Abdominal and Pelvic Radiology Practice Questions

Q: CT abdomen shows: (Recent NEET Pattern 2016-17)

Diverticulosis. ***Diverticulosis*** - The image shows an out-pouching of the colonic wall (indicated by the white arrow), characteristic of a **diverticulum**. - **Diverticulosis** refers to the presence of multiple such diverticula, often seen in the colon on CT scans. *Hiatus hernia* - A hiatus hernia involves the protrusion of the **stomach** through the **esophageal hiatus** of the diaphragm into the chest cavity. - This image does not show any gastric organ extending above the diaphragm. *Gallstones* - Gallstones are calcified deposits found within the **gallbladder**, appearing as bright, high-density structures. - The structure indicated by the arrow is clearly an out-pouching of the bowel wall, not a calcified stone within the gallbladder. *Acute pancreatitis* - Acute pancreatitis is characterized by **inflammation of the pancreas**, often visible as pancreatic enlargement, peripancreatic fat stranding, and fluid collections. - The image does not show any signs suggestive of pancreatic inflammation or changes in the pancreas itself.

Q: The barium swallow shows presence of:

Bird beak appearance. ***Bird beak appearance*** - The image shows a **smooth, tapered narrowing of the distal esophagus** with proximal esophageal dilation, a classic sign of **achalasia**. - This appearance resembles a **bird's beak** on a barium swallow study due to the failure of the **lower esophageal sphincter** to relax. *Apple core appearance* - The **apple core sign** is characteristic of an **annular stricture** in the colon, typically caused by a **colonic carcinoma**. - It describes irregular, circumferential narrowing of the bowel lumen with overhanging edges, which is not seen here. *Schatzki's ring* - A **Schatzki's ring** is a benign, circumferential, thin mucosal ring located at the **esophagogastric junction**. - It typically causes intermittent dysphagia for solids but does not present with the diffuse narrowing and significant proximal dilation seen in the image. *Esophageal web* - An **esophageal web** is a thin, eccentric protrusion of mucosa into the esophageal lumen, usually found in the **proximal esophagus**. - It is typically a subtle finding and does not cause the extensive, tapered narrowing and associated proximal dilation observed in this barium swallow.

Q: The following image shows:

Xanthogranulomatous pyelonephritis. ***Xanthogranulomatous pyelonephritis*** - The imaging shows an enlarged kidney with replacement of renal parenchyma by **hypodense mass lesions** and ill-defined contours, often described as a **"bear paw" sign** due to dilated calyces containing purulent material. - The presence of **calcifications** (staghorn calculus) and chronic inflammatory changes in the renal parenchyma further supports xanthogranulomatous pyelonephritis, a severe chronic infection often associated with **obstructive nephropathy**. *Splenic hematoma* - A splenic hematoma would appear as a **hypodense collection within the spleen**, potentially with surrounding active extravasation if acute, which is not depicted in the image (the visible pathology is renal). - The spleen appears distinct from the kidney pathology shown, and there are no characteristic features of a splenic injury. *Emphysematous pyelonephritis* - This condition is characterized by **gas formation within the renal parenchyma** and collecting system, appearing as hypodense areas with specific Hounsfield units corresponding to gas, which is not primarily seen here. - While both are severe kidney infections, the main features in the image point to chronic destruction rather than acute gas-forming infection. *Renal pelvic calculus* - A renal pelvic calculus would appear as a **bright, hyperdense structure within the renal pelvis or calyces**, distinct and well-defined. - While calcifications are present, they are part of a larger, destructive process involving the entire kidney parenchyma, which is more characteristic of xanthogranulomatous pyelonephritis rather than an isolated calculus.

Q: The following urinary bladder on MCU is diagnostic of:

VUR. ***VUR (Vesicoureteral Reflux)*** - The image is a **micturating cystourethrogram (MCU)** showing the urinary bladder filled with contrast - The white arrows point to areas where **contrast material is refluxing from the bladder back into the ureters** - This retrograde flow of urine from the bladder into the ureters is **diagnostic of VUR** - VUR is graded from I to V based on the severity of reflux and associated ureteral/renal pelvic dilatation *Posterior urethral valve* - Would show a **dilated posterior urethra** with abrupt narrowing at the valve level - Typically seen as a **keyhole sign** on MCU in male children - May have secondary VUR but the primary finding would be urethral obstruction - Not the primary diagnosis in this image showing bilateral ureteral reflux *Bladder diverticulum* - Would appear as an **outpouching from the bladder wall** - Shows contrast-filled sac communicating with the bladder lumen - Does not show reflux into ureters as the primary finding - Not demonstrated in this MCU *Ureterocele* - Appears as a **cystic dilatation of the distal ureter** within the bladder - Seen as a **cobra head sign** or filling defect in the bladder - May cause obstruction but does not show retrograde reflux into ureters - Not the finding depicted in this image

Q: The following barium swallow study shows which of the following?

Esophageal varices. ***Esophageal varices*** - The Barium Swallow image clearly demonstrates a **serpiginous**, worm-like, or **rosary bead-like appearance** along the esophageal wall, which is characteristic of esophageal varices. - Varices are dilated submucosal veins and appear as **filling defects** on barium studies, especially when distended. *Schatzki ring* - A Schatzki ring is a **thin, symmetric mucosal ring** at the esophagogastric junction, causing solid food dysphagia. - It presents as a **smooth, circumferential narrowing** on a barium swallow, which is not seen here. *Candida esophagitis* - Candida esophagitis typically appears as **ulcerations, plaques, or nodularity** with an irregular, cobblestone pattern on barium swallow. - This image does not show the characteristic **"shaggy" or "cobblestone"** appearance associated with candidal plaques. *Reflux esophagitis* - Reflux esophagitis can manifest as **mucosal irregularity, erosions, or strictures**, but not the distinct serpiginous filling defects seen in this image. - Severe reflux can cause peptic strictures, which appear as **smooth, tapered narrowings**, different from the irregular variceal pattern.

Q: A 45-year-old female patient complains of dysphagia for one year. UGI endoscopy was normal. Diagnosis is: (Recent NEET Pattern 2016-17)

Diffuse esophageal spasm. ***Diffuse esophageal spasm*** - The image shows a **"corkscrew" or "rosary bead" esophagus**, which is a classic radiographic finding in diffuse esophageal spasm due to uncoordinated esophageal contractions. - Dysphagia in this context, coupled with a normal UGI endoscopy (ruling out mechanical obstruction visible by scope), points to a motility disorder. *Zenker's diverticulum* - This is an **outpouching of the pharyngeal mucosa** occurring above the upper esophageal sphincter. - It would typically appear as a distinct barium-filled pouch on a barium swallow, not the diffuse spasm seen in the image. *Dysphagia lusoria* - This is dysphagia caused by **vascular compression of the esophagus**, usually an aberrant right subclavian artery. - It would manifest as a localized external compression rather than the widespread functional spasm shown. *Esophageal carcinoma* - Esophageal carcinoma would typically present as a **fixed filling defect, stricture, or ulceration** on a barium swallow, often with abnormal mucosal patterns. - The UGI endoscopy would likely show an abnormality if carcinoma were present.

Q: A patient complains of episodes of dysphagia and chest pain. The barium study presentation of the patient is shown below. A radiologist will describe this condition as all except:

Cobble stone appearance. ***Cobble stone appearance*** - **Cobblestone appearance** on barium swallow studies is typically associated with **Crohn's disease** affecting the bowel, characterized by deep ulcerations intersected by edematous mucosa. - This image clearly shows severe, disorganized contractions in the esophagus, which is characteristic of a **motility disorder**, not Crohn's. *Corkscrew appearance* - The image distinctly shows a **twisted, irregular contour** of the esophageal lumen, which is well-described as a **corkscrew esophagus**. - This finding is classic for **diffuse esophageal spasm** (DES), where powerful, uncoordinated contractions occur. *Rosary bead esophagus* - This term is another descriptive phrase for the appearance of the esophagus in **diffuse esophageal spasm**. - The appearance resembles beads on a rosary due to the **simultaneous, non-peristaltic contractions** causing segmental narrowing and outpouching. *Pseudodiverticula* - While not true diverticula which are herniations of all layers, the saccular outpouchings seen between the spastic contractions can be described as **pseudodiverticula**. - These are formed by the irregular, forceful contractions transiently distorting the esophageal wall.

Q: A patient presents with abdominal pain, diarrhea and weight loss. He gives a history of taking treatment for pulmonary TB. What does the barium film of the patient show?

Pulled up cecum. ***Pulled up cecum*** - The image shows a **deformed and pulled-up cecum** (indicated by the arrow) which is characteristic of **intestinal tuberculosis (TB)**, especially when combined with a history of pulmonary TB, abdominal pain, diarrhea, and weight loss. - This appearance is due to **fibrosis and contracture** caused by chronic inflammation from Mycobacterium tuberculosis infection affecting the ileocecal region, leading to architectural distortion and shortening. *Saw tooth* - A "sawtooth" appearance is typically associated with **spasm** or **haustral changes** in the colon, which is not the primary finding or most specific sign for intestinal tuberculosis. - While irregular contours can be seen, the dominant feature here is the **distortion and displacement** of the cecum, not simple serrations. *Intestinal perforation* - Intestinal perforation would result in the extravasation of contrast material into the peritoneal cavity, which is **not seen** in this barium study. - Perforation is an acute, life-threatening condition, and its imaging findings are distinct from the chronic changes shown here. *Diverticulum formation* - **Diverticula** appear as small, pouch-like outpouchings from the bowel wall, which are **absent** in this image. - Diverticulosis is a common condition but does not explain the patient's symptoms or the specific cecal deformity shown, especially in the context of prior TB.

Q: Which of the following is shown in the barium study?

Menetrier's disease. ***Menetrier's disease*** - The barium study shows **markedly thickened gastric folds**, particularly in the fundus and body of the stomach, which is characteristic of Menetrier's disease. - This condition involves **hypertrophy of the gastric mucosa** with associated protein loss, which can be visualized as prominent folds on imaging. *Gastric ulcer* - A gastric ulcer would typically appear as a **focal collection of barium** (crater) that projects beyond the normal gastric lumen, often with surrounding edema. - The image does not show a discrete ulcer crater but rather diffuse thickening of the gastric folds. *Esophageal varices* - Esophageal varices would be seen as **serpiginous filling defects** within the esophagus, particularly in the distal portion. - The image focuses on the stomach and does not display the characteristic features of esophageal varices. *Mallory-Weiss syndrome* - Mallory-Weiss syndrome involves **longitudinal tears in the esophageal mucosa**, usually near the gastroesophageal junction. - These tears are best identified endoscopically and would not typically be visible as diffuse gastric fold thickening on a barium study.

Q: What is the radiological sign demonstrated in the image provided?

Cobblestone appearance. ***Cobblestone appearance*** - The image shows a **barium study** of the small bowel, revealing an irregular, nodular mucosal pattern, which is characteristic of the **cobblestone appearance**. - This appearance is typically seen in **Crohn's disease** due to deep ulcerations crisscrossing with edematous, inflamed mucosa. - The combination of **linear ulcers** and **transverse fissures** separated by areas of edematous mucosa creates this distinctive pattern. *Belt sign* - The **belt sign** is a radiological finding on **CT imaging** associated with **blunt abdominal trauma**, particularly **seat belt injuries**. - It refers to bowel wall thickening, mesenteric hematoma, or abdominal wall bruising in the distribution of a seat belt. - This sign is not observed in the gastrointestinal barium study pattern shown in this image. *String sign* - The **string sign** is also seen in Crohn's disease but refers to a **severely narrowed or stenotic bowel lumen**, appearing as a thin, continuous string of barium. - This occurs due to chronic inflammation leading to fibrotic strictures. - While Crohn's can cause both findings, the image prominently displays the nodular, irregular mucosal pattern rather than a simple string-like narrowing. *Coffee bean sign* - The **coffee bean sign** is a classic radiographic finding in **sigmoid volvulus** on plain abdominal X-ray. - A massively dilated, gas-filled loop of bowel creates an appearance resembling a coffee bean. - This sign is distinct from the intestinal mucosal pattern observed in the provided barium study.

Question 1

CT abdomen shows: (Recent NEET Pattern 2016-17)

Accepted Answer

Diverticulosis

Answer

Hiatus hernia

Answer

Gallstones

Answer

Acute pancreatitis

Question 2

The barium swallow shows presence of:

Accepted Answer

Bird beak appearance

Answer

Apple core appearance

Answer

Schatzki's ring

Answer

Esophageal web

Question 3

The following image shows:

Accepted Answer

Xanthogranulomatous pyelonephritis

Answer

Splenic hematoma

Answer

Emphysematous pyelonephritis

Answer

Renal pelvic calculus

Question 4

The following urinary bladder on MCU is diagnostic of:

Accepted Answer

VUR

Answer

Posterior urethral valve

Answer

Bladder diverticulum

Answer

Ureterocele

Question 5

The following barium swallow study shows which of the following?

Accepted Answer

Esophageal varices

Answer

Schatzki ring

Answer

Candida esophagitis

Answer

Reflux esophagitis

Question 6

A 45-year-old female patient complains of dysphagia for one year. UGI endoscopy was normal. Diagnosis is: (Recent NEET Pattern 2016-17)

Accepted Answer

Diffuse esophageal spasm

Answer

Zenker's diverticulum

Answer

Dysphagia lusoria

Answer

Esophageal carcinoma

Question 7

A patient complains of episodes of dysphagia and chest pain. The barium study presentation of the patient is shown below. A radiologist will describe this condition as all except:

Accepted Answer

Cobble stone appearance

Answer

Corkscrew appearance

Answer

Rosary bead esophagus

Answer

Pseudodiverticula

Question 8

A patient presents with abdominal pain, diarrhea and weight loss. He gives a history of taking treatment for pulmonary TB. What does the barium film of the patient show?

Accepted Answer

Pulled up cecum

Answer

Saw tooth

Answer

Intestinal perforation

Answer

Diverticulum formation

Question 9

Which of the following is shown in the barium study?

Accepted Answer

Menetrier's disease

Answer

Gastric ulcer

Answer

Esophageal varices

Answer

Mallory-Weiss syndrome

Question 10

What is the radiological sign demonstrated in the image provided?

Accepted Answer

Cobblestone appearance

Answer

Belt sign

Answer

String sign

Answer

Coffee bean sign

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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