Abdominal and Pelvic Radiology Practice Questions

Q: What is the investigation of choice in suspected gall bladder stone?

Ultrasound. **Explanation:** **Ultrasound (USG)** is the investigation of choice (IOC) for suspected gallbladder stones (cholelithiasis) due to its high sensitivity (>95%) and specificity. The underlying medical concept relies on the fact that gallstones appear as **hyperechoic (bright) structures** within the gallbladder lumen that demonstrate **posterior acoustic shadowing** and move with changes in patient positioning. USG is non-invasive, radiation-free, cost-effective, and can simultaneously evaluate for complications like cholecystitis (e.g., gallbladder wall thickening or pericholecystic fluid). **Why other options are incorrect:** * **X-ray:** Only about 10–15% of gallstones are radiopaque (contain enough calcium to be seen). Most gallstones are cholesterol-based and radiolucent, making X-ray an unreliable screening tool. * **Barium study:** This is used to visualize the gastrointestinal lumen (esophagus, stomach, or bowel). It has no role in visualizing the interior of the gallbladder. * **Oral Cholecystography (OCG):** Historically used to assess gallbladder function and stones, it has been entirely replaced by USG because it is time-consuming, requires contrast ingestion, and depends on adequate hepatic function and intestinal absorption. **Clinical Pearls for NEET-PG:** * **Gold Standard for Choledocholithiasis (CBD stones):** ERCP (Therapeutic) or MRCP (Diagnostic). * **IOC for Acute Cholecystitis:** Ultrasound (look for Murphy’s sign under the probe). * **Most Sensitive/Gold Standard for Acute Cholecystitis:** HIDA scan (Radionuclide scan). * **WES Triad (Wall-Echo-Shadow):** A classic USG finding seen when the gallbladder is completely filled with stones.

Q: Rigler's triad is seen in which of the following conditions?

Gallstone ileus. **Explanation:** **Rigler’s Triad** is a classic radiological finding diagnostic of **Gallstone Ileus**. This condition occurs when a large gallstone erodes through the gallbladder wall into the adjacent bowel (usually the duodenum) via a cholecystoenteric fistula. The stone then travels distally until it impacts, typically at the narrowest part of the small bowel—the **ileocecal valve**. The triad consists of: 1. **Pneumobilia:** Air within the biliary tree (due to the fistula). 2. **Small Bowel Obstruction:** Dilated loops of small bowel with fluid levels. 3. **Ectopic Gallstone:** A radiopaque stone visible in the right iliac fossa or pelvis. *(Note: Presence of two out of three signs is often sufficient for diagnosis on imaging.)* **Analysis of Incorrect Options:** * **A. Pneumoperitoneum:** Characterized by **Rigler’s Sign** (not triad), where air on both sides of the bowel wall makes the wall clearly visible. * **B. Intestinal Obstruction:** While gallstone ileus causes obstruction, "Rigler’s triad" is specific to the etiology involving a gallstone. Simple obstruction lacks pneumobilia. * **D. Ulcerative Colitis:** Associated with "Lead pipe appearance" (loss of haustrations) or "Toxic megacolon," but not Rigler’s triad. **High-Yield Pearls for NEET-PG:** * **Rigler’s Sign vs. Rigler’s Triad:** Do not confuse them. Sign = Pneumoperitoneum; Triad = Gallstone ileus. * **Most common site of impaction:** Terminal ileum. * **Most common fistula:** Cholecystoduodenal fistula. * **Gold standard investigation:** CT Abdomen (more sensitive than X-ray for identifying the triad).

Q: Gas in the great vessels of a fetus indicates which of the following?

Fetal death. **Explanation:** The presence of gas in the great vessels (aorta, vena cava, or heart) of a fetus is known as **Robert’s Sign**. This is a classic radiological sign of **intrauterine fetal death (IUFD)**. **Why the correct answer is right:** Robert’s Sign occurs due to the decomposition of fetal blood, which leads to the release of gases (primarily nitrogen) into the circulatory system. It is one of the earliest radiological signs of fetal demise, often appearing within 12 to 24 hours after death. It is best visualized on a plain X-ray or ultrasound as echogenic foci with shadowing within the fetal heart or large vessels. **Why the incorrect options are wrong:** * **Fetal distress (A):** This is a clinical state (often diagnosed via heart rate monitoring or Doppler) where the fetus is compromised but alive. Gas formation does not occur in a living fetus. * **Postmature fetus (B):** A fetus beyond 42 weeks gestation may show signs of placental insufficiency or meconium staining, but gas in the vessels is not a feature of postmaturity. * **Premature fetus (D):** Prematurity refers to early birth. While premature fetuses are at higher risk, the presence of intravascular gas specifically indicates death, not the gestational age. **High-Yield Clinical Pearls for NEET-PG:** Other radiological signs of fetal death include: 1. **Spalding’s Sign:** Overlapping of fetal skull bones due to loss of liquor and brain liquefaction (usually appears 4–7 days after death). 2. **Deuel’s Halo Sign:** Elevation of the fetal scalp fat due to edema, creating a "halo" appearance. 3. **Brakeman’s Sign:** Abnormal angulation or collapse of the fetal spine. 4. **Ultrasound (Gold Standard):** The definitive diagnosis of IUFD is the absence of fetal cardiac activity on real-time ultrasound.

Q: What is the gold standard investigation for diagnosing cystic echinococcosis?

Ultrasound (USG). **Explanation:** **Cystic Echinococcosis (Hydatid Disease)** is caused by the larval stage of *Echinococcus granulosus*. **Why Ultrasound (USG) is the Gold Standard:** Ultrasound is the primary diagnostic tool and the "gold standard" because it is highly sensitive, non-invasive, and cost-effective. It allows for the visualization of pathognomonic features such as daughter cysts, "hydatid sand," and the "water lily sign" (detached endocyst). Furthermore, the **WHO-IWGE classification**, which guides the management (surgery vs. PAIR vs. medical therapy), is based entirely on USG findings. **Analysis of Incorrect Options:** * **X-ray:** While it may show calcification of the cyst wall or a "double contour" sign in lung hydatids, it lacks the sensitivity and detail required for a definitive diagnosis or staging. * **ELISA:** Serology is a supportive investigation. It is useful for confirming the diagnosis but can yield false negatives in intact or calcified cysts and false positives due to cross-reactivity with other helminths. * **CT scan:** CT is superior for detecting calcification and identifying cysts in extra-hepatic locations (e.g., bone, brain), but it is not the first-line gold standard for routine abdominal screening and staging. **High-Yield Clinical Pearls for NEET-PG:** * **Definitive Host:** Dog; **Intermediate Host:** Sheep (Man is an accidental dead-end host). * **Most common site:** Liver (Right lobe > Left lobe), followed by the Lungs. * **Casoni’s Test:** An immediate hypersensitivity skin test (now largely replaced by ELISA). * **Management:** Small, inactive cysts (CE4/CE5) are monitored; active cysts are treated with **Albendazole** and/or the **PAIR** technique (Puncture, Aspiration, Injection, Re-aspiration).

Q: Which of the following radiographic signs is NOT typically seen in pneumoperitoneum?

Tillaux sign. **Explanation:** **Pneumoperitoneum** refers to the presence of free air within the peritoneal cavity, usually signifying a perforated hollow viscus—a surgical emergency. **Why Tillaux Sign is the Correct Answer:** **Tillaux sign** is a clinical sign associated with **mesenteric cysts**. It refers to a zone of resonance (tympanity) found on percussion over the center of the cyst, surrounded by a zone of dullness. This occurs because the cyst displaces the air-filled bowel loops to the periphery. It is not a radiographic sign of free air. **Analysis of Incorrect Options (Radiographic Signs of Pneumoperitoneum):** * **Football Sign:** Seen on a supine radiograph when a large amount of free air collects under the anterior abdominal wall, outlining the entire peritoneal cavity in an oval shape resembling an American football. * **Rigler’s Sign (Double Wall Sign):** Occurs when air is present on both the inside (intraluminal) and outside (extraluminal) of the bowel wall, making the bowel wall clearly visible as a discrete line. * **Cupola Sign:** Refers to an arcuate lucency seen on a supine chest or abdominal X-ray, representing air trapped under the central tendon of the diaphragm (the "cupola"). **NEET-PG High-Yield Pearls:** * **Gold Standard/Most Sensitive View:** The **Upright (Erect) Chest X-ray** is the most sensitive plain film for detecting free air under the diaphragm (as little as 1–2 ml). * **Alternative View:** If the patient cannot stand, the **Left Lateral Decubitus** view is preferred (air collects over the liver shadow). * **Doge’s Cap Sign:** Another name for air in the Morison’s pouch. * **Falciform Ligament Sign:** Visualization of the falciform ligament due to free air outlining it on both sides.

Q: Which of the following diseases characteristically shows urinary bladder calcification that radiologically resembles a fetal head in the pelvis?

Schistosomiasis. **Explanation** The correct answer is **Schistosomiasis**. **1. Why Schistosomiasis is Correct:** Schistosomiasis (specifically *Schistosoma haematobium*) is a parasitic infection where adult worms reside in the vesical venous plexus. The female deposits eggs in the bladder wall, leading to a chronic granulomatous reaction. Over time, these eggs undergo massive calcification. Radiologically, this appears as a thin, curvilinear, radio-opaque rim outlining the bladder wall. When the bladder is empty, the calcified wall collapses and folds, creating a characteristic **"fetal head"** appearance in the pelvis. This is also known as a "calcified bladder shell." **2. Why Other Options are Incorrect:** * **Tuberculosis (TB):** While TB can cause bladder calcification, it typically results in a small, contracted, and irregular "thimble bladder." Calcification is more common in the kidneys (putty kidney) and ureters than the bladder. * **Chronic Cystitis:** Chronic inflammation (like encrusted cystitis) can cause patchy mucosal calcification, but it does not produce the distinct, continuous curvilinear outline seen in Schistosomiasis. * **Malignancy:** Bladder tumors (like Squamous Cell Carcinoma) may show stippled or irregular internal calcification, but they do not outline the entire bladder wall to resemble a fetal head. **3. NEET-PG High-Yield Pearls:** * **Vector:** *S. haematobium* is transmitted by the **Bulinus snail**. * **Cancer Association:** Chronic Schistosomiasis is a major risk factor for **Squamous Cell Carcinoma (SCC)** of the bladder, rather than the more common Transitional Cell Carcinoma (TCC). * **Diagnostic Feature:** Presence of **terminal spines** on eggs in urine microscopy. * **Treatment:** Praziquantel is the drug of choice.

Q: The 'spider leg' sign on an intravenous pyelogram (IVP) suggests which of the following conditions?

Polycystic kidney. **Explanation:** The **'Spider leg' appearance** on an Intravenous Pyelogram (IVP) is a classic radiological sign of **Autosomal Dominant Polycystic Kidney Disease (ADPKD)**. This appearance occurs because multiple large, fluid-filled cysts within the renal parenchyma exert pressure on the collecting system. This leads to the **elongation, narrowing, and stretching** of the renal calyces, making them resemble the long, thin legs of a spider. **Analysis of Options:** * **Polycystic Kidney (Correct):** As explained, the bilateral enlargement of the kidneys by multiple cysts distorts the pelvicalyceal system into thin, elongated structures. * **Renal Stone:** Typically presents as a radiopaque shadow (on KUB) or a filling defect (on IVP). It may cause proximal dilatation but does not cause the characteristic stretching of calyces. * **Hypernephroma (Renal Cell Carcinoma):** Usually presents as a localized mass causing focal displacement or amputation of a single calyx (distortion), rather than the generalized "spider leg" stretching seen in polycystic disease. * **Hydronephrosis:** Characterized by the **ballooning or blunting** of the calyces (clubbing) due to obstruction, which is the morphological opposite of the thinned "spider legs." **High-Yield Clinical Pearls for NEET-PG:** * **Swiss Cheese Appearance:** The nephrogram phase of an IVP in ADPKD shows multiple radiolucent areas (cysts) against the enhancing parenchyma. * **ADPKD Associations:** Berry aneurysms (Circle of Willis), hepatic cysts (most common extra-renal site), and mitral valve prolapse. * **Imaging Choice:** While IVP shows the 'spider leg' sign, **Ultrasonography** is the screening modality of choice, and **CT/MRI** are more sensitive for characterization.

Question 1

What is the investigation of choice in suspected gall bladder stone?

Accepted Answer

Ultrasound

Answer

X-ray

Answer

Barium study

Answer

Oral cholecystography

Question 2

Rigler's triad is seen in which of the following conditions?

Accepted Answer

Gallstone ileus

Answer

Pneumoperitoneum

Answer

Intestinal obstruction

Answer

Ulcerative colitis

Question 3

Which of the following renal stones are radio-lucent?

Accepted Answer

Cysteine and Uric acid

Answer

Calcium phosphate and Uric acid

Answer

Calcium phosphate and Xanthine

Answer

Cysteine and Xanthine

Question 4

Gas in the great vessels of a fetus indicates which of the following?

Accepted Answer

Fetal death

Answer

Fetal distress

Answer

Postmature fetus

Answer

Premature fetus

Question 5

What is the best investigation to detect pneumoperitoneum?

Accepted Answer

Plain X-ray chest, erect

Answer

Plain X-ray abdomen, erect

Answer

Left lateral decubitus film

Answer

CT Scan

Question 6

What is the gold standard investigation for diagnosing cystic echinococcosis?

Accepted Answer

Ultrasound (USG)

Answer

X-ray

Answer

ELISA

Answer

CT scan

Question 7

Which of the following radiographic signs is NOT typically seen in pneumoperitoneum?

Accepted Answer

Tillaux sign

Answer

Football sign

Answer

Rigler's sign

Answer

Cupola sign

Question 8

Which of the following diseases characteristically shows urinary bladder calcification that radiologically resembles a fetal head in the pelvis?

Accepted Answer

Schistosomiasis

Answer

Tuberculosis

Answer

Chronic cystitis

Answer

Malignancy

Question 9

Which of the following is the most probable diagnosis based on the provided X-ray of the abdomen?

Accepted Answer

Multiple air-fluid levels, suggestive of adhesions and bands

Answer

Gas under the diaphragm, suggestive of peritonitis

Answer

Bird beak appearance, suggestive of volvulus

Answer

Normal X-ray, PA view

Question 10

The 'spider leg' sign on an intravenous pyelogram (IVP) suggests which of the following conditions?

Accepted Answer

Polycystic kidney

Answer

Renal stone

Answer

Hypernephroma

Answer

Hydronephrosis

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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