Abdominal and Pelvic Radiology Practice Questions

Q: Which of the following is NOT a radiological sign of urogenital tuberculosis?

Enlarged Bladder. ***Enlarged Bladder*** - An **enlarged bladder** is not a typical radiological sign of urogenital tuberculosis. Instead, bladder involvement often leads to a **contracted**, **fibrotic**, and **small bladder**, known as a **thimble bladder**, due to chronic inflammation and scarring. - The progressive fibrosis and inflammation characteristic of urogenital tuberculosis cause a decrease in bladder capacity, leading to a small and non-compliant bladder rather than an enlarged one. *"Smudged Papillae" and "Moth eaten Calyx"* - **Smudged papillae** and a **moth-eaten calyx** are classic radiological findings in renal tuberculosis, indicating destruction and ulceration of the renal papillae and calyces. - These terms describe the characteristic erosive changes in the kidney parenchyma caused by granulomatous inflammation. *Putty Kidney* - A **putty kidney** (also known as a **cement kidney** or **autonephrectomy**) refers to a chronically diseased, calcified, and non-functional kidney, which is a late-stage manifestation of renal tuberculosis. - This indicates diffuse caseous necrosis and calcification, leading to a shrunken and non-functioning organ. *Saw tooth Ureter* - The **sawtooth ureter** is a characteristic appearance on imaging studies due to **ureteral strictures** and inflammation in tuberculosis, resulting in an irregular, notched outline. - This irregular contour is caused by granulomatous inflammation and fibrosis along the ureteral wall, leading to areas of narrowing and dilatation.

Q: In a clinical ultrasound assessment, what is considered the normal thickness of the stomach wall?

5 mm. ***5 mm*** - A stomach wall thickness of **5 mm** is generally considered the upper limit of normal in a clinical ultrasound assessment. - Measurements exceeding **5 mm** may indicate the presence of pathology such as inflammation, edema, or malignancy. *2 mm* - A stomach wall thickness of **2 mm** is typically considered at the lower end of the normal range, or even slightly thinner than average, especially in a distended stomach. - While not necessarily abnormal, it does not represent the upper limit for normal thickness. *8 mm* - A stomach wall thickness of **8 mm** is usually considered significantly thickened and indicative of an underlying pathological process. - This measurement would prompt further investigation for conditions like gastritis, ulceration, or neoplastic changes. *10 mm* - A stomach wall thickness of **10 mm** is a definite sign of abnormal thickening and strongly suggests a significant infiltrative or inflammatory process. - This degree of thickening is rarely, if ever, a normal finding and warrants immediate clinical attention.

Q: What is the best diagnostic procedure for identifying complications in acute pancreatitis?

CT scan. ***CT scan*** - **CT scans** are excellent for visualizing the pancreas and surrounding structures, allowing for detailed assessment of complications like **necrosis**, **collections/pseudocysts**, and **vascular involvement**. - Contrast-enhanced CT (CECT) is particularly useful for differentiating viable from non-viable pancreatic tissue and assessing the extent of disease. *Ultrasound* - While useful for initial diagnosis by identifying **gallstones** (a common cause of pancreatitis), ultrasound is generally **poor for visualizing the pancreas** in the acute setting due to overlying bowel gas. - It has limited ability to detect and characterize **pancreatic necrosis** or other intra-abdominal complications. *MRI* - **MRI** is an excellent imaging modality for soft tissue characterization and can be used to assess pancreatic complications, including **fluid collections** and **necrosis**. - However, it is often less readily available and takes longer than CT, making it less practical for initial evaluation in acutely ill patients. *Pipida scan* - A **PIPIDA scan** (hepatobiliary iminodiacetic acid scan) is primarily used to evaluate **gallbladder function** and diagnose **acute cholecystitis** or **biliary obstruction**. - It provides no direct information about the pancreas or its complications in acute pancreatitis.

Q: A 50-year-old man suffering from left colon carcinoma. Which of the following is the MOST CHARACTERISTIC finding?

Apple core sign on imaging. ***Apple core sign on imaging*** - The **"apple core"** or **"napkin ring" sign** is a classic radiologic finding in **left-sided colon carcinoma** on barium enema or CT, indicating circumferential narrowing of the bowel lumen due to tumor growth. - This characteristic appearance results from the tumor encircling and constricting the colon, resembling an apple core after the core has been removed. *Bleeding can occur* - While bleeding is a common symptom of **colorectal cancer** (both left and right-sided), it is a **non-specific finding** and not the *most characteristic* for left colon carcinoma. - **Occult blood** in stool is more common with right-sided lesions, whereas visible **hematochezia** can occur with left-sided lesions. *Stools may be liquid* - **Liquid stools** are not a characteristic finding of left colon carcinoma; rather, **obstruction** can lead to **tenesmus** and **pencil-thin stools** or **constipation** due to tumor narrowing the lumen. - Diarrhea can sometimes be observed in more proximal colon tumors, but it's not specific to left colon cancer. *Mass may be present* - A **mass** often develops in **colorectal cancer**, but it is a **general feature** of many cancers and is not the *most characteristic* finding specifically for left colon carcinoma. - A palpable mass is more common in **right-sided tumors**, which can grow larger before causing obstructive symptoms.

Q: The coffee bean appearance on imaging is specifically associated with which condition?

Sigmoid volvulus. ***Sigmoid volvulus*** - The **coffee bean sign** on an abdominal X-ray is a classic finding in **sigmoid volvulus**, representing the hugely dilated, gas-filled loop of bowel. - This characteristic appearance is due to the **mesentery twisting** on itself, creating a closed-loop obstruction. *Testicular torsion* - This condition involves the **twisting of the spermatic cord**, leading to interrupted blood supply to the testis. - Imaging focuses on the **scrotum** (e.g., ultrasound) and does not produce a "coffee bean" sign on abdominal films. *Meconium ileus* - This is a form of **small bowel obstruction** in newborns caused by abnormally thick and sticky meconium. - Imaging typically shows **dilated loops of small bowel** and a **"soap bubble" appearance** due to trapped gas in meconium, not a coffee bean shape. *Ileal atresia* - This condition involves a **congenital blockage of the ileum**, leading to proximal bowel dilation. - While it causes bowel obstruction, the characteristic imaging features are **dilated bowel loops** with **air-fluid levels**, not the specific coffee bean shape seen in sigmoid volvulus.

Q: Which pancreatic lesion is characterized by a spongy appearance with central sunburst calcification?

Serous cystadenoma. ***Serous cystadenoma*** - **Serous cystadenomas** are characterized by a **spongy or honeycomb appearance** due to multiple small cysts filled with thin, watery fluid. - A **central stellate scar with "sunburst" calcification** is a classic radiological finding, though not always present. *Pancreatic adenocarcinoma* - Pancreatic adenocarcinoma typically presents as a **solid, infiltrative mass** on imaging, often causing ductal obstruction. - It rarely features a **cystic, spongy appearance** or central calcification; calcifications, if present, are usually amorphous and diffuse. *Mucinous cystadenocarcinoma* - **Mucinous cystadenocarcinomas** are usually macroscopic, **multilocular cysts** filled with viscous mucin, often with mural nodules indicating malignancy. - While they can present with calcification, it is typically **peripheral or curvilinear** rather than a central sunburst pattern. *Somatostatinoma* - **Somatostatinomas** are neuroendocrine tumors that manifest as solid masses, often in the head of the pancreas or duodenum. - They do not typically exhibit the **spongy architecture** or **central sunburst calcification** described for serous cystadenomas.

Q: What percentage of gallstones are radioopaque?

20%. ***20%*** - Approximately **10-20%** of gallstones contain enough **calcium** to be visible on plain abdominal radiographs, with **20%** being the most commonly cited figure in standard radiology references. - These radioopaque stones typically contain **calcium carbonate** or **calcium bilirubinate**. - The vast majority of gallstones are composed primarily of **cholesterol** (80-90%), which are **radiolucent** and not visible on plain X-rays. - **Ultrasound** remains the imaging modality of choice for gallstone detection, with sensitivity >95%. *10%* - While 10% represents the lower end of the accepted range (10-20%), most standard radiology references cite figures closer to **15-20%**. - Using 10% would be an overly conservative estimate that underrepresents the proportion of calcified gallstones. *30%* - 30% significantly overestimates the percentage of gallstones that are **radioopaque**. - This would suggest greater utility of plain radiography than is clinically observed. - Such a high percentage contradicts the well-established predominance of **cholesterol stones**, which constitute 80-90% of all gallstones. *40%* - 40% is far too high and contradicts established medical literature. - This would imply that nearly half of gallstones contain substantial **calcium**, which is inconsistent with their known composition. - Plain abdominal radiographs have low sensitivity (10-20%) for gallstone detection, making this percentage clinically unrealistic.

Q: String sign of Kantor is seen in:

Crohn's disease. ***Crohn's disease*** - The **string sign of Kantor** is a classic radiographic finding in advanced Crohn's disease, particularly affecting the **terminal ileum**. - It refers to the appearance of a thin, continuous linear shadow of barium representing a severely narrowed, rigid, and stenosed lumen due to chronic inflammation and fibrosis. *Ulcerative colitis* - Ulcerative colitis primarily affects the **colon** and rectum, causing diffuse mucosal inflammation. - Common radiographic findings include **loss of haustrations** (lead pipe appearance) and **pseudopolyps**, not the string sign. *Typhoid colitis* - Typhoid colitis is a rare manifestation of **typhoid fever** (caused by *Salmonella Typhi*) that involves inflammation of the colon. - This condition presents with features of acute colitis, but not the chronic inflammatory changes or strictures leading to a string sign. *Colorectal cancer* - Colorectal cancer typically presents as a **mass lesion** or an **apple-core stricture** on barium studies, representing an obstructing tumor. - While it can cause luminal narrowing, it does not typically produce the diffuse, long-segment "string sign" characteristic of Crohn's disease.

Q: Which of the following may be detected on the plain abdominal film and is a premalignant condition?

Porcelain gallbladder. ***Porcelain gallbladder*** - This condition is characterized by **calcification of the gallbladder wall**, appearing as a curvilinear or speckled calcification on a plain abdominal film. - It is considered a **premalignant condition** due to an increased risk of developing gallbladder carcinoma. *Limy bile* - **Limy bile** (or milk of calcium bile) is a thick, pasty, calcium-containing bile that can be seen within the gallbladder lumen on imaging but does not represent calcification of the gallbladder wall itself. - While it indicates chronic inflammation and potential biliary stasis, it is **not considered a premalignant condition** like porcelain gallbladder. *Adenomyosis of gallbladder* - This is a benign condition involving **hyperplasia of the muscularis propria** and **outpouchings of the mucosa** (Rokitansky-Aschoff sinuses) into the muscular layer. - It is typically diagnosed with ultrasound or MRI and is **not reliably detected on a plain abdominal film**, nor is it premalignant. *Cholesterosis* - Also known as **"strawberry gallbladder,"** cholesterosis is a benign condition where **cholesterol esters accumulate in the gallbladder mucosa**. - It is usually **not detectable on plain abdominal films** and is not considered a premalignant condition.

Q: The best method of investigation in case of acute cholecystitis is:

Radionuclide imaging. ***Radionuclide imaging (HIDA scan)*** - **Most accurate and specific test** for acute cholecystitis with **sensitivity 95-98%** and **specificity 90-95%** - **Directly demonstrates cystic duct obstruction** (pathognomonic feature of acute cholecystitis) by showing non-visualization of gallbladder when bile ducts and small bowel are visualized - **Gold standard diagnostic test** when definitive diagnosis is required, particularly in equivocal cases - Functional imaging that assesses **biliary patency** and confirms acute cholecystitis diagnosis *Ultrasound* - **First-line imaging modality** in clinical practice due to **availability**, **cost-effectiveness**, and **non-invasiveness** - Detects **gallstones**, **gallbladder wall thickening >3mm**, **pericholecystic fluid**, and **sonographic Murphy's sign** - **Lower specificity (80-85%)** compared to HIDA scan, may miss cases with incomplete obstruction - Excellent screening tool but HIDA scan reserved for **definitive diagnosis** when ultrasound is inconclusive *OCG (Oral cholecystography)* - **Obsolete imaging technique** replaced by modern modalities - Requires **12-14 hours** for contrast concentration, unsuitable for **acute settings** requiring rapid diagnosis - Contraindicated in patients with **impaired hepatic function** or **hyperbilirubinemia** *ERCP* - **Therapeutic endoscopic procedure**, not a diagnostic imaging test for cholecystitis - Indicated for **bile duct stones (choledocholithiasis)** or **biliary strictures**, not gallbladder pathology - **Invasive with significant risks** including pancreatitis, bleeding, and perforation

Question 1

Which of the following is NOT a radiological sign of urogenital tuberculosis?

Accepted Answer

Enlarged Bladder

Answer

Saw tooth Ureter

Answer

Putty Kidney

Answer

"Smudged Papillae" and "Moth eaten Calyx"

Question 2

In a clinical ultrasound assessment, what is considered the normal thickness of the stomach wall?

Accepted Answer

5 mm

Answer

2 mm

Answer

8 mm

Answer

10 mm

Question 3

What is the best diagnostic procedure for identifying complications in acute pancreatitis?

Accepted Answer

CT scan

Answer

Ultrasound

Answer

PIPIDA scan

Answer

MRI

Question 4

A 50-year-old man suffering from left colon carcinoma. Which of the following is the MOST CHARACTERISTIC finding?

Accepted Answer

Apple core sign on imaging

Answer

Bleeding can occur

Answer

Stools may be liquid

Answer

Mass may be present

Question 5

The coffee bean appearance on imaging is specifically associated with which condition?

Accepted Answer

Sigmoid volvulus

Answer

Testicular torsion

Answer

Meconium ileus

Answer

Ileal atresia

Question 6

Which pancreatic lesion is characterized by a spongy appearance with central sunburst calcification?

Accepted Answer

Serous cystadenoma

Answer

Pancreatic adenocarcinoma

Answer

Mucinous cystadenocarcinoma

Answer

Somatostatinoma

Question 7

What percentage of gallstones are radioopaque?

Accepted Answer

20%

Answer

10%

Answer

30%

Answer

40%

Question 8

String sign of Kantor is seen in:

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Typhoid colitis

Answer

Colorectal cancer

Question 9

Which of the following may be detected on the plain abdominal film and is a premalignant condition?

Accepted Answer

Porcelain gallbladder

Answer

Limy bile

Answer

Adenomyosis of gallbladder

Answer

Cholesterosis

Question 10

The best method of investigation in case of acute cholecystitis is:

Accepted Answer

Radionuclide imaging

Answer

OCG

Answer

Ultrasound

Answer

ERCP

Abdominal and Pelvic Radiology — MCQs

Abdominal and Pelvic Radiology — MCQs

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