Barium Studies

Barium Studies

Q. 1

Apple core sign in barium enema is seen with?

 A Ileocecal tuberculosis
 B

Carcinoma esophagus

 C Colon carcinoma
 D Achalasia cardia
Q. 1

Apple core sign in barium enema is seen with?

 A Ileocecal tuberculosis
 B

Carcinoma esophagus

 C Colon carcinoma
 D Achalasia cardia
Ans. C

Explanation:

Colon carcinoma REF: Sutton’s Radiology 7th edition volume 1 page 625, Fundamentals of diagnostic radiology William E. Brant, Clyde A. Helms – Page 851, http://radiopaedia.org/articles/apple-core-sign

Apple core sign:

The apple core sign, also known as a napkin ring sign, is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma. The same term has also been used for the circumferential erosion of the femoral neck seen in synovial osteochondromatosis


Q. 2 “Bird of Prey” sign is seen in the radiographic barium examination of:
 A Gastric volvulus
 B Intussusception
 C Sigmoid volvulus
 D Cecal volvulus
Q. 2 “Bird of Prey” sign is seen in the radiographic barium examination of:
 A Gastric volvulus
 B Intussusception
 C Sigmoid volvulus
 D Cecal volvulus
Ans. C

Explanation:

Sigmoid volvulus


Q. 3

On radiography widened duodenal ‘C’ loop with irregular mucosal pattern on upper gastrointestinal barium series is most likely due to:

 A

Duodenal ileus

 B

Chronic pancreatitis

 C

Duodenal ulcer

 D

Carcinoma head of pancreas

Q. 3

On radiography widened duodenal ‘C’ loop with irregular mucosal pattern on upper gastrointestinal barium series is most likely due to:

 A

Duodenal ileus

 B

Chronic pancreatitis

 C

Duodenal ulcer

 D

Carcinoma head of pancreas

Ans. D

Explanation:

Widening of duodenal C loop, inverted 3 sign of Frostburg and rose thorn appearance is seen in carcinoma head of pancreas. The treatment is Whipple’s procedure.

Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5, “ Pancreatic Disease in The Childhood”, In the Book, “Radiology of The Pancreas”, Springer Publications, USA, Page 116


Q. 4

Corkscrew esophagus on barium swallow is seen in which of the following conditions?

 A

Carcinoma esophagus

 B

Scleroderma

 C

Achalasia cardia

 D

Diffuse esophagus spasm

Q. 4

Corkscrew esophagus on barium swallow is seen in which of the following conditions?

 A

Carcinoma esophagus

 B

Scleroderma

 C

Achalasia cardia

 D

Diffuse esophagus spasm

Ans. D

Explanation:

In diffuse esophageal spasm(DES), barium swallow shows that normal sequential peristalsis below the arch of aorta is replaced by uncoordinated simultaneous contractions that produce the appearance of curling or multiple ripples in the wall, sacculations, and pseudodiverticula called the cork screw esophagus.

The classic manometric findings in these patients are characterized by the frequent occurrence of simultaneous waveforms and multi-peaked esophageal contractions, which may be of abnormally high amplitude or long duration.

Ref: Mayo Clinic Internal Medicine Board Review By Amit Ghosh, MD, 9th Edition, Page 235; Cancer of The Upper Gastrointestinal Tract By Mitchell C. Posne, Chapter 27; Schwartz’s Principles of Surgery, 9th Edition, Chapter 25


Q. 5

About Achalasia Cardia:

1. Dysphagia is a presenting symptom
2. The cause is the absence of Auerbach’s plexus
3. Esophagectomy is the treatment
4. Motility improving agents are used in treatment
5. Barium swallow shows irregular filling defects in lower esophagus
 A

1,2,3 False & 4,5 True

 B

1,2,4 True & 3,5 False

 C

2,3,4 True &1,5 False

 D

1,3,5 True & 2,4 False

Q. 5

About Achalasia Cardia:

1. Dysphagia is a presenting symptom
2. The cause is the absence of Auerbach’s plexus
3. Esophagectomy is the treatment
4. Motility improving agents are used in treatment
5. Barium swallow shows irregular filling defects in lower esophagus
 A

1,2,3 False & 4,5 True

 B

1,2,4 True & 3,5 False

 C

2,3,4 True &1,5 False

 D

1,3,5 True & 2,4 False

Ans. B

Explanation:

Achalasia is a rare disease caused by loss of ganglion cells within the esophageal myentric plexus.

Patients mostly presents with dysphagia, regurgitation, chest pain and weight loss.

It is diagnosed by barium swallow and esophageal manometry.

Barium swallow shows a beak like appearence.

Esophageal manometry shows impaired lower esophageal sphincter relaxation and absent peristalsis.

Most common surgical procedure for achalasia is Heller’s myotomy performed in conjunction with partial fundoplication.


Q. 6

In which of the following conditions the lead pipe appearance of the colon on a barium enema is seen ‑

 A

Amoebiasis

 B

Ulcerative colitis

 C

Tuberculosis of the colon

 D

Crohn’s involvement of the colon

Q. 6

In which of the following conditions the lead pipe appearance of the colon on a barium enema is seen ‑

 A

Amoebiasis

 B

Ulcerative colitis

 C

Tuberculosis of the colon

 D

Crohn’s involvement of the colon

Ans. D

Explanation:

Ans. is ‘d’ i.e., Crohn’s involvement of the colon


Q. 7

Diffuse esophageal dilatation on barium swallow is seen in:

 A

Achlasia

 B

Trypanosomiasis

 C

Etidronate therapy

 D

a and b

Q. 7

Diffuse esophageal dilatation on barium swallow is seen in:

 A

Achlasia

 B

Trypanosomiasis

 C

Etidronate therapy

 D

a and b

Ans. D

Explanation:

A i.e. Achlasia; B i.e. Trypanosomiasis

–  In Achlasia & Trypanosomiasis, there is diffuse dilatation of oesophagusQ.

In scleroderma only lower esophagus dialatesQ.

Oral biphosphonates like etidronate are poorly absorbed & have a potential to produce ulceration and reflux.


Q. 8

All of the following are diagnostic barium follow through features of ileocecal tuberculosis EXCEPT

 A

Apple – core appearance

 B

Pulled up contracted cecum

 C

Widening of ileocecal angle

 D

Strictures involving terminal ileum

Q. 8

All of the following are diagnostic barium follow through features of ileocecal tuberculosis EXCEPT

 A

Apple – core appearance

 B

Pulled up contracted cecum

 C

Widening of ileocecal angle

 D

Strictures involving terminal ileum

Ans. A

Explanation:

A i.e. Apple core sign

Apple core sign is seen in carcinoma of colonQ whereas ileocecal tuberculosis presents with stricture of terminal ileum, widening of ileocecal angle and pulled up contracted cecumQ on barium study.


Q. 9

A newborn baby not passed meconium for 48 hours since birth, presents with vomiting and distension of abdomen. The most appropriate investigation for evaluation would be?

 A

Barium enema study

 B

Manometry

 C

Rectal biopsy

 D

Fecal fat estimation

Q. 9

A newborn baby not passed meconium for 48 hours since birth, presents with vomiting and distension of abdomen. The most appropriate investigation for evaluation would be?

 A

Barium enema study

 B

Manometry

 C

Rectal biopsy

 D

Fecal fat estimation

Ans. A

Explanation:

A i.e., Barium enema study

  • Main indications for water soluble contrast barium enema are neonatal low gastrointestinal obstructionQ, suspected post -necrotizing enterocolitis strictures, Hirschsprung’s diseaseQ and after colonic surgery. Colonoscopy has replaced barium enema in inflammatory bowel disease allowing concurrent biopsy & avoiding ionizing radiation.
  • For anorectal malformation, infant is held upside down for 3 – 4 minutes , with a metallic object or coin strapped to the site of anus or metal bougie inserted into the blind anus and a radiograph is taken in inverted position.

The distance between the top end of rectal gas and metal indicator indicates the length of malformed rectum. Sufficient gas may have collected in large intestine, 6 hours after birth, to cast radiographic shadow. But sometimes 24 hours wait is required.

Neonates with delayed passage of meconium beyond first 24 hours of life with abdominal distension & bilious vomiting are indicative of Hirschsprung’s disease. However, it can also present with chronic constipation starting from 1st few weeks of life without fecal soiling in children & adults, in whom per-rectal examination reflects contracted rectal wall and may provide temporary relief from constipation.


Q. 10

On barium swallow the grade IV esophageal varices appear as –

 A

Mucosal folds above the carina

 B

Mucosal folds below the carina

 C

Mucosal folds at the carina

 D

A thick band

Q. 10

On barium swallow the grade IV esophageal varices appear as –

 A

Mucosal folds above the carina

 B

Mucosal folds below the carina

 C

Mucosal folds at the carina

 D

A thick band

Ans. B

Explanation:

Ans is ‘b’ ie Mucosal folds below the carina 


Q. 11

Second swallowing in barium meal studies is found in‑

 A

Pharyngeal pouch

 B

Achalasia cardia

 C

Scleroderma

 D

Reflux esophagitis

Q. 11

Second swallowing in barium meal studies is found in‑

 A

Pharyngeal pouch

 B

Achalasia cardia

 C

Scleroderma

 D

Reflux esophagitis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pharyngeal pouch


Q. 12

Most useful investigation in sliding hernia in female

 A

Fluoroscopy

 B

Barium-meal

 C

Palpation method

 D

Ultrasound

Q. 12

Most useful investigation in sliding hernia in female

 A

Fluoroscopy

 B

Barium-meal

 C

Palpation method

 D

Ultrasound

Ans. B

Explanation:

Ans. is ‘b’ i.e., Barium meal 


Q. 13

Colonic diverticulosis is best diagnosed by

 A

Colonoscopy

 B

Nuclear scan

 C

Barium enema

 D

CT scan

Q. 13

Colonic diverticulosis is best diagnosed by

 A

Colonoscopy

 B

Nuclear scan

 C

Barium enema

 D

CT scan

Ans. C

Explanation:

Ans. is ‘c’ i.e. Barium enema 

“Diverticula are best seen on barium enema. Colonoscopy is a less sensitive means of detecting diverticula.”

CMDT 2007

  • Diverticulosis refers to presence of multiple diverticula
  • Diverticulitis refers to inflammation and infection associated with a diverticulum.

Best investigation for

Diverticulosis – Barium enema

Diverticulitis – CT scan

  • On barium enema diverticulosis shows characteristic ‘saw tooth’ appearance

Q. 14

The area of the colon which is least visualized by barium studies –

 A

Sigmoid

 B

Hepatic flexure

 C

Splenic flexure

 D

Caecum

Q. 14

The area of the colon which is least visualized by barium studies –

 A

Sigmoid

 B

Hepatic flexure

 C

Splenic flexure

 D

Caecum

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sigmoid colon 


Q. 15

In intestinal obstruction, investigations needed are ‑

 A

Barium swallow

 B

Intestinal barium meal

 C

Stomach barium meal

 D

All

Q. 15

In intestinal obstruction, investigations needed are ‑

 A

Barium swallow

 B

Intestinal barium meal

 C

Stomach barium meal

 D

All

Ans. B

Explanation:

Answer is ‘b’ i.e. Intestinal barium meal

  • The diagnosis of intestinal obstruction is suspected in any patient presenting with abdominal pain, vomiting, distension and obstipation.
  • Plain radiographs usually confirm the clinical suspicion and can also define the site of obstruction. Maingot’s 10/e, p 1163 writes that 4 x-ray views of the abdomen are essential in all pts. suspected of intestinal obstruction.

i) upright chest, ii) upright abdomen, iii) supine abdomen & iv) left lateral decubitus view.

whereas Sabiston, Harrison & CSDT write for only 2 views – the erect abdomen & the supine abdomen.

Also know that Bailey 24/e, p 1189 writes that “Erect abdominal films are no longer routinely obtained and the radiological diagnosis is based on a supine abdominal film. An erect film may subsequently be requested when further doubt exists”

  • Other investigations which may be done are:
  • CT scan

– CT is useful in cases in which diagnosis is not readily apparent by plain abdominal film, or if an abdominal tumor or abscess is suspected to be the cause of obstruction.

– CT is helpful in identifying the location and cause of obstruction.

  • Barium studies
  • A barium enema is done if a large bowel obstruction is suspected.
  • Barium studies for small bowel obstructions are

Barium meal follow through (BMFT)

– Enteroclysis (small bowel enema)

– these studies are done in patients in whom a recurring or low-grade mechanical obstruction is suspected.

– these studies are contraindicated in acute obstructions – Bailey 24/e, p 1190

– BMFT & enteroclysis are also contraindicated in large bowel obstruction as barium may get insipissated in the colon.


Q. 16

Which is true about Intusssusception ‑

 A

Common in neonates

 B

Fever always present

 C

Not associated with tumors of intestine

 D

Usually relieved by barium enema

Q. 16

Which is true about Intusssusception ‑

 A

Common in neonates

 B

Fever always present

 C

Not associated with tumors of intestine

 D

Usually relieved by barium enema

Ans. D

Explanation:

Ans. is ‘d’ i.e., Usually relieved by barium enema 


Q. 17

Complete Rx of intussception is indicated by

 A

Free passage of barium in the terminal ileum

 B

Passage of feces and flatus along with barium

 C

Improvement of clinical condition

 D

None

Q. 17

Complete Rx of intussception is indicated by

 A

Free passage of barium in the terminal ileum

 B

Passage of feces and flatus along with barium

 C

Improvement of clinical condition

 D

None

Ans. A

Explanation:

Ans. is ‘a’ i.e., Free passage of barium in the terminal ileum 


Q. 18

A lady presented with non progressive dysphagia only for solids. Barium study showed proximal esophageal dilatation with distal constriction. The most likely diagnosis is.

 A

Peptic Stricture

 B

Carcinoma Esophagus

 C

Achalasia Cardia

 D

Lower Esophageal Ring

Q. 18

A lady presented with non progressive dysphagia only for solids. Barium study showed proximal esophageal dilatation with distal constriction. The most likely diagnosis is.

 A

Peptic Stricture

 B

Carcinoma Esophagus

 C

Achalasia Cardia

 D

Lower Esophageal Ring

Ans. D

Explanation:

Answer is D (Lower esophageal ring)

Non progressive (episodic) dysphagia only for solids is characteristic of lower esophageal rings (Schatzki’s ring). The ring is apparent as a constriction in the lower esophagus on barium swallow.

Peptic stricture and carcinoma esophagus present with progressive dysphagia for solids while Achalasia presents with progressive dysphagia for both solids and liquids.


Q. 19

A young patient presents with history of dysphagia more to liquid than solids. The first investigation you will do is:

 A

Barium swallow

 B

Esophagoscopy

 C

Ultrasound of the chest

 D

C.T. scan of the chest

Q. 19

A young patient presents with history of dysphagia more to liquid than solids. The first investigation you will do is:

 A

Barium swallow

 B

Esophagoscopy

 C

Ultrasound of the chest

 D

C.T. scan of the chest

Ans. A

Explanation:

Answer is A (Barium swallow)

Presence of progressive dysphagia for both liquids and solids suggest a probable diagnosis of Achalasia Cardia. Barium swallow should be the first / initial investigation.

‘In evaluating a patient with dysphagia. a barium .swallow should be the first test performed’


Q. 20

Substance utilized for barium meal follow through study:     

September 2011

 A

Barium carbonate

 B

Barium sulphate

 C

Barium oxide

 D

Barium hydroxide

Q. 20

Substance utilized for barium meal follow through study:     

September 2011

 A

Barium carbonate

 B

Barium sulphate

 C

Barium oxide

 D

Barium hydroxide

Ans. B

Explanation:

Ans. B: Barium sulphate

Since there is no natural contrast in the alimentary tract, its radiographic demonstration required the use of artificial contrast medium

Barium sulphate, through which X-rays can not pass, is the contrast universally employed in performing alimentary tract studies


Q. 21

‘Thumb print’ appearance on Barium enema is found in:       

September 2003

 A

Volvulus

 B

Gastric ulcer

 C

Bowel ischemia

 D

Intussusception

Q. 21

‘Thumb print’ appearance on Barium enema is found in:       

September 2003

 A

Volvulus

 B

Gastric ulcer

 C

Bowel ischemia

 D

Intussusception

Ans. C

Explanation:

Ans. C i.e. Bowel ischemia


Q. 22

‘Carman meniscus sign’ in barium meal is pathognomic of:       

September 2003

 A

Malignant gastric ulcer

 B

Lipoma stomach

 C

Gastric polyposis

 D

Lymphoma

Q. 22

‘Carman meniscus sign’ in barium meal is pathognomic of:       

September 2003

 A

Malignant gastric ulcer

 B

Lipoma stomach

 C

Gastric polyposis

 D

Lymphoma

Ans. A

Explanation:

Ans. A i.e. Malignant gastric ulcer


Q. 23

Reversed “3” sign on barium studies is seen in which condition: 

September 2009

 A

Ampullary carcinoma

 B

carcinoma stomach

 C

Carcinoma head of pancreas

 D

Insulinoma

Q. 23

Reversed “3” sign on barium studies is seen in which condition: 

September 2009

 A

Ampullary carcinoma

 B

carcinoma stomach

 C

Carcinoma head of pancreas

 D

Insulinoma

Ans. C

Explanation:

Ans. C: Carcinoma head of pancreas

Plain radiographs have no role in establishing a firm diagnosis of pancreatic carcinoma. Pancreatic calcifications may be seen concurrently in approximately 2% of patients who have chronic pancreatitis complicated by pancreatic carcinoma. Upper GI barium studies may reveal an extrinsic impression of the mass on the posteroinferior aspect of the antrum of the stomach. This is known as antral pad sign.

The medial margin of the descending duodenum may be pulled medially at the level of the ampulla, forming a reversed-3 appearance. This is known as Frostberg 3 sign.

Infiltration of the duodenal mucosa may cause a spiculated appearance with irregularity and thickening of the duodenal mucosa.


Q. 24

‘Saw tooth’ appearance on barium enema may be seen in:           

March 2004

 A

Diverticular disease of colon

 B

Carcinoma colon

 C

Colitis

 D

Polyps

Q. 24

‘Saw tooth’ appearance on barium enema may be seen in:           

March 2004

 A

Diverticular disease of colon

 B

Carcinoma colon

 C

Colitis

 D

Polyps

Ans. A

Explanation:

Ans. A i.e. Diverticular disease of colon


Q. 25

Barium meal picture of carcinoma stomach shows:

 A

Filling defect

 B

Loss of rugosity

 C

Small capacity of stomach

 D

All of the above

Q. 25

Barium meal picture of carcinoma stomach shows:

 A

Filling defect

 B

Loss of rugosity

 C

Small capacity of stomach

 D

All of the above

Ans. D

Explanation:

Ans. All of the above


Q. 26

Coiled spring appearance on barium enema is seen in:

 A

Carcinoma colon

 B

Sigmoid volvulus

 C

Intussusception

 D

Deal atresia

Q. 26

Coiled spring appearance on barium enema is seen in:

 A

Carcinoma colon

 B

Sigmoid volvulus

 C

Intussusception

 D

Deal atresia

Ans. C

Explanation:

Ans. Intussusception


Q. 27

‘Scalloping’ of the edge of sigmoid colon on barium enema seen in:

 A

Diverticulosis

 B

Ulcerative colitis

 C

Carcinoma colon

 D

Pneumatosis intestinalis

Q. 27

‘Scalloping’ of the edge of sigmoid colon on barium enema seen in:

 A

Diverticulosis

 B

Ulcerative colitis

 C

Carcinoma colon

 D

Pneumatosis intestinalis

Ans. D

Explanation:

Ans. Pneumatosis intestinalis


Q. 28

Pipe stem appearance in barium enema is seen in:

 A

Crohns disease

 B

Ulcerative colitis

 C

Schistosomiasis

 D

Carcinoma colon

Q. 28

Pipe stem appearance in barium enema is seen in:

 A

Crohns disease

 B

Ulcerative colitis

 C

Schistosomiasis

 D

Carcinoma colon

Ans. B

Explanation:

Ans. Ulcerative colitis


Q. 29

The X-ray finding of small intestinal malabsorption syndrome are all except:

 A

Increased transit time

 B

Mucosal atrophy

 C

Dilatation of bowel

 D

Flocculation of barium

Q. 29

The X-ray finding of small intestinal malabsorption syndrome are all except:

 A

Increased transit time

 B

Mucosal atrophy

 C

Dilatation of bowel

 D

Flocculation of barium

Ans. A

Explanation:

Ans. Increased transit time


Q. 30

Left atrial enlargement is best seen with:

 A

Chest X-ray AP view

 B

Chest X-ray left lateral view

 C

Barium swallow right anterior oblique view

 D

Barium swallow left anterior oblique view

Q. 30

Left atrial enlargement is best seen with:

 A

Chest X-ray AP view

 B

Chest X-ray left lateral view

 C

Barium swallow right anterior oblique view

 D

Barium swallow left anterior oblique view

Ans. C

Explanation:

Ans. Barium swallow right anterior oblique view


Q. 31

All are seen in left atrium enlargement except:

 A

Posterior displacement of the oesophagus on barium meal

 B

Straightening of the left main hronchus

 C

A double shadow of right atrium

 D

Retrosternal lucency on lateral film

Q. 31

All are seen in left atrium enlargement except:

 A

Posterior displacement of the oesophagus on barium meal

 B

Straightening of the left main hronchus

 C

A double shadow of right atrium

 D

Retrosternal lucency on lateral film

Ans. D

Explanation:

Ans. Retrosternal lucency on lateral film


Q. 32

Which of the following is a less useful diagnostic procedure in a case of acute haematemesis?

 A

Barium meal

 B

Endoscopy

 C

Gastric content aspiration

 D

Angiography

Q. 32

Which of the following is a less useful diagnostic procedure in a case of acute haematemesis?

 A

Barium meal

 B

Endoscopy

 C

Gastric content aspiration

 D

Angiography

Ans. A

Explanation:

Ans. Barium meal


Q. 33

On radiography widened duodenal ‘C’ loop with irregular mucosal pattern on upper gastrointestinal barium series is most likely due to:

 A

Chronic pancreatitis

 B

Carcinoma head of pancreas

 C

Duodenal ulcer

 D

Duodenal ileus

Q. 33

On radiography widened duodenal ‘C’ loop with irregular mucosal pattern on upper gastrointestinal barium series is most likely due to:

 A

Chronic pancreatitis

 B

Carcinoma head of pancreas

 C

Duodenal ulcer

 D

Duodenal ileus

Ans. B

Explanation:

Ans. Carcinoma head of pancreas


Q. 34

Following are common features of malignant gastric ulcer on barium meal except:

 A

Location on the greater curvature

 B

Carman’s meniscus sign

 C

Radiating folds which do not reach the edge of the ulcer

 D

Lesser curvature ulcer with a nodular rim

Q. 34

Following are common features of malignant gastric ulcer on barium meal except:

 A

Location on the greater curvature

 B

Carman’s meniscus sign

 C

Radiating folds which do not reach the edge of the ulcer

 D

Lesser curvature ulcer with a nodular rim

Ans. A

Explanation:

Ans. Location on the greater curvature


Q. 35

In which of the following conditions the lead pipe appearance of the colon on a barium enema is seen?

 A

Amoebiasis

 B

Ulcerative colitis

 C

Tuberculosis of the colon

 D

Crohn’s involvement of the colon

Q. 35

In which of the following conditions the lead pipe appearance of the colon on a barium enema is seen?

 A

Amoebiasis

 B

Ulcerative colitis

 C

Tuberculosis of the colon

 D

Crohn’s involvement of the colon

Ans. B

Explanation:

Ans. Ulcerative colitis


Q. 36

On barium swallow posterior indentation is seen due to:

 A

Left atrium

 B

Aortic knuckle

 C

Aberrant right subclavian

 D

Sling of pulmonary artery

Q. 36

On barium swallow posterior indentation is seen due to:

 A

Left atrium

 B

Aortic knuckle

 C

Aberrant right subclavian

 D

Sling of pulmonary artery

Ans. C

Explanation:

Ans. Aberrant right subclavian



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