1.

BIRADS score 5 is:

a. Negative
b. Probably benign
c. Suspicious abnormality
d. Highly suggestive of malignancy

2. Popcorn calcification in mammography is seen in:

a. Fibroadenoma
b. Fat necrosis
c. Cystosarcoma phyllodes
d. CA Breast

3. Mercedes benz sign or Seagull sign is seen in:

a. Gallstones
b. Renal stones
c. CBD stones
d. Hydatid cyst

4. Investigation of choice in suspected gallbladder stone is:

a. Ultrasound
b. X-ray
c. Barium study
d. Oral cholecystography

5. “Chain of lakes” appearance seen in:

a. Acute pancreatitis
b. Chronic pancreatitis
c. Carcinoma pancreas
d. Strawberry gallbladder
6. For hiatus hernia, investigation of choice is:
a. Barium meal follow through
b. Barium meal upper GI
c. Barium meal upper GI in Trendelenberg position
d. Barium meal double contrast

7. Radiologic feature suggestive of achalasia cardia is:

a. Absence of gastric air bubble
b. Air fluid level in mediastinum
c. Sigmoid esophagus
d. All of the above

8. Bird’s beak appearance is seen in:

a. Volvulus
b. Intussusception
c. Achalasia
d. Ulcerative colitis

9. Best investigation for Zenker’s diverticulum is:

a. Barium swallow
b. Endoscopy
c. CECT
d. EUS

10. Investigation contraindicated for Lower GIT bleeding:

a. Endoscopy
b. Angiography
c. CT
d. Barium studies

11.Investigation of choice to diagnose hypertrophic pyloric stenosis

in infants is:
a. Contrast radiology
b. Gastroscopy
c. Ultrasound abdomen
d. CT abdomen
12. Best investigation for acute intestinal obstruction is:
a. Barium studies
b. X-ray
c. USG
d. ERCP

13. Ectopic mucosa of Meckel’s diverticulum is diagnosed by:

a. Tc-99 radionuclide scan
b. Angiography
c. CT
d. Endoscopy

14. Features of intussusceptions are:

a. Claw sign
b. Target sign
c. Dove sign
d. Coiled spring sign
e. Dance sign

15. Initial investigation of choice for biliary obstruction:

a. CT Abdomen
b. ERCP
c. MRCP
d. USG

16.All are sings of malignancy for a mass on mammogram except

a) Speculations
b) Lymphadenopathy
c) Taller than wide
d) Oval shape
e) Calcifications
A 40-year-old woman presents to hospital with epigastric discomfort and
jaundice.
1. What is the investigation and what does it show?
2. What are the important complications of this condition?
3. What is Charcot’s triad and what does it signify?
4. What is the treatment for the X-ray findings?
5. What are the important complications of this investigation?
1. The investigation is an endoscopic retrograde cholangiopancreatogram
(ERCP). It demonstrates residual stones in the common bile duct.
2. Complications of common bile duct stones:
• Jaundice.
• Acute pancreatitis.
• Acute cholangitis: Escherichia coli, Klebsiella spp., Staphylococcus,
Streptococcus, Clostridium spp.
3. Charcot’s triad of symptoms occurring in acute suppurative cholangitis:
• Pain: similar to that in cholecystitis.
• Jaundice: intermittent/persistent.
• Rigors: indicates cholangitis.
4. At ERCP, endoscopic sphincterotomy and extraction of the stones is
effective in 85–95%. Failing this, exploration of the common bile duct
should be performed:
• Laparoscopic.
• Open: transduodenal sphincteroplasty.
• Choledochoduodenostomy.
5. Complications of ERCP:
• Failed ERCP:
• Failed cannulation of the common bile duct especially after a
polyagastrectomy.
• Failed stone extraction.
• Acute pancreatitis.
• Acute cholangitis.
• Bleeding secondary to intervention: retroperitoneal haemorrhage.
1. What is the radiological investigation and what are the features shown?
2. What is the likely diagnosis ?
3. List the suspected causes
4. What are the local and general complications?
5. Discuss the treatment options
A 30-year-old woman presents with a change in bowel habit in the form of
very frequent watery diarrhoea.
1. What is the radiological investigation and what are the features shown?
2. What is the likely diagnosis and how can this be confirmed?
3. List the other associated radiological features encountered in this
condition.
4. What are the local and general complications?
5. Discuss the treatment option
1. This is a single-contrast gastrograffin enema, which demonstrates an
extensive featureless colon with loss of haustrations, narrowing of the
lumen and shortening. There is also mucosal irregularity in the transverse
colon consistent with ulceration.
2. Diagnosis: the most likely diagnosis is that of ulcerative colitis, which can
be confirmed by sigmoidoscopy and rectal biopsy.
3. Radiological signs in ulcerative colitis:
• Earliest sign: loss of haustrations, especially in the distal colon.
• Narrow contracted (pipe stem) colon.
• Alteration in mucosal outline.
• Pseudopolyps in 15% of cases.
• Increase in the presacral space.
4.
• Local complications:
• Pseudopolyposis (15%).
• Carcinoma (3.5%).
• Fibrous stricture (6%).
• Toxic dilatation (1.5%).
• Massive haemorrhage (3%).
• Rectovaginal fistulas, fistula in ano, ischiorectal abscesses and
haemorrhoids.
• General complications:
• Liver changes (cirrhosis) (19%).
• Skin lesions (pyoderma gangrenosum, erythema nodosum) (2%).
• Arthritis (11%).
• Iritis, anaemia, stomatitis, renal disease.
• Sclerosing cholangitis (12%).
• Cholangiocarcinoma (uncommon).
5. Treatment:
• Main general principles are: maintenance of fluid and electrolyte balance,
correction of anaemia, adequate nutrition. Sedatives and tranquillisers are
a useful adjunct to treatment.
• Specific treatment:
• Anticolitics:
– 5-Aminosalicylic acid (5-ASA).
– Salazopyrin, olsalazine, enteric coated mesalazine (doses depend on
disease activity).
• Steroid preparations (hydrocortisone foam, prednisolone enemas).
• Systemic steroids.
• Operative options:
– One-stage panproctocolectomy with formation of a permanent
ileostomy.
– Total colectomy with iliorectal anastomosis.
– Restorative panproctocolectomy with the formation of an ileoanal pouch.
A 30-year-old woman presents to her general practitioner with a history of
recurrent chest infections and dysphagia.
1. What are the radiological features shown?
2. What is the diagnosis?
3. What might be the next non-radiological investigation performed, and
list the typical findings.
4. What are the treatment options?
1. This is a barium swallow that demonstrates a dilated oesophagus
containing a large amount of food residue. In addition, the distal
aspect is tapered
mimicking the classical ‘bird’s beak’ appearance.
2. Diagnosis: achalasia of the oesophagus (synonymous with
cardiospasm).
3. The next logical investigation would be an oesophagoscopy: once
the
instrument has passed the cricoid cartilage, it appears to enter a gaping
cave partially filled with dirty water, which laps to and fro with
respiratory movement. Once the fluid is aspirated, the cardiac orifice
is located
with difficulty, owing to its contracted state and often eccentric
position.
4. Treatment options:
• Operations:
• Heller’s modified cardiomyotomy (Heller performed anterior and
posterior myotomy). This procedure can be done by:
– Laparoscopic route.
– Abdominal route.
– Thoracic route.
• Sometimes the above operation is combined with an antireflux
procedure if troublesome postoperative gastro-oesophageal reflux is
anticipated.
• Balloon dilatation.
A 70-year-old woman presents to Accident and Emergency with severe
epigastric pain and in a shocked state.
1. What does the plain film show?
2. What is the clinical diagnosis and what is the commonest cause?
3. What percentage of such cases have no previous history of ongoing
disease? Name two common medications predisposing to this condition.
4. What percentage of cases have no signs on plain films?
5. What is the treatment for the commonest cause?
1. This erect chest film demonstrates free gas under the diaphragms
bilaterally.
2.
• Diagnosis: perforation of a hollow viscus.
• Commonest cause: peptic ulceration of the duodenum.
3. In 20% of cases, there is no previous history of peptic ulcer disease, and
this condition is especially prevalent on those being treated with
corticosteroids and NSAIDs.
4. In 30% of cases, no free intraperitoneal gas is detected on plain films.
5. Treatment:
• After adequate fluid and electrolyte correction, emergency laparotomy is
performed. The perforation is closed with interrupted sutures reinforced
with an omental patch.
• Note that if perforation occurs secondary to a gastric ulcer, then a gastric
biopsy must also be taken at laparotomy to exclude perforation in a
malignant gastric ulcer.
• In selected cases of perforated duodenal ulcers, a definitive procedure can
be done such as:
• Pyloroplasty and truncal vagotomy.
• Closure of the perforation followed by posterior, short loop, isoperistaltic
gastrojejunostomy and truncal vagotomy