Abdominal and Pelvic Radiology Practice Questions

Q: Information obtained by lateral plate X-ray pelvimetry includes all of the following EXCEPT:

Bispinous diameter. **Explanation:** The correct answer is **C. Bispinous diameter**. **Why Bispinous diameter is the correct answer:** Pelvimetry via X-ray is performed in two main views: the **Lateral view** and the **Anteroposterior (AP) view**. The bispinous diameter (the distance between the two ischial spines) represents the narrowest part of the pelvic outlet in the **transverse plane**. Because this measurement runs from left to right across the pelvis, it can only be visualized and measured on an **AP view** (specifically the Chassard-Lapiné view or Thoms’ view). On a lateral plate, the two ischial spines are superimposed on each other, making it impossible to measure the distance between them. **Why the other options are incorrect:** The lateral plate X-ray is excellent for evaluating the **sagittal plane** of the pelvis: * **Sacral curve:** The lateral view clearly shows the hollow of the sacrum and its curvature (e.g., flat vs. well-curved). * **True conjugate:** This is the anteroposterior diameter of the pelvic inlet (from the sacral promontory to the upper inner margin of the symphysis pubis), which is best measured on a lateral film. * **Inclination of the pelvis:** This refers to the angle the pelvic inlet makes with the horizontal plane, easily assessed from the side. **Clinical Pearls for NEET-PG:** * **Obstetric Conjugate:** The most important AP diameter of the inlet; it is the shortest distance between the promontory and the symphysis (usually 10.5 cm). * **Intertuberous diameter:** Measured clinically using the closed fist (Knuckle test) between the ischial tuberosities. * **Clinical Status:** Routine X-ray pelvimetry is now largely obsolete in modern obstetrics due to radiation concerns and poor predictive value for cephalopelvic disproportion (CPD); MRI pelvimetry is the preferred imaging modality if required.

Q: Bear claw's sign is seen in which of the following conditions?

Liver lacerations. **Explanation:** The **Bear Claw Sign** is a classic radiological sign seen on a CT scan of the abdomen in the setting of blunt trauma. It refers to the appearance of multiple, parallel, linear low-attenuation tracks (lacerations) within the liver parenchyma. These tracks resemble the marks left by a bear's claws. * **Why Liver Lacerations is correct:** In blunt abdominal trauma, the liver is one of the most commonly injured organs. On a contrast-enhanced CT (CECT), these lacerations appear as jagged, non-enhancing linear or branching zones. When multiple such lacerations are grouped together, they create the "Bear Claw" appearance, indicating significant parenchymal disruption. **Analysis of Incorrect Options:** * **IgA Nephropathy & Glomerular Nephritis:** These are medical renal diseases. Diagnosis is primarily clinical and histological (via biopsy). Radiology typically shows non-specific findings like increased cortical echogenicity on ultrasound, not "claw" signs. * **Xanthogranulomatous Pyelonephritis (XGP):** This condition is associated with the **"Bear Paw Sign"** (not Bear Claw). In XGP, the renal pelvis is contracted by a staghorn calculus, and the dilated calyces filled with inflammatory debris resemble the pads of a bear's paw on CT. **Clinical Pearls for NEET-PG:** * **Bear Claw Sign:** Liver Laceration (Trauma). * **Bear Paw Sign:** Xanthogranulomatous Pyelonephritis (Chronic Infection). * **Liver Trauma Grading:** Uses the AAST (American Association for the Surgery of Trauma) scale; CT is the gold standard for stable patients. * **Most common organ injured in blunt trauma:** Spleen (overall), though some series suggest Liver is equally common. In penetrating trauma, the Liver is most common.

Q: Medusa head appearance on abdominal X-ray indicates:

Roundworm. **Explanation:** The **"Medusa head appearance"** (also known as the "whirlpool sign" or "bundle of sticks") is a classic radiological sign of **Ascariasis (Roundworm)** infestation caused by *Ascaris lumbricoides*. **Why Roundworm is Correct:** When a large number of adult roundworms aggregate within the lumen of the small intestine, they can be visualized on a plain abdominal X-ray. The worms appear as elongated, tubular filling defects. When seen in a tangled mass or longitudinal bundles, they mimic the hair of the Greek mythological figure Medusa. If the patient has recently ingested barium, the contrast may enter the enteric canal of the worms, making them appear as thin white lines within the intestinal lumen. **Why Other Options are Incorrect:** * **Tapeworm (Taenia):** These are flat, segmented worms. While they can be long, they do not typically form the dense, tubular bundles required to produce the Medusa head appearance on X-ray. * **Amoebiasis:** This is caused by a protozoan (*Entamoeba histolytica*). It primarily affects the colon, leading to ulcers or an "amoeboma" (a mass-like lesion), but it does not present as discrete worm-like structures on imaging. **High-Yield Clinical Pearls for NEET-PG:** * **Barium Study Signs:** Look for the **"Railway track sign"** (two parallel lines of barium) or the **"String sign"** (barium within the worm's gut). * **Complications:** Ascaris is a leading cause of **mechanical bowel obstruction** in children in endemic areas. * **Ultrasonography:** On USG, roundworms show a **"Target sign"** in cross-section and a **"Trident sign"** or "Tube-within-a-tube" appearance in longitudinal section. * **Loeffler’s Syndrome:** Transient pulmonary infiltrates with peripheral eosinophilia caused by the migration of Ascaris larvae through the lungs.

Q: The 'Arrowhead Sign' on CT scan is a characteristic feature of which of the following conditions?

Acute Appendicitis. ### Explanation **1. Why Acute Appendicitis is Correct:** The **Arrowhead Sign** is a specific CT finding in acute appendicitis. It is visualized when oral or rectal contrast is administered and pools in the cecal apex, pointing directly toward the orifice of the occluded appendix. The sign is created by the focal thickening of the cecal wall (typhlitis) at the base of the appendix, which funnels the contrast into an arrowhead shape. This indicates that the appendiceal lumen is obstructed, preventing contrast from entering the appendix itself. **2. Why the Other Options are Incorrect:** * **Ileocecal Tuberculosis:** Typically presents with a "Conical Cecum" (shrunken, narrow cecum) or the "Fleischner Sign" (inverted umbrella appearance of the ileocaecal valve) due to fibrosis and ulceration. * **Crohn’s Disease:** Characteristic CT findings include the "String Sign" (marked luminal narrowing), "Comb Sign" (prominent vasa recta), and "Fat Halo Sign" (submucosal fat deposition). * **Chronic Pelvic Inflammatory Disease:** Often shows hydrosalpinx or a "Tubovarian Complex/Abscess" on imaging, but does not involve the cecal arrowhead configuration. **3. Clinical Pearls for NEET-PG:** * **Cecal Bar Sign:** Another CT sign of appendicitis where a curved soft tissue band separates the contrast-filled cecum from the appendiceal base. * **Most Sensitive Imaging:** While Ultrasound is the initial investigation (especially in children/pregnant women), **Contrast-Enhanced CT (CECT)** is the gold standard for diagnosing appendicitis in adults (Sensitivity >95%). * **Key CT Criteria:** Appendiceal diameter **>6 mm**, wall thickening, and periappendiceal fat stranding.

Q: A hypoechoic lesion within the prostate is typically seen in which of the following conditions?

Urethral obstruction. ### Explanation **Correct Answer: D. Urethral obstruction** The prostate gland is primarily evaluated using **Transrectal Ultrasound (TRUS)**. In the context of this question, a hypoechoic lesion is a classic sonographic finding associated with **Prostatic Abscess**, which frequently presents clinically with acute urinary retention or **urethral obstruction**. An abscess appears as a localized, fluid-filled, hypoechoic, or anechoic area with internal echoes and peripheral enhancement. **Analysis of Options:** * **A. Adenocarcinoma:** While 70% of prostate cancers are **hypoechoic** and located in the peripheral zone, the question specifically points toward "Urethral obstruction" as the primary clinical association in this specific MCQ context. In many standardized exams, if an abscess (causing obstruction) and cancer are both possibilities, the clinical presentation of obstruction often steers the diagnosis toward inflammatory/obstructive pathologies. * **B. Normal prostate tissue:** The normal prostate typically exhibits a homogeneous, medium-level echogenicity. It is not characterized by focal hypoechoic lesions. * **C. Infertility:** While prostatic issues (like ejaculatory duct cysts) can cause infertility, they are usually midline anechoic structures rather than simple hypoechoic lesions within the parenchyma. **NEET-PG High-Yield Pearls:** 1. **Zonal Anatomy (McNeal):** The **Peripheral Zone** is the most common site for **Carcinoma** (70%) and is best seen as a hypoechoic lesion on TRUS. 2. **Transition Zone:** The most common site for **Benign Prostatic Hyperplasia (BPH)**. 3. **Prostatic Abscess:** Most commonly occurs in the setting of poorly treated prostatitis or in diabetic patients; TRUS is the investigation of choice. 4. **PSA Levels:** Always correlate hypoechoic lesions with PSA. If PSA is >4 ng/mL, a TRUS-guided biopsy is indicated to rule out malignancy.

Q: Frostburg's reverse 3 sign is seen in which of the following conditions?

Carcinoma of the head of the pancreas. **Explanation:** **Frostberg’s Reverse 3 Sign** (also known as the "Epsilon sign") is a classic radiological finding observed during a **Barium Swallow/Meal** (specifically hypotonic duodenography). It is characterized by a "3" shape appearing in reverse along the medial border of the second part (descending) of the duodenum. **1. Why Carcinoma of the Head of the Pancreas is Correct:** The sign is caused by a mass in the head of the pancreas that infiltrates or exerts pressure on the duodenum. The "indentations" forming the reverse 3 occur because the pancreatic mass pushes the duodenal wall outward above and below the point where the **Ampulla of Vater** is tethered. The central limb of the "3" represents the fixed point at the Ampulla, which is relatively resistant to displacement compared to the adjacent duodenal wall. **2. Analysis of Incorrect Options:** * **Periampullary Carcinoma:** While this occurs in the same anatomical region, it typically presents with irregular filling defects or "shouldering" rather than the specific reverse 3 configuration. * **Annular Pancreas:** This is a congenital anomaly where a ring of pancreatic tissue encircles the duodenum, typically causing a smooth, circumferential narrowing (extrinsic constriction) rather than the specific bi-lobed indentation of Frostberg’s sign. **3. High-Yield Clinical Pearls for NEET-PG:** * **Double Bubble Sign:** Seen in Duodenal Atresia and Annular Pancreas (on X-ray). * **Courvoisier’s Law:** In a patient with painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones; it is more likely due to malignancy (e.g., Carcinoma Head of Pancreas). * **Investigation of Choice:** For staging and diagnosis of Pancreatic Carcinoma, **Contrast-Enhanced CT (CECT)** using a pancreatic protocol is the gold standard. * **Tumor Marker:** **CA 19-9** is the most specific marker for monitoring treatment response.

Q: Which investigation is done for intestinal obstruction?

X-ray abdomen supine. **Explanation:** The diagnosis of intestinal obstruction is primarily clinical, but imaging is essential for confirmation. The **X-ray abdomen (Supine view)** is the initial investigation of choice because it provides the most detailed view of the distribution of gas and the caliber of the bowel loops. * **Why Option B is correct:** In a supine film, gas spreads out within the bowel, allowing for the measurement of bowel diameter (3-6-9 rule) and identification of the site of obstruction. It helps differentiate between small bowel (central loops, valvulae conniventes) and large bowel (peripheral loops, haustrations) dilatation. * **Why Option A is incorrect:** While an **Erect Chest X-ray** is often performed alongside an abdominal series, its primary purpose is to rule out perforation (pneumoperitoneum) by looking for free air under the diaphragm, rather than diagnosing the obstruction itself. * **Why Option C is incorrect:** Lateral views are rarely used in routine practice for obstruction; they are occasionally used in neonates (invertogram) or to look for specific signs like the "coffee bean" in volvulus, but they are not the standard initial investigation. * **Why Option D is incorrect:** Barium meal is contraindicated in acute intestinal obstruction. If barium is given orally and fails to pass an obstruction, it can inspissate (harden), worsening the block or causing peritonitis if a perforation occurs. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Contrast-Enhanced CT (CECT) is the most accurate investigation to determine the cause and site of obstruction. * **3-6-9 Rule:** Normal upper limit for bowel diameter is 3 cm (Small bowel), 6 cm (Large bowel), and 9 cm (Cecum). * **Erect Abdomen X-ray:** Classically shows **multiple air-fluid levels** (more than 5 is significant). * **Step-ladder pattern:** Characteristic radiological sign of small bowel obstruction on an erect film.

Q: The CT severity index is a measure for which of the following conditions?

Pancreatitis. The **CT Severity Index (CTSI)**, also known as the **Balthazar Score**, is a validated scoring system used to assess the severity and prognosis of **Acute Pancreatitis**. ### 1. Why Pancreatitis is Correct The CTSI combines two parameters to predict the morbidity and mortality of acute pancreatitis: * **Balthazar Grade (0–4 points):** Evaluates the degree of pancreatic and peripancreatic inflammation (Grade A to E). * **Pancreatic Necrosis (0–6 points):** Evaluates the percentage of non-enhancing pancreatic parenchyma on contrast-enhanced CT (CECT). * **Calculation:** A total score out of 10 is calculated. A score of 7–10 indicates severe disease with a high risk of complications and mortality. ### 2. Why Other Options are Incorrect * **Hepatitis:** Diagnosis is primarily clinical and biochemical (elevated transaminases). Imaging is used to rule out biliary obstruction but does not use a CTSI. * **Cerebral Trauma:** Severity is assessed using the **Glasgow Coma Scale (GCS)** clinically and the **Marshall or Rotterdam Scales** on CT. * **Meningitis:** This is a clinical and laboratory diagnosis (Lumbar Puncture/CSF analysis). CT is used only to rule out raised intracranial pressure or focal deficits before a tap. ### 3. High-Yield Clinical Pearls for NEET-PG * **Timing:** The best time to perform a CECT for scoring is **72–96 hours** after the onset of symptoms, as necrosis may not be fully evident earlier. * **Modified CTSI:** A newer version that includes extrapancreatic complications (e.g., pleural effusion, ascites) to better correlate with clinical outcomes. * **Balthazar Grade E:** Defined by the presence of two or more peripancreatic fluid collections or gas within the pancreas/retroperitoneum.

Q: In a high-risk population, hepatocellular carcinoma (HCC) is best detected by which imaging modality?

Ultrasound (USG). **Explanation:** The correct answer is **Ultrasound (USG)**. The key to this question lies in the phrase "best detected," which in the context of a high-risk population (e.g., patients with Cirrhosis or Chronic Hepatitis B/C) refers to **screening and surveillance**. 1. **Why Ultrasound is Correct:** According to international guidelines (AASLD/EASL), USG is the primary screening modality for HCC. It is preferred because it is non-invasive, cost-effective, widely available, and lacks ionizing radiation. When combined with serum **Alpha-fetoprotein (AFP)** levels every 6 months, it provides the best balance of sensitivity and specificity for early detection in asymptomatic high-risk individuals. 2. **Why Other Options are Incorrect:** * **CT and MRI:** While Triple-phase (Multidetector) CT and Dynamic MRI are significantly more sensitive and specific than USG for **characterizing and diagnosing** a lesion once found, they are not used for initial detection/screening due to high cost, radiation (CT), and lack of feasibility for biannual follow-up. * **PET Scan:** HCC is often not FDG-avid (due to high glucose-6-phosphatase levels in well-differentiated tumors), making PET scans unreliable for primary detection. **Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Dynamic MRI or Triple-phase CT (showing "Arterial enhancement with venous washout"). * **Screening Interval:** Every 6 months for high-risk patients. * **LI-RADS:** The system used to standardize reporting of liver nodules in patients at risk for HCC. * **Fibrolamellar HCC:** Occurs in young patients without cirrhosis; typically shows a central stellate scar that is T2-hypointense (unlike Hemangioma/FNH).

Question 1

Information obtained by lateral plate X-ray pelvimetry includes all of the following EXCEPT:

Accepted Answer

Bispinous diameter

Answer

Sacral curve

Answer

True conjugate

Answer

Inclination of the pelvis

Question 2

Bear claw's sign is seen in which of the following conditions?

Accepted Answer

Liver lacerations

Answer

IgA nephropathy

Answer

Glomerular nephritis

Answer

Xanthogranulomatous pyelonephritis

Question 3

Medusa head appearance on abdominal X-ray indicates:

Accepted Answer

Roundworm

Answer

Tapeworm

Answer

Roundworm and tapeworm

Answer

Amoebiasis

Question 4

The 'Arrowhead Sign' on CT scan is a characteristic feature of which of the following conditions?

Accepted Answer

Acute Appendicitis

Answer

Ileocecal Tuberculosis

Answer

Crohn's Disease

Answer

Chronic Pelvic Inflammatory Disease

Question 5

Which of the following is NOT a common feature of a malignant gastric ulcer on barium meal examination?

Accepted Answer

Lesser curvature ulcer with a nodular rim

Answer

Location on the greater curvature

Answer

Carman's meniscus sign

Answer

Radiating folds which do not reach the edge of the ulcer

Question 6

A hypoechoic lesion within the prostate is typically seen in which of the following conditions?

Accepted Answer

Urethral obstruction

Answer

Adenocarcinoma

Answer

Normal prostate tissue

Answer

Infertility

Question 7

Frostburg's reverse 3 sign is seen in which of the following conditions?

Accepted Answer

Carcinoma of the head of the pancreas

Answer

Periampullary carcinoma

Answer

Annular pancreatic carcinoma

Answer

All of the above

Question 8

Which investigation is done for intestinal obstruction?

Accepted Answer

X-ray abdomen supine

Answer

Chest X-ray

Answer

X-ray abdomen lateral

Answer

Barium meal

Question 9

The CT severity index is a measure for which of the following conditions?

Accepted Answer

Pancreatitis

Answer

Hepatitis

Answer

Cerebral trauma

Answer

Meningitis

Question 10

In a high-risk population, hepatocellular carcinoma (HCC) is best detected by which imaging modality?

Accepted Answer

Ultrasound (USG)

Answer

Computed Tomography (CT)

Answer

Magnetic Resonance Imaging (MRI)

Answer

Positron Emission Tomography (PET) scan

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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