupting the lymphatic drainage and spreading cancer cells to the inguinal lymph nodes). Diagnosis is confirmed via orchidectomy. * **CECT:** While CECT of the abdomen and pelvis is the investigation of choice for **staging** a diagnosed testicular germ cell tumor (to check for retroperitoneal lymphadenopathy), it is not the primary tool for evaluating the swelling itself. * **MRI:** Though highly accurate, it is expensive and not readily available. It is reserved as a problem-solving tool when USG findings are inconclusive. **High-Yield Clinical Pearls for NEET-PG:** * **Testicular Torsion:** USG with Color Doppler shows **absent or decreased blood flow** (Investigation of choice). * **Epididymo-orchitis:** USG shows an enlarged, hypoechoic testis with **increased vascularity** (Hyperemia). * **Tumor Marker Triad:** For testicular tumors, always correlate USG findings with **AFP, beta-hCG, and LDH**. * **Microlithiasis:** Seen as multiple "starry sky" punctate calcifications on USG; it is a known risk factor for malignancy.

Q: What is the earliest radiological finding of Crohn's disease?

Aphthous lesions. **Explanation:** **Correct Answer: C. Aphthous lesions** In Crohn's disease, the earliest macroscopic radiological finding is the **aphthous ulcer**. These appear on a double-contrast barium enema as small, superficial, punctate collections of barium surrounded by a radiolucent halo of edema (the "target" or "bull's eye" sign). They typically occur over lymphoid follicles and represent the initial stage of mucosal inflammation before deeper ulceration occurs. **Analysis of Incorrect Options:** * **A. Cobblestone appearance:** This is a characteristic but **late** finding. It results from deep longitudinal and transverse ulcers intersecting, leaving islands of relatively normal, edematous mucosa between them. * **B. Raspberry appearance:** This is a classic radiological description for **Schistosomiasis** of the colon, not Crohn's disease. * **D. String sign of Kantor:** This refers to the severe narrowing of the terminal ileum due to transmural inflammation and spasm. While highly characteristic of Crohn's, it indicates **advanced** fibrostenotic disease rather than early changes. **NEET-PG High-Yield Pearls:** * **Distribution:** Crohn's is characterized by "skip lesions" (discontinuous involvement) and most commonly affects the terminal ileum. * **Proud Flesh:** These are inflammatory polyps (pseudopolyps) seen between areas of ulceration. * **Comb Sign:** On CT/MRI, this refers to the prominence of the vasa recta due to hypervascularity in the mesentery, indicating active inflammation. * **Creeping Fat:** The extension of mesenteric fat around the bowel wall is a pathognomonic surgical/radiological feature.

Q: An X-ray showing intestinal obstruction is presented. Which view is depicted?

X-ray abdomen erect. ***X-ray abdomen erect*** - The **erect abdominal X-ray** is the standard view for diagnosing intestinal obstruction as it demonstrates **air-fluid levels** and the characteristic **step-ladder pattern** of dilated bowel loops. - This view allows gravity to separate air and fluid within obstructed bowel segments, making the obstruction clearly visible with **horizontal air-fluid interfaces**. *X-ray abdomen left lateral* - This view is not routinely used for diagnosing intestinal obstruction as it provides limited visualization of **air-fluid levels** compared to the erect view. - Left lateral positioning does not optimally demonstrate the **characteristic patterns** of bowel obstruction like step-ladder appearance or multiple air-fluid levels. *X-ray in prone position* - The **prone position** is not suitable for intestinal obstruction evaluation as gravity cannot effectively separate air and fluid within the bowel loops. - This positioning makes it difficult to identify **air-fluid levels**, which are crucial diagnostic features of bowel obstruction. *X-ray in right lateral decubitus* - While this position can show **free air** in cases of perforation, it is not the standard view for diagnosing simple intestinal obstruction. - The **right lateral decubitus** position is primarily used to detect **pneumoperitoneum** rather than evaluating bowel obstruction patterns.

Q: A patient presents with severe right upper quadrant pain associated with nausea and vomiting, exacerbation during inspiration, and tenderness on palpation. Which of the following imaging modalities is the investigation of choice for this patient?

Ultrasonography. ### Explanation The clinical presentation of severe right upper quadrant (RUQ) pain, nausea, vomiting, and tenderness exacerbated by inspiration (positive **Murphy’s sign**) is classic for **Acute Cholecystitis**. **Why Ultrasonography (USG) is the Correct Answer:** USG is the **initial investigation of choice** for suspected acute cholecystitis and biliary pathologies. It is highly sensitive (up to 95%) and specific. Key diagnostic findings on USG include: * Gallbladder wall thickening (>3 mm). * Pericholecystic fluid. * Presence of gallstones (cholelithiasis). * **Sonographic Murphy’s sign:** Maximal tenderness when the USG probe is pressed directly over the gallbladder (more specific than the physical exam sign). **Why Other Options are Incorrect:** * **B. CT Scan:** While CT is excellent for identifying complications (like perforation or gangrene) and evaluating the entire abdomen, it is less sensitive than USG for detecting gallstones and is more expensive with radiation exposure. * **C. MRI (MRCP):** Highly accurate for detecting ductal stones (choledocholithiasis) but is time-consuming, expensive, and not used as a first-line emergency tool. * **D. X-ray:** Only 10–15% of gallstones are radiopaque (calcium-containing). A plain radiograph is generally non-diagnostic for cholecystitis. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** While USG is the *initial* choice, **HIDA scan (Cholescintigraphy)** is the most sensitive/gold standard for diagnosing acute cholecystitis (showing non-visualization of the gallbladder). * **Emphysematous Cholecystitis:** Look for "gas in the gallbladder wall" on X-ray or CT; this is a surgical emergency often seen in diabetic patients. * **WES Triad (Wall-Echo-Shadow):** A USG sign indicating a gallbladder packed with stones.

Q: What is the investigation of choice for a pregnant lady presenting with an upper abdominal mass?

MRI. **Explanation:** The investigation of choice for a pregnant patient with an upper abdominal mass is **MRI**. **1. Why MRI is the Correct Answer:** In pregnancy, the primary goal is to achieve high diagnostic accuracy while ensuring fetal safety. MRI is the preferred modality because it provides excellent soft-tissue contrast and anatomical detail without the use of ionizing radiation. According to current guidelines, MRI is considered safe during all trimesters of pregnancy. It is particularly superior for characterizing complex masses (e.g., adnexal, hepatic, or pancreatic) when Ultrasound (the initial screening tool) is inconclusive. **2. Why Other Options are Incorrect:** * **CT Scan:** Uses ionizing radiation, which carries risks of teratogenesis and fetal carcinogenesis, especially during the first trimester. It is generally avoided unless it is a life-threatening emergency where MRI is unavailable. * **Barium Meal:** This is a fluoroscopic procedure involving significant radiation exposure to the maternal abdomen and fetus. Furthermore, it only evaluates the lumen of the GI tract and cannot characterize an extrinsic abdominal mass. * **DSA (Digital Subtraction Angiography):** An invasive procedure involving high-dose radiation and iodinated contrast. It is reserved for therapeutic interventions (like embolization), not primary diagnosis. **Clinical Pearls for NEET-PG:** * **First-line investigation** for any abdominal pathology in pregnancy: **Ultrasound (USG)**. * **Investigation of choice (IOC)** if USG is inconclusive: **MRI**. * **Contrast Safety:** Gadolinium (MRI contrast) is generally avoided in pregnancy as it crosses the placenta; however, non-contrast MRI is highly diagnostic. * **Radiation Rule:** The "10-rad rule" suggests that fetal risk is significantly increased only at doses above 100 mGy (10 rads); however, the ALARA (As Low As Reasonably Achievable) principle always favors MRI over CT.

Q: A previously healthy 61-year-old woman presents with a 3-week history of altered bowel habit and rectal bleeding. She refuses to undergo colonoscopy. Which of the following is the next best investigation?

CT colonography. **Explanation:** The clinical presentation of altered bowel habits and rectal bleeding in a 61-year-old is highly suspicious for **Colorectal Carcinoma (CRC)**. While colonoscopy is the gold standard for diagnosis and biopsy, **CT Colonography (CTC)**, also known as "Virtual Colonoscopy," is the preferred alternative when a patient refuses or cannot tolerate conventional colonoscopy. **Why CT Colonography is the Correct Choice:** * **High Sensitivity:** CTC uses thin-slice CT data and 3D reconstruction to detect polyps and masses >10mm with sensitivity comparable to optical colonoscopy. * **Non-Invasive:** It does not require sedation and carries a much lower risk of perforation compared to traditional colonoscopy. * **Staging Capability:** Unlike barium studies, CTC can simultaneously evaluate the bowel wall, extraluminal extension, and distant metastases (TNM staging). **Analysis of Incorrect Options:** * **B. CT Abdomen and Pelvis:** A standard contrast-enhanced CT without specific colonic distension (air/CO2) has poor sensitivity for detecting small mucosal lesions or early-stage tumors. * **C. Barium Enema:** Historically used, but now largely replaced by CTC. It has lower sensitivity for small polyps and cannot provide information regarding extraluminal spread or lymphadenopathy. * **D. Barium Meal Follow-Through:** This is used to evaluate the **small intestine** (e.g., Crohn’s disease). It is not an appropriate investigation for suspected rectal or colonic pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Apple Core Sign:** The classic radiological appearance of annular constricting colorectal carcinoma on barium studies. * **Screening:** In average-risk individuals, screening for CRC should begin at age 45. * **Contraindication:** CTC is contraindicated in patients with acute diverticulitis or recent bowel surgery due to the risk of perforation during insufflation.

Question 1

What is the investigation of choice for testicular swelling?

Accepted Answer

Ultrasonography (USG)

Answer

Fine Needle Aspiration Cytology (FNAC)

Answer

Contrast-Enhanced Computed Tomography (CECT)

Answer

Magnetic Resonance Imaging (MRI)

Question 2

What is the earliest radiological finding of Crohn's disease?

Accepted Answer

Aphthous lesions

Answer

Cobblestone appearance

Answer

Raspberry appearance

Answer

String sign of Kantor

Question 3

An X-ray showing intestinal obstruction is presented. Which view is depicted?

Accepted Answer

X-ray abdomen erect

Answer

X-ray abdomen left lateral

Answer

X-ray in prone position

Answer

X-ray in right lateral decubitus

Question 4

A patient presents with severe right upper quadrant pain associated with nausea and vomiting, exacerbation during inspiration, and tenderness on palpation. Which of the following imaging modalities is the investigation of choice for this patient?

Accepted Answer

Ultrasonography

Answer

CT Scan

Answer

MRI

Answer

X-ray

Question 5

For hiatus hernia, what is the investigation of choice?

Accepted Answer

Barium meal upper GI in Trendelenburg position

Answer

Barium meal follow-through

Answer

Barium meal upper GI

Answer

Barium meal double contrast

Question 6

The triad of pelvic lipomatosis includes all of the following except?

Accepted Answer

Thickening of the colon

Answer

Pelvic radiolucency

Answer

Elevation of an intact rectosigmoid

Answer

Pear-shaped bladder

Question 7

What type of CT scan is used to characterize the chemical composition of kidney stones?

Accepted Answer

Dual-source CT

Answer

Spiral CT

Answer

Multidetector CT

Answer

HRCT

Question 8

What is the investigation of choice for a pregnant lady presenting with an upper abdominal mass?

Accepted Answer

MRI

Answer

Barium meal

Answer

CT scan

Answer

DSA

Question 9

What is the investigation of choice for retroperitoneal soft tissue sarcomas?

Accepted Answer

CT Scan

Answer

MRI

Answer

USG

Answer

PET scan

Question 10

A previously healthy 61-year-old woman presents with a 3-week history of altered bowel habit and rectal bleeding. She refuses to undergo colonoscopy. Which of the following is the next best investigation?

Accepted Answer

CT colonography

Answer

CT abdomen and pelvis

Answer

Barium enema

Answer

Barium meal follow-through

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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