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Make a list of 30 questions on GIT radiology viva for exam going md exam with short answer

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I have enough information from the textbook to compile a comprehensive, high-yield viva Q&A list. Let me now produce the full 30-question set.

30 High-Yield GIT Radiology Viva Questions (MD Exam)

Plain Abdominal Radiograph (AXR)

1. What are the indications for a plain abdominal X-ray (AXR) in the acute abdomen? Suspected viscus perforation, bowel obstruction, assessment of bowel wall pattern (ischaemia/colitis), and detection of intra-abdominal foreign bodies. — Grainger & Allison's Diagnostic Radiology
2. How do you differentiate small bowel from large bowel on a plain AXR?
  • Small bowel: centrally located, multiple loops, thin and frequent valvulae conniventes (cross the full width of the lumen), calibre <3 cm
  • Large bowel: peripheral, haustral folds (partial, do not cross full width), calibre >6 cm (>9 cm caecum)
3. What is Rigler's sign (double wall sign)? On a supine AXR, gas on both sides of the bowel wall makes the wall visible. Normally only the inner (mucosal) surface is seen because gas must be outside the bowel (pneumoperitoneum) to outline the outer wall. It is diagnostic of pneumoperitoneum. — Grainger & Allison's Diagnostic Radiology
4. What are the radiological signs of pneumoperitoneum on a supine AXR?
  • Rigler's (double wall) sign
  • Right upper quadrant gas (perihepatic, subhepatic, Morrison's pouch)
  • Fissure for ligamentum teres
  • Gas outlining falciform ligament
  • Cupola sign (gas collecting under the central diaphragm)
  • Football sign (large pneumoperitoneum in neonates)
5. What conditions can simulate pneumoperitoneum (pseudo-pneumoperitoneum)?
  • Chilaiditi syndrome (colon interposed between liver and diaphragm)
  • Subphrenic abscess
  • Curvilinear atelectasis
  • Diaphragmatic irregularity/multiple humps
  • Subdiaphragmatic fat
  • Cysts in pneumatosis intestinalis — Grainger & Allison's Diagnostic Radiology
6. What percentage of perforated peptic ulcers show free gas on erect CXR, and where is it best seen? Approximately 70% of perforated peptic ulcers show free gas. It is best seen under the right hemidiaphragm on an erect CXR, which outlines the smooth surface of the liver clearly.
7. What is pneumatosis intestinalis, and what is its significance? Gas within the bowel wall (intramural gas). It may be benign (e.g., pneumatosis coli associated with COPD) or life-threatening (bowel ischaemia/infarction). In the context of ischaemia, it is associated with portal venous gas and carries a high mortality. Clinical correlation with serum lactate and CRP is essential. — Grainger & Allison's Diagnostic Radiology
8. How do you distinguish portal venous gas from pneumobilia on AXR/CT?
  • Portal venous gas: peripherally located in small vessels at the liver edge
  • Pneumobilia: centrally located, branching pattern, more prominent centrally On CT, this distinction is reliable; on plain AXR it can be difficult.

Small Bowel Obstruction (SBO)

9. What are the plain radiograph findings in small bowel obstruction (SBO)?
  • Dilated central loops of small bowel (>3 cm) with valvulae conniventes
  • Air-fluid levels on erect AXR (step-ladder pattern)
  • String of beads sign (gas bubbles trapped between valvulae in fluid-filled loops — virtually diagnostic of SBO)
  • Paucity of gas in the large bowel
  • Sensitivity of plain AXR for SBO is approximately 66%
10. What is the 'string of beads' sign? A line of small gas bubbles trapped between valvulae conniventes in an almost completely fluid-filled, grossly dilated small bowel. It is virtually diagnostic of small bowel obstruction. — Grainger & Allison's Diagnostic Radiology
11. What is gallstone ileus, and what is the classic radiological triad (Rigler's triad)? Gallstone ileus is SBO caused by a large gallstone (usually 2–3 cm) that erodes through the gallbladder wall into the duodenum, bypassing the bile duct, and impacts in the terminal ileum. Rigler's triad:
  1. Small bowel obstruction
  2. Pneumobilia (gas in the biliary tree)
  3. Ectopic calcified gallstone (seen in ~1/3 of cases) Accounts for ~2% of SBO cases.

Large Bowel Obstruction (LBO)

12. What are the radiological findings of large bowel obstruction?
  • Dilatation of colon proximal to the obstruction (haustral pattern visible)
  • Caecal diameter >9 cm is a critical threshold (risk of perforation)
  • Cut-off point at the level of obstruction
  • Competent ileocaecal valve causes closed-loop obstruction with gross caecal dilatation
13. What is sigmoid volvulus, and what are its radiological features? Sigmoid volvulus is twisting of the sigmoid colon on its mesenteric axis causing closed-loop obstruction.
  • Plain AXR: "coffee bean" or "bent inner tube" sign — a massively dilated ahaustral sigmoid loop bent on itself, pointing toward the right upper quadrant
  • Barium enema/CT: "bird's beak" / "ace of spades" deformity at the level of the twist
14. What is caecal volvulus, and how does it differ radiologically from sigmoid volvulus? Caecal volvulus: the caecum rotates and may appear in the mid-abdomen or left upper quadrant as a kidney-shaped gas shadow. The distal colon and rectum are collapsed. Unlike sigmoid volvulus, the apex points toward the left upper quadrant. Less common than sigmoid volvulus.

Contrast Studies

15. What are the indications and contraindications of a barium swallow? Indications: dysphagia, suspected oesophageal perforation (use water-soluble contrast first), motility disorders, hiatus hernia, strictures, achalasia Contraindications: suspected perforation (barium is contraindicated — use water-soluble Gastrografin); tracheo-oesophageal fistula (use non-ionic water-soluble contrast)
16. What is the 'rat tail' appearance on barium swallow, and what causes it? A smooth, tapered narrowing of the distal oesophagus resembling a rat's tail. It is the classic appearance of achalasia, caused by failure of relaxation of the lower oesophageal sphincter with proximal dilatation. Carcinoma of the oesophagus produces an irregular, shouldered (shouldering) stricture — not smooth.
17. What is the difference between a 'shouldered' vs. 'tapering' stricture on barium swallow?
  • Shouldered / shelf-like / apple core: abrupt transition, irregular mucosa — suggests malignancy
  • Smooth tapering: gradual transition, intact mucosa — suggests benign stricture (peptic, Schatzki ring) or achalasia
18. What is a barium meal (upper GI series), and what conditions does it diagnose? Fluoroscopic study with barium to examine the oesophagus, stomach, and duodenum. It diagnoses peptic ulcer disease, gastric carcinoma, pyloric stenosis, hiatal hernia, and motility disorders. A double-contrast technique (barium + gas) gives better mucosal detail.
19. What are the radiological features of a benign vs. malignant gastric ulcer on barium meal?
FeatureBenignMalignant
ProjectionProjects beyond gastric wallWithin gastric lumen
MarginsSmooth, regularIrregular, nodular
Mucosal foldsRadiate to ulcer edgeAmputated, clubbed folds
ShapeRound/ovalIrregular
Hampton's linePresent (1–2 mm line across ulcer neck)Absent
20. What is small bowel follow-through (SBFT) / enteroclysis, and what does it assess?
  • SBFT: patient drinks barium, serial images taken to follow transit through small bowel
  • Enteroclysis (small bowel enema): barium introduced via nasojejunal tube — superior mucosal detail Both assess Crohn's disease, small bowel tumours, malabsorption, obstruction.
21. What is the 'string sign of Kantor' on SBFT? A thin, thread-like band of contrast in the terminal ileum caused by severe spasm and mucosal thickening in Crohn's disease. Represents tight luminal narrowing from chronic transmural inflammation.
22. What are the radiological features of Crohn's disease on barium studies?
  • Cobblestone mucosa (transverse and longitudinal ulcers with intact mucosa between)
  • Fistulae and sinus tracts
  • Skip lesions
  • String sign (tight stricture)
  • Rose-thorn ulcers (deep fissuring ulcers)
  • Thumbprinting (less common than in ischaemic colitis)
23. What is a barium enema, and what are its indications? Fluoroscopic study of the colon via rectal instillation of barium. Indications: change in bowel habit, suspected colonic carcinoma, diverticular disease, colitis, strictures, fistulae, and reduction of intussusception (air enema now preferred). Largely replaced by CT colonography and colonoscopy.
24. What is the 'apple core' sign on barium enema? An annular ("apple core") stricture with irregular, shouldered edges and mucosal destruction. It is the classic appearance of carcinoma of the colon, most commonly in the sigmoid or descending colon.
25. What is thumbprinting on AXR/barium enema, and what does it indicate? Smooth, rounded indentations on the colonic wall resembling a thumb print caused by submucosal oedema, haemorrhage, or tumour infiltration. Classic causes:
  • Ischaemic colitis (most classic)
  • Acute severe ulcerative colitis
  • Lymphoma
  • Hereditary angio-oedema

CT & Ultrasound of the GIT

26. What are the CT features of acute appendicitis?
  • Appendix diameter >6 mm with wall thickening (>2 mm)
  • Periappendiceal fat stranding
  • Appendicolith (calcified faecolith in ~25–30%)
  • Peri-appendiceal fluid
  • "Target sign" (thickened wall with enhancement)
  • Perforation: free gas, abscess
27. What is the CT 'whirl sign' and 'beak sign', and in what condition are they seen? Both are seen in intestinal volvulus/closed-loop obstruction:
  • Whirl sign: spiralling of mesentery, bowel, and vessels around a fixed point — indicates torsion
  • Beak sign: tapered narrowing of bowel at the point of torsion resembling a bird's beak
28. What are the ultrasound features of intussusception?
  • "Target" or "doughnut" sign on transverse view: outer hypoechoic ring (oedematous bowel) surrounding an echogenic centre (intussuscepted bowel)
  • "Pseudokidney" sign on longitudinal view: the intussusceptum within the intussuscipiens resembles a kidney Ultrasound is the investigation of choice in paediatric intussusception; sensitivity >97%.
29. What is the role of CT in gastrointestinal haemorrhage? CT angiography (CTA) detects active bleeding at rates as low as 0.3–0.5 mL/min (vs. 0.5–1 mL/min for conventional angiography and 1 mL/min for nuclear scintigraphy). CT shows:
  • Hyperattenuating blush of contrast within the lumen indicating active bleeding
  • Can identify the source (e.g., diverticulum, angiodysplasia, tumour)
  • Guides surgical or interventional management
30. What is MRCP, and what are its advantages over ERCP in biliary imaging? Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive MRI technique using heavily T2-weighted sequences to visualise bile ducts and pancreatic ducts. Advantages over ERCP:
  • Non-invasive (no contrast injection, no radiation)
  • No risk of pancreatitis, cholangitis, or perforation
  • Can visualise ducts proximal to a complete obstruction
  • Overall accuracy >90% for choledocholithiasis Limitation: purely diagnostic (no therapeutic capability); ERCP remains the gold standard for therapeutic intervention (stone extraction, stenting).
Sources: Grainger & Allison's Diagnostic Radiology, Sleisenger & Fordtran's Gastrointestinal and Liver Disease, Yamada's Textbook of Gastroenterology
These 30 questions cover the core themes examiners target in GIT radiology vivas: plain film interpretation, contrast studies (barium), CT/US findings, and classic radiological signs. Good luck with your MD exam!

CT also involve

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I now have comprehensive textbook content to compile an expanded CT-focused GIT radiology viva list. Here it is:

30 GIT Radiology Viva Questions — With Full CT Coverage (MD Exam)

SECTION A: Plain Abdominal X-Ray (AXR) — 8 Questions

1. What are the indications for a plain AXR in the acute abdomen? Suspected viscus perforation, bowel obstruction, assessment of bowel wall pattern (ischaemia/colitis), and intra-abdominal foreign body detection. — Grainger & Allison's Diagnostic Radiology
2. How do you differentiate small bowel from large bowel on AXR?
FeatureSmall BowelLarge Bowel
PositionCentralPeripheral
FoldsValvulae conniventes (complete, frequent)Haustra (partial, sparse)
Calibre<3 cm>6 cm (caecum >9 cm)
3. What is Rigler's sign (double wall sign)? Gas on both sides of the bowel wall makes the wall visible on a supine AXR. This indicates pneumoperitoneum — free extraluminal gas outlines the outer bowel wall.
4. List the signs of pneumoperitoneum on a supine AXR.
  • Rigler's sign (double wall sign)
  • Cupola sign (gas under central diaphragm)
  • Gas outlining falciform ligament
  • Right upper quadrant gas (perihepatic, subhepatic, Morrison's pouch)
  • Football sign (neonates — large pneumoperitoneum) — Grainger & Allison's Diagnostic Radiology
5. What is the 'string of beads' sign on AXR and what does it indicate? Small gas bubbles trapped between valvulae conniventes in a nearly fluid-filled, grossly dilated small bowel loop. It is virtually diagnostic of small bowel obstruction (SBO).
6. What is gallstone ileus and what is Rigler's triad? SBO caused by a large gallstone (2–3 cm) eroding through the gallbladder wall into the duodenum and impacting in the terminal ileum. Rigler's triad:
  1. SBO on AXR
  2. Pneumobilia (gas in biliary tree)
  3. Ectopic calcified gallstone (visible in ~1/3 of cases)
7. What is the 'coffee bean sign' and in which condition is it seen? Massively dilated, ahaustral sigmoid loop folded on itself pointing toward the right upper quadrant on AXR — classic for sigmoid volvulus. The two limbs of the loop form the two halves of the "coffee bean."
8. How do you distinguish portal venous gas from pneumobilia on AXR?
  • Portal venous gas: peripheral, in small branches at the liver edge
  • Pneumobilia: central, branching toward the hilum CT distinguishes these reliably; on plain AXR the distinction can be difficult.

SECTION B: CT of the GIT — 12 Questions (Core Focus)

9. What are the CT features of acute appendicitis?
  • Appendix diameter >6 mm with wall thickening (>2 mm)
  • Periappendiceal fat stranding
  • Appendicolith (calcified faecolith in ~25–30% of cases)
  • Periappendiceal fluid
  • Enhancing, thickened wall ("target sign")
  • Perforation: free gas, phlegmon, abscess — Rosen's Emergency Medicine; Mulholland & Greenfield's Surgery
10. What are the CT features of acute diverticulitis and how is it graded? CT findings:
  • Colonic wall thickening (usually sigmoid)
  • Pericolic fat stranding
  • Diverticulae
  • Pericolic fluid, abscess, fistula, or free gas in complicated disease
Modified Hinchey Classification (CT-based):
StageCT FindingsTreatment
IPericolic abscessAntibiotics ± drainage
IIDistant/pelvic abscessPercutaneous drainage
IIIPurulent peritonitisSurgery
IVFaecal peritonitisEmergency surgery
— Mulholland & Greenfield's Surgery
11. What are the CT signs of acute mesenteric ischaemia?
  • Bowel wall thickening / mucosal hyperenhancement (early)
  • Bowel wall hypoenhancement or non-enhancement (late/transmural infarction)
  • Pneumatosis intestinalis (intramural gas)
  • Portal venous gas — ominous sign indicating transmural infarction
  • Mesenteric fat stranding
  • Mesenteric arterial or venous thrombosis (SMA/SMV occlusion visible on CTA)
CT angiography (CTA) is the investigation of choice for acute mesenteric ischaemia. — Yamada's Textbook of Gastroenterology; Current Surgical Therapy
12. What is the 'whirl sign' on CT and in which conditions is it seen? Spiralling/twisting of mesentery, vessels, and bowel around a fixed pivot point — seen in intestinal volvulus and closed-loop obstruction. In sigmoid volvulus, the whirl is at the pelvic brim; in caecal volvulus, it is in the right lower quadrant. — Grainger & Allison's Diagnostic Radiology
13. What CT findings differentiate SBO from paralytic ileus?
FeatureSBOParalytic Ileus
Transition pointPresentAbsent
Bowel dilatationSmall bowel (with decompressed colon)Diffuse (small + large bowel)
CauseMechanical (hernia, adhesion, tumour)Post-op, sepsis, electrolyte disturbance
PeristalsisIncreased (early), absent (late)Absent throughout
CT with IV contrast is now the investigation of choice for SBO — sensitivity ~94%, superior to plain AXR (66%).
14. What is CT colonography (CTC / virtual colonoscopy)? Helical CT scanning of the colon (with air/CO₂ insufflation) producing 2D and 3D endoluminal images.
  • Sensitivity for polyps ≥10 mm: 90–92%; for 6–9 mm: 78%
  • Poor sensitivity for polyps <5 mm
  • No sedation required; cannot biopsy or remove polyps
  • Can detect extracolonic pathology simultaneously
  • Indicated for: failed/incomplete colonoscopy, anticoagulated patients, CRC screening — Sleisenger & Fordtran's GI and Liver Disease
15. How is CT used to stage oesophageal cancer? CT of thorax, abdomen, and pelvis (with IV contrast; arterial + portal venous phases for upper abdomen):
  • Assesses T stage (wall thickening, invasion of adjacent structures — aorta, trachea)
  • Assesses N stage (regional lymph nodes; nodes >10 mm in short axis are suspicious)
  • Assesses M stage (liver, lung, adrenal, peritoneal metastases)
  • FDG PET-CT is the standard of care if radical treatment is planned — superior for detecting unsuspected metastatic disease
  • EUS is superior to CT for T and N staging (delineates 5 wall layers) — Grainger & Allison's Diagnostic Radiology
16. What are the CT criteria for T staging of gastric cancer? Based on 8th edition TNM:
T StageCT Appearance
T1Tumour confined to mucosa/submucosa; trilaminar wall pattern preserved
T2Tumour into muscularis propria; wall thickening, no outer margin breach
T3Tumour through muscularis propria into subserosa; perigastric fat stranding
T4aTumour perforates serosa; irregular outer margin
T4bTumour invades adjacent organs; loss of fat planes
CT findings: focal wall thickening ≥6 mm, loss of trilaminar appearance, abnormal enhancement. — Grainger & Allison's Diagnostic Radiology
17. What is linitis plastica and what are its CT features? Diffuse infiltrating gastric adenocarcinoma involving the entire stomach wall (signet-ring cell carcinoma most common histology). CT shows: diffuse wall thickening of the entire stomach with marked luminal narrowing ("leather bottle" stomach), loss of normal layers, reduced distensibility on both supine and prone views. Poor prognosis.
18. What are the CT features of acute pancreatitis, and what is the Balthazar CT Severity Index (CTSI)? CT features: pancreatic enlargement, peripancreatic fat stranding, fluid collections, and areas of non-enhancement (necrosis).
Balthazar Grading (pancreatic appearance):
GradeCT AppearancePoints
ANormal pancreas0
BFocal/diffuse enlargement1
CPeripancreatic inflammation2
DSingle fluid collection3
ETwo or more fluid collections4
Necrosis score (added to grade): 0% = 0 pts; <30% = 2 pts; 30–50% = 4 pts; >50% = 6 pts. CTSI = Balthazar grade + necrosis score (max 10). Score ≥7 → mortality ~17%. IV contrast is mandatory to assess necrosis (non-enhancing areas). — Yamada's Textbook of Gastroenterology
19. How does CT differentiate a pancreatic pseudocyst from walled-off necrosis?
FeaturePseudocystWalled-off Necrosis (WON)
Arises fromAcute oedematous pancreatitisNecrotising pancreatitis
ContentsHomogeneous fluid densityHeterogeneous — fluid + solid necrotic debris
WallWell-defined, enhancingWell-defined, enhancing
Timing>4 weeks>4 weeks
TreatmentUsually conservative/endoscopic drainageOften requires debridement (VARD/NOTES)
— Yamada's Textbook of Gastroenterology
20. What is the role of CT in GIT haemorrhage? CT angiography (CTA) detects active bleeding at rates as low as 0.3–0.5 mL/min:
  • Shows contrast blush (hyperattenuating extravasation of contrast into the lumen)
  • Identifies the source: diverticulum, angiodysplasia, tumour, Dieulafoy's lesion
  • Superior to nuclear scintigraphy (detects ≥1 mL/min) and conventional angiography (≥0.5 mL/min)
  • Guides surgical or angiographic (embolisation) intervention

SECTION C: Contrast Studies (Barium) — 7 Questions

21. What are the radiological differences between a benign and malignant gastric ulcer on barium meal?
FeatureBenignMalignant
ProjectionProjects beyond gastric wallWithin gastric lumen
MarginsSmooth, regularIrregular, nodular
Mucosal foldsRadiate to ulcer marginAmputated / clubbed
Hampton's linePresentAbsent
ShapeRound / ovalIrregular
22. What is the 'rat tail' appearance on barium swallow? Smooth, tapering narrowing of the distal oesophagus with proximal dilatation — classic for achalasia (failure of LOS relaxation). Contrast: malignant oesophageal stricture shows an irregular, shouldered ("apple core") narrowing.
23. What is the 'string sign of Kantor' and what does it represent? A thin thread of barium through the terminal ileum on SBFT or enteroclysis — represents severe luminal narrowing from chronic transmural inflammation, fibrosis, and spasm in Crohn's disease.
24. What is the 'apple core' lesion on barium enema? Annular, irregular stricture with mucosal destruction and shouldered edges — classic appearance of carcinoma of the colon (most often sigmoid or descending colon).
25. What is thumbprinting on AXR/barium enema and what does it indicate? Smooth scalloped indentations on the colonic wall from submucosal oedema or haemorrhage. Causes: ischaemic colitis (most classic), severe ulcerative colitis, lymphoma, hereditary angio-oedema.
26. What are barium study features of ulcerative colitis vs. Crohn's disease?
FeatureUlcerative ColitisCrohn's Disease
DistributionContinuous, rectum upwardDiscontinuous (skip lesions)
Bowel affectedColon onlyAny part of GIT
UlcersSuperficial, collar-studDeep, rose-thorn, fissuring
MucosaLead-pipe colon (chronic)Cobblestone
FistulaeRareCommon
StricturesRareCommon
27. What are the radiological features of intussusception and what is the role of imaging?
  • Ultrasound (investigation of choice in children): "doughnut/target sign" on transverse view; "pseudokidney sign" on longitudinal view — sensitivity >97%
  • Barium/air enema: "coiled spring" sign; also therapeutic (hydrostatic/pneumatic reduction)
  • CT: target sign; lead point (e.g., Meckel's diverticulum, polyp, lymphoma) identifiable, especially in adults

SECTION D: Ultrasound & Special Topics — 3 Questions

28. What are the ultrasound features of acute cholecystitis relevant to a GIT radiology viva?
  • Gallstones (echogenic foci with posterior acoustic shadowing)
  • Gallbladder wall thickening >3 mm
  • Pericholecystic fluid
  • Sonographic Murphy's sign (tenderness over GB under probe)
  • Dilated CBD >6 mm suggests choledocholithiasis
29. What is MRCP and how does it compare to ERCP? Non-invasive MRI using heavily T2-weighted sequences to image bile ducts and pancreatic ducts.
FeatureMRCPERCP
InvasivenessNon-invasiveInvasive (endoscopic)
RadiationNoneYes
ComplicationsNonePancreatitis, cholangitis, perforation
Sensitivity for CBD stones>90%~95% (gold standard)
Therapeutic capabilityNoneYes (stone removal, stenting, sphincterotomy)
Proximal obstructionCan visualise beyond blockageCannot pass obstruction
30. What is the role of PET-CT in GIT malignancy? FDG PET-CT is standard of care for:
  • Oesophageal cancer: detects unsuspected metastases (superior to CT alone) — mandatory before radical treatment
  • Colorectal cancer: detection of hepatic and extra-hepatic metastases; evaluating treatment response; detecting recurrence (CEA rise with negative CT)
  • Gastric cancer: staging and response assessment Limitation: lesions <1 cm and mucinous tumours may be FDG-negative. — Grainger & Allison's Diagnostic Radiology; Current Surgical Therapy
Key sources: Grainger & Allison's Diagnostic Radiology, Sleisenger & Fordtran's GI and Liver Disease, Yamada's Textbook of Gastroenterology, Mulholland & Greenfield's Surgery
This revised list gives ~40% CT-specific content covering: CT appendicitis, diverticulitis (Hinchey grading), mesenteric ischaemia, volvulus signs, CT colonography, oesophageal/gastric/colorectal staging, pancreatitis CTSI, pseudocyst vs. walled-off necrosis, GI haemorrhage CTA, and PET-CT — all the high-yield CT topics examiners ask in MD vivas.
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