Abdominal and Pelvic Radiology Practice Questions

Q: Which investigation is being performed?

T-tube cholangiography. ***T-tube cholangiography*** - Shows characteristic appearance of **T-tube** in the **common bile duct** with contrast filling the biliary tree, typically performed **post-operatively** after cholecystectomy or bile duct exploration. - The **T-shaped radiopaque tube** is clearly visible extending from the CBD to the external drainage, allowing assessment of **biliary patency** and **residual stones**. *ERCP* - Involves **endoscopic** insertion of contrast through the **ampulla of Vater** via duodenoscope, showing biliary tree without external drainage tubes. - Would not show a **T-tube** in the bile duct; instead shows contrast injected **retrograde** through the **papilla**. *MRCP* - **Non-invasive MRI** technique that visualizes biliary tree using **T2-weighted sequences** without contrast injection. - Does not involve any **tubes or catheters**; produces detailed images of bile ducts through **magnetic resonance** technology. *Percutaneous transhepatic Cholangiography* - Involves **needle puncture** through the **liver parenchyma** to access intrahepatic bile ducts, with contrast injected **percutaneously**. - Would show **needle tract** or **catheter** through liver tissue, not a T-tube configuration in the CBD.

Q: What is a characteristic feature of the post-ovulatory endometrium observed on ultrasound?

Prominent posterior enhancement. The appearance of the endometrium on ultrasound changes predictably according to the phases of the menstrual cycle. **Explanation of the Correct Answer:** After ovulation, the corpus luteum produces **progesterone**, which initiates the **secretory phase**. Under the influence of progesterone, the endometrial glands become tortuous and filled with glycogen-rich secretions, and the stroma becomes edematous. This increased vascularity and fluid content make the endometrium **hyperechoic (bright)** and thick. Because this tissue is fluid-rich and uniform, it allows sound waves to pass through easily with minimal attenuation, leading to **prominent posterior acoustic enhancement** (increased brightness behind the uterus). **Analysis of Incorrect Options:** * **A. Single hyperechoic thin line:** This is characteristic of the **menstrual phase** or the early proliferative phase, where the functional layer has shed, leaving only the thin basal layer. * **B. Three line sign:** This is the classic appearance of the **late proliferative (pre-ovulatory) phase**. It consists of a central echogenic line (uterine cavity) surrounded by two hypoechoic layers (functional zone) and two outer echogenic lines (basal layer). * **C. Prominent halo:** A hypoechoic subendometrial halo is often seen in the proliferative phase due to the compact nature of the inner myometrium; it is not a specific feature of the post-ovulatory phase. **NEET-PG High-Yield Pearls:** * **Proliferative Phase (Estrogen):** "Three-line sign" (Trilaminar appearance). * **Secretory Phase (Progesterone):** Uniformly hyperechoic, thick endometrium with posterior enhancement. * **Post-menopausal Endometrium:** Should normally be ** 5 mm or bleeding is present, a biopsy is required to rule out endometrial carcinoma. * **Dating:** Ultrasound is most accurate for dating the cycle based on endometrial morphology rather than just thickness.

Q: Fleischner sign is characteristic of which condition?

Ileocecal tuberculosis. **Explanation:** **Fleischner sign** refers to a prominent, gaping, and patulous ileocecal valve (ICV) caused by the thickening of the lips of the valve and terminal ileum. It is a classic radiological finding in **Ileocecal Tuberculosis (TB)**, typically seen on a Barium enema. 1. **Why Ileocecal TB is correct:** In intestinal TB, the ileocecal region is the most common site of involvement due to the abundance of lymphoid tissue (Peyer’s patches). Inflammation and subsequent fibrosis lead to a rigid, wide-open ICV (Fleischner sign). This is often associated with the **Stierlin sign** (rapid emptying of the inflamed segment, leaving a narrow string of barium). 2. **Why other options are incorrect:** * **Ulcerative Colitis:** Characterized by "Lead pipe" appearance (loss of haustrations) and "Backwash ileitis," but the ICV is typically incompetent rather than thickened/patulous. * **Crohn’s Disease:** Features "String sign of Kantor" (marked narrowing of the terminal ileum) and "Cobblestone appearance." While it involves the ileum, the specific patulous valve sign is not characteristic. * **Ischaemic Colitis:** Classically presents with "Thumbprinting" on X-ray/CT due to submucosal edema and hemorrhage, usually at splenic flexure (Griffith’s point). **High-Yield Clinical Pearls for NEET-PG:** * **Sterling Sign:** Rapid emptying of the terminal ileum due to irritability (seen in TB). * **Conical Cecum:** Shrunken, inverted cecum due to fibrosis in TB. * **Goose-neck deformity:** Seen in TB when the terminal ileum enters a contracted cecum at an abnormal angle. * **Key differentiator:** TB often involves the **ileocecal angle**, whereas Crohn’s more commonly involves the **terminal ileum** while sparing the cecum initially.

Q: Hyperchoice hepatic metastases on USG are seen in which of the following malignancies?

Carcinoma of colon (Mucinous adenocarcinoma). **Explanation:** The echogenicity of hepatic metastases on ultrasound (USG) is a high-yield topic for NEET-PG. While most liver metastases are hypoechoic, **hyperechoic (bright)** metastases are characteristic of specific primary tumors. **Why Option B is Correct:** **Carcinoma of the colon**, particularly **mucinous adenocarcinoma**, is the most common cause of hyperechoic liver metastases. The increased echogenicity is primarily due to **calcifications** within the tumor tissue or the presence of highly reflective interfaces within the mucin-producing cells. Other common causes of hyperechoic metastases include Renal Cell Carcinoma (RCC), Breast Carcinoma, and Neuroendocrine tumors (e.g., Carcinoid). **Analysis of Incorrect Options:** * **Option A (Carcinoma of Ovary):** While ovarian cancer can metastasize to the liver, it typically presents as peritoneal seeding or surface scalloping. When parenchymal, they are often cystic or complex, but not classically described as primarily hyperechoic unless there is significant psammomatous calcification. * **Option C (Urinary Bladder Carcinoma):** These are relatively rare causes of liver metastases compared to GI malignancies and do not typically present with a hyperechoic signature. * **Option D (Mucinous Cystadenoma):** This is a benign (though potentially pre-malignant) cystic neoplasm of the liver or pancreas. It is a primary lesion, not a metastatic one. **High-Yield Clinical Pearls for NEET-PG:** 1. **Hypoechoic Metastases:** Most common; typically from Lung, Breast (can be both), and Lymphoma. 2. **Target/Bull’s Eye Sign:** A hypoechoic halo around a hyperechoic center; highly suggestive of malignancy (often Bronchogenic Carcinoma). 3. **Calcified Metastases:** Think Mucinous Adenocarcinoma of the Colon or Stomach. 4. **Cystic Metastases:** Think Cystadenocarcinoma (Ovary/Pancreas) or Sarcomas (Leiomyosarcoma).

Q: Which of the following is NOT a CT finding of acute pancreatitis?

Dilation of the pancreatic duct. ### Explanation In the context of acute pancreatitis, CT imaging is primarily used to assess the severity, identify complications, and rule out other causes of acute abdomen. **Why Option A is the Correct Answer:** **Dilation of the pancreatic duct** is typically a hallmark of **chronic pancreatitis** or obstructive pathologies (such as a periampullary tumor or a stone in the distal CBD). In acute pancreatitis, the inflammatory process leads to interstitial edema and swelling of the pancreatic parenchyma, which tends to **compress** the duct rather than dilate it. **Analysis of Incorrect Options:** * **B. Fuzzy outline of the pancreas:** This represents peripancreatic fat stranding. It is one of the earliest signs of inflammation as the proteolytic enzymes leak into the surrounding retroperitoneal fat. * **C. Peripancreatic fluid collection:** This is a common feature of acute pancreatitis (Balthazar Grade D/E). These collections occur due to inflammation and vascular leakage and can later evolve into pseudocysts or walled-off necrosis. * **D. Edematous pancreas:** This refers to the diffuse or focal enlargement of the gland due to inflammatory exudate, which is the defining radiological feature of interstitial edematous pancreatitis. **NEET-PG High-Yield Pearls:** 1. **Balthazar Scoring System:** Used to grade the severity of acute pancreatitis based on CT findings (A: Normal, B: Focal/diffuse enlargement, C: Peripancreatic inflammation, D: Single fluid collection, E: Two or more collections/gas). 2. **CT Severity Index (CTSI):** Combines the Balthazar grade with the degree of pancreatic necrosis. 3. **Timing:** The best time to perform a CECT to assess for necrosis is **72 hours** after the onset of symptoms; scans done earlier may underestimate the extent of tissue death. 4. **Sentinel Loop:** A classic X-ray finding in acute pancreatitis representing a localized ileus of a jejunal loop near the pancreas.

Q: Which of the following is NOT a radiological sign of Ulcerative colitis?

Raspberry appearance. **Explanation:** The correct answer is **A. Raspberry appearance**, as this is a classic radiological sign of **Schistosomiasis** (caused by *Schistosoma mansoni*), not Ulcerative Colitis (UC). In Schistosomiasis, the "raspberry" appearance refers to the multiple, small, rounded filling defects seen on a barium enema due to granulomatous polyps. **Analysis of other options:** * **Lead Pipe appearance:** This is a hallmark sign of chronic UC. It occurs due to the loss of normal haustral markings, bowel shortening, and mural thickening, making the colon appear as a smooth, rigid tube. * **Toxic megacolon:** A life-threatening complication of UC characterized by total or segmental non-obstructive colonic dilatation (usually >6 cm) associated with systemic toxicity. * **Pseudopolyps:** These are islands of regenerating or normal mucosa surrounded by areas of extensive ulceration and inflammation. On imaging, they appear as multiple small filling defects. **High-Yield Clinical Pearls for NEET-PG:** * **Stove-pipe colon:** Another name for the Lead Pipe appearance. * **Collar-button ulcers:** Deep, flask-shaped ulcers seen in acute UC when the ulceration penetrates the muscularis mucosa. * **Backwash ileitis:** Involvement of the terminal ileum in UC (seen in ~10-20% of cases with pancolitis). * **String Sign of Kantor:** Associated with **Crohn’s Disease**, not UC (due to terminal ileal narrowing). * **Thumbprinting:** Suggests bowel wall edema, commonly seen in ischemic colitis or severe UC.

Q: What does 'pseudo kidney' refer to on ultrasound?

Thickened bowel loop. **Explanation:** The **'Pseudo-kidney' sign** is a classic sonographic appearance where a segment of bowel mimics the morphology of a kidney. This occurs when there is significant **mural thickening of a bowel loop** (the "cortex") surrounding a central echogenic area representing trapped air, mucus, or collapsed mucosa (the "medullary/sinus" equivalent). **Why Option A is correct:** In conditions like **Intussusception**, inflammatory bowel disease (Crohn’s), or bowel malignancies (Lymphoma/Adenocarcinoma), the bowel wall becomes edematous and thickened. On ultrasound, the hypoechoic thickened wall resembles the renal cortex, while the central echogenic lumen resembles the renal sinus, creating the "pseudo-kidney" appearance. **Why other options are incorrect:** * **B. Hydronephrosis:** This refers to the dilatation of the renal pelvis and calyces, typically appearing as an interconnected fluid-filled (anechoic) collection within the kidney, not a bowel mimic. * **C. Unascended kidney (Pelvic Kidney):** This is a true kidney located in an ectopic position. It possesses actual renal architecture (pyramids, vessels) rather than just mimicking the shape. * **D. Undescended testes:** These appear as oval, homogeneous structures in the inguinal canal or abdomen, often associated with a "mediastinum testis" (linear echogenic band), but do not resemble a kidney. **High-Yield Clinical Pearls for NEET-PG:** * **Intussusception:** The most common cause of the pseudo-kidney sign in children. Other associated signs include the **Target sign** or **Donut sign** (transverse view). * **Doughnut Sign:** Also refers to bowel wall thickening where the hypoechoic rim is prominent. * **Clinical Correlation:** If you see a pseudo-kidney sign in an elderly patient with weight loss, suspect **Gastrointestinal Malignancy**.

Q: Ultrasonography of the liver shows a starry sky appearance. This is a feature of which condition?

Acute viral hepatitis. ### Explanation **Correct Answer: A. Acute viral hepatitis** The **"Starry Sky" appearance** on ultrasound is a classic radiological sign of **Acute Viral Hepatitis**. This pattern is created by two concurrent pathological processes: 1. **Decreased Liver Echogenicity:** Due to diffuse hepatocellular edema, the liver parenchyma becomes darker (hypoechoic). 2. **Increased Portal Triad Echogenicity:** The walls of the portal venous branches appear bright (hyperechoic) and more prominent against the dark background of the edematous liver. **Analysis of Incorrect Options:** * **B & C (Primary Biliary Cirrhosis & Primary Sclerosing Cholangitis):** These are chronic cholestatic diseases. They typically present with features of cirrhosis (nodular surface, coarse echotexture) or biliary tree abnormalities (beading of ducts in PSC), rather than the starry sky pattern. * **D (Hydatid Cyst):** This presents with characteristic cystic patterns, such as the **"Water Lily sign"** (detached endocyst) or a **"Wheel-spoke appearance"** (daughter cysts), rather than diffuse parenchymal changes. **High-Yield Clinical Pearls for NEET-PG:** * **Sensitivity:** While "Starry Sky" is a classic textbook sign, it is not highly sensitive; many patients with acute hepatitis have a normal-looking liver on USG. * **Differential Diagnosis:** A similar appearance can occasionally be seen in **Leukemic infiltration** of the liver, toxic shock syndrome, or fasting. * **Gallbladder involvement:** In acute hepatitis, look for **diffuse gallbladder wall thickening** with a small lumen (due to decreased bile production). * **Contrast:** The opposite of the starry sky is the **"Bright Liver,"** seen in **Fatty Liver (Steatosis)**, where the parenchyma is hyperechoic and portal vein walls are poorly visualized.

Question 1

What is the investigation of choice for a small intestine tumor?

Accepted Answer

Barium follow-through

Answer

Echocardiography

Answer

X-ray abdomen

Answer

CT scan with contrast

Question 2

Which investigation is being performed?

Accepted Answer

T-tube cholangiography

Answer

ERCP

Answer

MRCP

Answer

Percutaneous transhepatic Cholangiography

Question 3

What is a characteristic feature of the post-ovulatory endometrium observed on ultrasound?

Accepted Answer

Prominent posterior enhancement

Answer

Single hyperechoic thin line

Answer

Three line sign

Answer

Prominent halo

Question 4

Fleischner sign is characteristic of which condition?

Accepted Answer

Ileocecal tuberculosis

Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Ischaemic colitis

Question 5

Hyperchoice hepatic metastases on USG are seen in which of the following malignancies?

Accepted Answer

Carcinoma of colon (Mucinous adenocarcinoma)

Answer

Carcinoma of ovary

Answer

Urinary bladder carcinoma

Answer

Mucinous cystadenoma

Question 6

Which of the following is NOT a CT finding of acute pancreatitis?

Accepted Answer

Dilation of the pancreatic duct

Answer

Fuzzy outline of the pancreas

Answer

Peripancreatic fluid collection

Answer

Edematous pancreas

Question 7

Which of the following is NOT a radiological sign of Ulcerative colitis?

Accepted Answer

Raspberry appearance

Answer

Toxic megacolon

Answer

Lead Pipe appearance

Answer

Pseudopolyps

Question 8

Which is the most important sign of significance of renal artery stenosis on an angiogram?

Accepted Answer

Presence of collaterals

Answer

A percentage diameter stenosis > 70%

Answer

Post-stenotic dilatation of the renal artery

Answer

A systolic pressure gradient > 20 mm Hg across the lesion

Question 9

What does 'pseudo kidney' refer to on ultrasound?

Accepted Answer

Thickened bowel loop

Answer

Hydronephrosis

Answer

Unascended kidney

Answer

Undescended testes

Question 10

Ultrasonography of the liver shows a starry sky appearance. This is a feature of which condition?

Accepted Answer

Acute viral hepatitis

Answer

Primary biliary cirrhosis

Answer

Primary sclerosing cholangitis

Answer

Hydatid cyst

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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