LE 3 (GIT) Batch 2026

Question 1

CASE 1:
An abdominal radiograph of a 6-week-old male presenting with vomiting is shown.

Identify the pointed structure in the image.
a. Esophagus
b. Small intestine
c. Stomach
d. Large intestine

Analyze the intestinal gas pattern seen on the X-ray.
a. Normal
b. Abnormal
c. Equivocal
d. Indeterminate

Provide the radiographic impression based on the image.
a. Normal neonatal gas pattern
b. Gastric outlet obstruction
c. Midgut volvulus
d. Small bowel obstruction

Answer 1

Identify the pointed structure in the image:
c. Stomach
Analyze the intestinal gas pattern seen on the X-ray:
b. Abnormal
Provide the radiographic impression based on the image:
b. Gastric outlet obstruction

A 6-week-old male with vomiting and an X-ray showing a distended stomach with minimal gas in the intestines is concerning for pyloric stenosis, a form of gastric outlet obstruction.

Question 2

CASE 2:
A scout film of the abdomen of a 27-year-old male presenting with abdominal pain is shown.

Identify the pointed structure in the image.
a. Esophagus
b. Stomach
c. Small intestine
d. Large intestine

Analyze the intestinal gas pattern seen on the X-ray.
a. Normal
b. Abnormal
c. Equivocal
d. Indeterminate

Provide the radiographic impression based on the image.
a. Normal intestinal gas pattern
b. Generalized ileus
c. Colonic ileus
d. Small bowel obstruction

Answer 2

Identify the pointed structure in the image:
d. Large intestine
Analyze the intestinal gas pattern seen on the X-ray:
b. Abnormal
Provide the radiographic impression based on the image:
d. Small bowel obstruction

A scout film revealing dilated loops of small bowel with air-fluid levels is characteristic of small bowel obstruction (SBO), commonly due to adhesions, hernias, or strictures.

Question 3

CASE 3:
A barium enema study of a 72-year-old male presenting with hematochezia is shown.

Identify the pointed structure in the image.
a. Esophagus
b. Stomach
c. Small intestine
d. Large intestine

The classic radiographic sign of an “apple core deformity” is demonstrated. This finding is most commonly associated with:
a. Focal spasm
b. Neoplasm
c. Metastasis
d. Tuberculosis

Answer 3

Identify the pointed structure in the image:
d. Large intestine
The classic radiographic sign of an “apple core deformity” is demonstrated. This finding is most commonly associated with:
b. Neoplasm

An apple core lesion in a barium enema study is a classic sign of colorectal carcinoma, where an annular constricting tumor narrows the lumen of the colon.

Question 4

CASE 4:
Abdominal radiographs of three different patients with rigid abdomen are shown.

The pointed lucencies in the images represent:
a. Normal air within the bowel
b. Free peritoneal air
c. Abscess formation
d. Pneumatosis intestinalis

Provide the radiographic impression based on the images.
a. Normal abdomen
b. Pneumothorax
c. Pneumoperitoneum
d. Gut obstruction

Answer 4

The pointed lucencies in the images represent: b. Free peritoneal air
Provide the radiographic impression based on the images:
c. Pneumoperitoneum

Free air under the diaphragm on an upright abdominal radiograph indicates pneumoperitoneum, which suggests bowel perforation, a surgical emergency.

Question 5

CASE 5:
A CT scan of a 45-year-old female with abdominal pain is presented.

The difference in intestinal wall enhancement seen in the image suggests:
a. Normal enhancement pattern
b. Ischemic bowel disease
c. Small bowel obstruction
d. Generalized ileus

Answer 5

The difference in intestinal wall enhancement seen in the image suggests:
b. Ischemic bowel disease

Bowel wall hypoenhancement, thickening, and pneumatosis intestinalis on CT suggest ischemia, commonly due to mesenteric ischemia or infarction from arterial or venous occlusion.

Question 6

Findings of centrally located branching lucencies in a CT scan of a post-laparoscopic cholecystectomy patient are indicative of:
a. Post-surgical intestinal changes
b. Pneumobilia
c. Portal venous gas
d. Hepatic abscess formation

Answer 6

b. Pneumobilia
Rationale: Pneumobilia (air within the biliary tree) is commonly seen after procedures like ERCP or cholecystectomy and presents as branching gas lucencies in the central liver on CT.

Question 7

Findings of mottled lucencies outlining the bowel wall in a radiograph of a premature neonate are most likely due to:
a. Normal retained stools
b. Necrotizing enterocolitis
c. Lactose intolerance
d. Midgut volvulus

Answer 7

b. Necrotizing enterocolitis
Rationale: Pneumatosis intestinalis (gas within the bowel wall) is a hallmark radiographic finding of necrotizing enterocolitis (NEC), a severe condition in premature neonates.

Question 8

Gas in the porto-mesenteric venous system is an ominous sign for:
a. Normal intestinal gas pattern
b. Hepatic amebic abscess
c. Non-viable bowel
d. Reversible bowel ischemia

Answer 8

c. Non-viable bowel
Rationale: Portal venous gas indicates bowel infarction and necrosis, often seen in mesenteric ischemia and necrotizing enterocolitis, requiring urgent intervention.

Question 9

An abdominal radiograph of a middle-aged woman presenting with back pain shows obliteration of the flank stripes. This raises the possibility of:
a. Bowel obstruction
b. Retroperitoneal pathology
c. Peritonitis
d. Pneumoperitoneum

Answer 9

b. Retroperitoneal pathology
Rationale: Loss of the psoas shadow or flank stripes on an abdominal X-ray suggests retroperitoneal hemorrhage, mass, or infection.

Question 10

A 25-year-old male with long-standing vague abdominal pain and weight loss undergoes a CT scan of the abdomen, which shows a lead-pipe bowel configuration with filiform structures in the mucosa. The most likely diagnosis is:
a. Acute appendicitis
b. Crohn’s disease
c. Ulcerative colitis
d. Diverticulosis

Answer 10

c. Ulcerative colitis
Rationale: The lead-pipe colon (loss of haustral folds) is characteristic of chronic ulcerative colitis, differentiating it from Crohn’s disease, which causes skip lesions and cobblestoning.

Question 11

A middle-aged female presents at the OPD with hemoptysis and right lower quadrant pain. A barium study reveals a pulled-up cecum with narrowing of the terminal ileum and a gaping ileocecal valve. The most likely diagnosis is:
a. Ulcerative colitis
b. Acute appendicitis
c. Gastritis
d. Tuberculosis

Answer 11

d. Tuberculosis
Rationale: Ileocecal tuberculosis presents with a pulled-up cecum, thickening of the ileocecal valve, and narrowing of the terminal ileum (“inverted umbrella sign”).

Question 12

Which of the following is true regarding malrotation with midgut volvulus?
a. The location of the cecum is normal in 80-90% of cases
b. A double-bubble sign may be seen on plain abdominal radiograph
c. The cecum and right colon are seen in their normal anatomic position
d. There is a long mesenteric attachment for the bowel

Answer 12

b. A double-bubble sign may be seen on plain abdominal radiograph
Rationale: The double-bubble sign (gas in the stomach and duodenum) suggests duodenal obstruction, which can occur in midgut volvulus due to Ladd’s bands.

Question 13

The characteristic radiographic feature of achalasia on barium study is:
a. Foreshortening and stricturing of the distal esophagus
b. Rat-tail deformity of the distal esophagus
c. Corkscrew appearance of the esophagus
d. Multiple outpouchings or pseudodiverticula

Answer 13

b. Rat-tail deformity of the distal esophagus
Rationale: Achalasia is characterized by smooth tapering of the distal esophagus, giving a rat-tail or bird’s beak appearance on barium swallow.

Question 14

In intussusception, the prolapsing part of the bowel is known as the:
a. Intussusceptum
b. Intussuscipiens
c. Perforation
d. None of the above

Answer 14

a. Intussusceptum
Rationale: The intussusceptum is the segment that invaginates into the receiving bowel segment (intussuscipiens).

Question 15

The typical sign of intussusception seen on ultrasonography is the:
a. Double-bubble sign
b. Coiled spring sign
c. Stierlin sign
d. Target sign

Answer 15

d. Target sign
Rationale: The target sign (also called donut sign) is seen in transverse ultrasound images of intussusception, representing the layers of the invaginated bowel.

Question 16

The most common site of gastrointestinal tuberculosis is the:
a. Sigmoid colon
b. Stomach
c. Ileocecal segment
d. Duodenum

Answer 16

c. Ileocecal segment
Rationale: Ileocecal TB is the most common form of abdominal TB, presenting with wall thickening, strictures, and caseating granulomas.

Question 17

Marked distention of a loop of large bowel with its long axis extending from the right lower quadrant to the epigastrium or left upper quadrant, showing a kidney-shaped configuration, suggests:
a. Malrotation
b. Sigmoid volvulus
c. Cecal volvulus
d. Intussusception

Answer 17

c. Cecal volvulus
Rationale: Cecal volvulus presents with a coffee bean or kidney-shaped mass in the mid-upper abdomen due to torsion of the cecum.

Question 18

The characteristic radiographic feature of diffuse esophageal spasm on barium swallow is:
a. Foreshortening and stricturing of the distal esophagus
b. Rat-tail deformity of the distal esophagus
c. Corkscrew appearance of the esophagus
d. Multiple outpouchings or pseudodiverticula

Answer 18

c. Corkscrew appearance of the esophagus
Rationale: The corkscrew esophagus results from simultaneous, uncoordinated contractions in diffuse esophageal spasm (DES), causing a characteristic multiple indentations appearance on barium swallow.

Question 19

A precursor to appendiceal perforation, characterized by focal wall non-enhancement on CT scan representing necrosis, is:
a. Gangrenous appendicitis
b. Acute appendicitis
c. Diverticulitis
d. Ulcerative colitis

Answer 19

a. Gangrenous appendicitis
Rationale: Gangrenous appendicitis occurs when ischemia leads to necrosis and perforation. It presents as wall thickening with focal non-enhancement on CT.

Question 20

An adult male presents to the ER with sudden onset of nausea, vomiting, and abdominal pain.
Abdominal CT scan shows a characteristic coffee-bean morphology of the dilated large bowel pointing to the left iliac fossa. These findings are consistent with:
a. Sigmoid volvulus
b. Cecal volvulus
c. Colorectal carcinoma
d. Tuberculosis

Answer 20

a. Sigmoid volvulus
Rationale: Sigmoid volvulus presents as a coffee bean sign (large, dilated sigmoid loop), often pointing toward the left upper quadrant. It is common in elderly and constipated patients.

Question 21

All of the following are CT scan findings of acute appendicitis, EXCEPT:
a. Wall enhancement and thickening of more than 3 mm
b. Mural hyperemia with color flow Doppler
c. Cecal bar sign
d. Appendiceal dilatation of more than 6 mm in diameter

Answer 21

b. Mural hyperemia with color flow Doppler
Rationale: Mural hyperemia with color flow Doppler is a feature of ultrasound, not CT. CT findings of acute appendicitis include:

Appendiceal dilatation >6 mm
Wall thickening and enhancement
Periappendiceal fat stranding
Appendicolith (in some cases)

Question 22

A radiographic sign of a malignant gastric ulcer is:
a. Kirklin meniscus complex
b. Ulcer collar
c. Telltale triangle sign
d. Hampton’s line

Answer 22

a. Kirklin meniscus complex
Rationale:
The Kirklin Meniscus Complex is a radiographic finding of gastric malignancy, where a shallow ulcer projects convexly inward into the lumen without extending beyond the gastric wall.

Other radiographic features of malignant gastric ulcers include:

Carmen Meniscus Sign (concave meniscus-shaped lesion due to malignancy)
Irregular ulcer crater with nodular margins
Abrupt transition between normal and abnormal mucosa
Ulcer located eccentrically within the tumor mass
Lack of distensibility and rigidity of the gastric wall
This differentiates malignant ulcers from benign gastric ulcers, which usually have smooth, round craters with Hampton’s line (a thin radiolucent band at the ulcer base indicating mucosal integrity).

Benign = Hampton’s line
Malignant = Kirklin meniscus complex

Question 23

The radiographic sign of sigmoid volvulus that shows three dense lines of the sigmoid wall converging towards the site of obstruction is:
a. Northern exposure sign
b. Frimann-Dahl sign
c. Liver overlap sign
d. Coffee bean sign

Answer 23

b. Frimann-Dahl sign
Rationale: Frimann-Dahl sign is seen in sigmoid volvulus, where the three converging lines represent the folded, distended sigmoid colon at the obstruction point.

Question 24

The classic feature of a benign gastric ulcer on an upper GI barium study, which represents an edematous rim of undermined mucosa surrounding the ulcer crater, producing a wide radiolucent band, is:
a. Carman-Kirklin meniscus complex
b. Hampton’s line
c. Ulcer collar
d. Ulcer mound

Answer 24

b. Hampton’s line
Rationale: Hampton’s line is seen in benign gastric ulcers, where a thin radiolucent line represents intact mucosa at the ulcer base.

Question 25

A 45-year-old female diagnosed with breast carcinoma, presenting with right upper quadrant pain and elevated serum AFP and liver enzymes, requires imaging to evaluate the liver. The most appropriate primary imaging method of choice is: a. Abdominal ultrasound b. Contrast-enhanced CT scan c. MRI d. Positron Emission Tomography (PET) scan

Answer 25

b. Contrast-enhanced CT scan Rationale: Contrast-enhanced CT is the preferred modality for liver metastases, providing detailed vascular and structural information. MRI may be used if further characterization is needed.

Question 26

Nuclear scintigraphy of the liver is primarily indicated for: a. Cavernous hemangioma b. Cholangiocarcinoma c. Hepatocellular carcinoma d. Multiple hepatic metastases

Answer 26

a. Cavernous hemangioma Rationale: Technetium-99m-labeled red blood cell scintigraphy is used for diagnosing cavernous hemangiomas, as they show delayed blood pool enhancement due to their vascular nature. Hepatocellular carcinoma (HCC) and cholangiocarcinoma are better evaluated with contrast-enhanced CT or MRI.

Question 27

A 15-year-old female presents with one day of right upper quadrant abdominal pain, direct tenderness in the upper abdomen, and vomiting of greenish-brown fluid. What will be the initial imaging test you will request? a. CT scan of the abdomen b. Endoscopy c. Ultrasound of the abdomen d. X-ray of the abdomen in supine and upright views

Answer 27

c. Ultrasound of the abdomen Rationale: Ultrasound is the first-line imaging for right upper quadrant pain, especially in gallbladder disease (e.g., cholecystitis, gallstones). CT scan is reserved for complications or uncertain diagnoses.

Question 28

Hepatomegaly is suspected on ultrasound based on which finding? a. Increased parenchymal echogenicity greater than the right kidney b. Extension of the right lobe border below the kidney c. Markedly sharpened inferior border of the right lobe d. Liver length less than 15.5 cm

Answer 28

b. Extension of the right lobe border below the kidney Rationale: Hepatomegaly is typically evaluated subjectively on imaging. The key ultrasound findings include: Rounding of the inferior liver border Extension of the right hepatic lobe below the right kidney Liver length >15.5 cm at the midclavicular line

Question 29

A 63-year-old male diagnosed with Hodgkin lymphoma undergoes imaging of the liver after 9 cycles of chemotherapy. The expected finding is: a. Contracted liver contour b. Displacement of intrahepatic blood vessels c. Increased parenchymal echogenicity on ultrasound d. Liver appears more dense than the spleen on non-enhanced CT

Answer 29

c. Increased parenchymal echogenicity on ultrasound Rationale: Chemotherapy-induced hepatotoxicity, including steatosis or sinusoidal obstruction syndrome, causes increased echogenicity on ultrasound. Liver density changes on CT depend on the specific condition.

Question 30

A patient with carcinoma of the liver complains of upper abdominal pain and swelling of the lower extremities. Hepatic vein thrombosis is suspected. Which characteristic finding is expected on contrast-enhanced CT scan of the abdomen? a. Innumerable regenerative nodules replacing normal liver parenchyma b. Marked coronary, gastroesophageal, splenorenal, and paraumbilical collateral vessels c. Prominent central liver enhancement in early scan images d. Progressive vascular fibrosis from chronic liver disease

Answer 30

c. Prominent central liver enhancement in early scan images Rationale: Budd-Chiari syndrome (hepatic vein thrombosis) shows centrilobular enhancement in early phases due to blood stasis and congestion, with later hypoattenuation due to ischemia.

Question 31

A hepatic cyst is best characterized by which imaging modality? a. CT scan b. Nuclear scintigraphy c. Ultrasound d. X-ray

Answer 31

c. Ultrasound Rationale: Ultrasound is the most effective modality for characterizing simple hepatic cysts, showing a well-defined, anechoic lesion with posterior acoustic enhancement.

Question 32

A routine abdominal ultrasound of a 29-year-old female with early pregnancy reveals a round, well-defined, homogeneous hyperechoic lesion in the right lobe of the liver. The primary consideration is: a. Cavernous hemangioma b. Hepatocellular carcinoma c. Metastasis d. Hepatic cyst

Answer 32

a. Cavernous hemangioma Rationale: Cavernous hemangiomas are the most common benign liver tumors and appear as homogeneous hyperechoic lesions on ultrasound. Hepatic cysts are anechoic, and HCC or metastases usually show mixed echogenicity.

Question 33

A contrast-enhanced CT scan of the abdomen reveals a sharply defined, water-density lesion in the left hepatic lobe, with no perceptible wall and no contrast enhancement. The primary consideration is: a. Cavernous hemangioma b. Primary hepatocellular carcinoma c. Metastasis from pancreatic carcinoma d. Hepatic cyst

Answer 33

d. Hepatic cyst Rationale: Hepatic cysts are well-defined, fluid-filled lesions that appear hypodense (water-density), non-enhancing, and thin-walled on contrast-enhanced CT.

Question 34

A solitary, peripherally located abscess in the right hepatic lobe is most likely: a. Amoebic b. Echinococcal c. Fungal d. Pyogenic

Answer 34

a. Amoebic Rationale: Amoebic liver abscesses are typically solitary and located in the right lobe due to hematogenous spread from the portal circulation.

Question 35

On routine CT scan, a hepatic adenoma was confirmed in the right lobe of the liver. The attending physician should request periodic monitoring because of: a. Risk of hemorrhage b. Prone to secondary infection c. Tendency to produce portal vein thrombosis d. Possibility of spontaneous resolution

Answer 35

a. Risk of hemorrhage Rationale: Hepatic adenomas are prone to rupture and hemorrhage, especially in hormonal stimulation (e.g., pregnancy, oral contraceptives).

Question 36

A 45-year-old male, alcoholic, with severe cachexia and globular abdomen, underwent imaging of the liver. The findings will most likely reveal: a. Angulated geometric boundaries of the lesion b. Innumerable regenerative nodules replacing normal hepatic parenchyma c. Liver appearing less dense than the spleen on non-contrast CT d. Diminished echogenicity adjacent to the gallbladder fossa

Answer 36

b. Innumerable regenerative nodules replacing normal hepatic parenchyma Rationale: Cirrhosis results in multiple regenerative nodules, which disrupt normal hepatic architecture.

Question 37

The most common risk factor for hepatocellular carcinoma in Asia is: a. Alcoholic cirrhosis b. Glycogen storage disease c. Hepatic steatosis d. Hepatitis B infection

Answer 37

d. Hepatitis B infection Rationale: Hepatitis B is highly endemic in Asia and a major cause of hepatocellular carcinoma (HCC) due to chronic liver damage and cirrhosis.

Question 38

On a triple-phase CT scan of the liver, which of the following findings is a classic feature that is almost equivalent to a histopathologic diagnosis of hepatocellular carcinoma? a. Edema in the mesentery, omentum, and peritoneum with splenomegaly and ascites b. Prominent central enhancement and weak peripheral enhancement c. Rapid washout during the portal venous phase d. Solitary, well-circumscribed mass with a central stellate scar

Answer 38

c. Rapid washout during the portal venous phase Rationale: Hepatocellular carcinoma (HCC) shows arterial phase enhancement with rapid washout in the portal venous phase, a nearly diagnostic imaging feature.

Question 39

Which of the following statements is true regarding liver trauma? a. Best evaluated by supine and upright abdominal radiographs b. Commonly affects the posterior segment of the right lobe c. Manifests as increased echogenicity surrounding the liver on ultrasound d. Most commonly injured intra-abdominal organ due to blunt abdominal trauma

Answer 39

b. Commonly affects the posterior segment of the right lobe

Question 40

A 50-year-old female, hypersthenic, with right upper quadrant pain precipitated by intake of fatty food, undergoes imaging. What is the most likely finding? a. Air in the biliary tract on radiographs b. Echogenic shadowing foci in the gallbladder on ultrasound c. Hypodense lesions in the liver on CT scan d. Increased tracer uptake of the gallbladder on nuclear scintigraphy

Answer 40

b. Echogenic shadowing foci in the gallbladder on ultrasound Rationale: Gallstones appear as echogenic foci with acoustic shadowing, especially in patients with biliary colic triggered by fatty food.

Question 41

A 45-year-old male with jaundice, abdominal pain, and a suspected mass on ultrasound undergoes MRCP. The finding of abrupt termination of the extrahepatic common bile duct is most likely due to: a. Cholecystolithiasis b. Klatskin tumor c. Mirizzi syndrome d. Pancreatic head carcinoma

Answer 41

d. Pancreatic head carcinoma Rationale: Pancreatic head tumors cause biliary obstruction, seen as abrupt narrowing or cutoff on MRCP.

Question 42

An irregular filling defect demonstrated on ERCP, located at the junction of the right and left hepatic ducts, is most likely due to: a. Cholangiocarcinoma b. Inspissated bile sludge c. Intrahepatic biliary calculi d. Mirizzi syndrome

Answer 42

a. Cholangiocarcinoma Rationale: Klatskin tumors (hilar cholangiocarcinoma) cause irregular filling defects at the biliary confluence.

Question 43

A 44-year-old male, alcoholic, with a history of severe epigastric pain and elevated serum amylase, undergoes CT scan showing an encapsulated collection of fluid and debris in the area of the pancreatic body and tail. The most likely diagnosis is: a. Pancreatic carcinoma b. Phlegmon c. Portal and splenic vein thrombosis d. Pseudocyst

Answer 43

d. Pseudocyst Rationale: Pancreatic pseudocysts form as complications of pancreatitis, presenting as fluid collections with debris and a well-defined wall.

Question 44

An oncologic surgeon decides to cancel a planned surgery for a patient with diagnosed pancreatic adenocarcinoma, despite the family insisting on proceeding. The most important reason for the cancellation of surgery is a CT finding of: a. Extension to the duodenum b. Lung metastasis c. Tumor necrosis d. Vascular encasement

Answer 44

d. Vascular encasement Rationale: Vascular invasion of the superior mesenteric artery or celiac trunk makes pancreatic adenocarcinoma unresectable, thus contraindicating surgery.