abdominal discomfort

Practice targeted AMC-style multiple-choice questions on abdominal discomfort.

Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.

Image by IkeTheSloth — CC0 1.0 · Source

A 55-year-old male presents to his GP complaining of a swelling in his right groin that has been present for several months. He states it is more noticeable when he is standing or coughing and sometimes causes a dull ache, but it is easily pushed back in when he lies down. He denies any fever, nausea, or acute pain. His vital signs are stable. Physical examination reveals the finding shown in the image. Considering the patient's history and the physical examination finding depicted, what is the most appropriate next step in management?

A. Recommend a trial of a supportive truss garment.

B. Referral for elective surgical repair.

C. Request an urgent ultrasound of the groin.

D. Advise watchful waiting and provide analgesia as needed.

E. Immediate surgical consultation for suspected incarceration.

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Image by IkeTheSloth — CC0 1.0 · Source

A 48-year-old man presents to his GP reporting an intermittent swelling in his right groin over the past six months. He notes it is more prominent when he is upright or coughing and disappears when he lies down. He experiences occasional mild discomfort but denies any acute pain, nausea, or vomiting. His past medical history is unremarkable, and vital signs are stable. Physical examination reveals the finding shown in the image. Considering the patient's history and the physical examination finding depicted, what is the most appropriate recommendation regarding definitive management for this patient?

A. Prescription of a truss for support

B. Watchful waiting with regular review

C. Elective surgical repair

D. Referral for ultrasound imaging

E. Urgent surgical exploration

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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).

Image by Hellerhoff — CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). The provided image was obtained as part of his staging workup. Which of the following is the MOST appropriate next step in management?

A. Surgical resection of the affected liver segments

B. Initiation of palliative care and symptom management

C. Observation with serial imaging every 3 months

D. Percutaneous radiofrequency ablation of the largest lesion

E. Referral to medical oncology for systemic chemotherapy

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Giant hiatal hernia, CT image. 63 year old man.

Image by Jmarchn — CC BY 4.0 · Source

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. He reports occasional regurgitation of undigested food. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A. H. pylori testing and eradication if positive

B. Surgical repair

C. Trial of proton pump inhibitors

D. Endoscopic surveillance

E. Dietary modification and lifestyle advice

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Image by Hellerhoff — CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A. Surgical resection of the affected liver segments

B. Initiation of palliative care and symptom management

C. Percutaneous radiofrequency ablation of liver lesions

D. Observation with serial imaging in three months

E. Referral to medical oncology for systemic chemotherapy

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Image by Ahmed Farhat, Daryn Towle — CC BY 4.0 · Source

A 68-year-old patient presents with chronic intermittent upper abdominal discomfort, postprandial fullness, and occasional regurgitation. Physical examination is unremarkable. A chest radiograph is performed as part of the workup. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate next step in management?

A. Initiate a trial of high-dose proton pump inhibitor therapy.

B. Advise dietary modifications and schedule follow-up in 3 months.

C. Referral for upper gastrointestinal endoscopy.

D. Arrange urgent surgical consultation for repair.

E. Request a barium swallow study to assess anatomy.

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A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm

Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 70-year-old man presents for a routine check-up. He reports occasional mild, non-radiating abdominal discomfort over the past few months, which he attributes to indigestion. He has a history of well-controlled hypertension and hyperlipidaemia, and quit smoking 10 years ago. Physical examination is unremarkable, with no palpable abdominal masses. Routine blood tests are within normal limits. An abdominal CT scan is performed to investigate the abdominal discomfort. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Initiate a trial of proton pump inhibitors for presumed dyspepsia.

B. Arrange immediate CT angiography to plan for endovascular repair.

C. Schedule a surveillance ultrasound in 6-12 months.

D. Reassure the patient that the findings are benign and require no follow-up.

E. Refer urgently for vascular surgical assessment.

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Image by Hellerhoff — CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history is significant for a recently diagnosed gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A. Observation with serial imaging

B. Palliative chemotherapy

C. Liver transplantation

D. Radiofrequency ablation of liver lesions

E. Surgical resection of the primary tumor

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 72-year-old man with a history of hypertension and smoking presents to his GP with mild, intermittent abdominal discomfort. His vital signs are stable, and abdominal examination is soft and non-tender. As part of the workup, a contrast-enhanced CT scan of the abdomen and pelvis is performed. The provided image is an axial view from this study. Based on the clinical context and the findings in the provided image, what is the most appropriate next step in this patient's management?

A. Referral for urgent endovascular repair planning

B. No further action is required at this time

C. Referral to a vascular surgeon for ongoing surveillance

D. Urgent surgical consultation for immediate repair

E. Repeat CT scan in 3 months to assess for growth

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Image by Jmarchn — CC BY 4.0 · Source

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A. Initiate a trial of high-dose proton pump inhibitors

B. Esophageal manometry to assess esophageal motility

C. Surgical consultation for consideration of fundoplication

D. Reassurance and dietary modification

E. Barium swallow study to evaluate for esophageal strictures

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Image by Hellerhoff — CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed, as shown. Which of the following is the MOST appropriate next step in management?

A. Initiation of immunotherapy

B. Palliative chemotherapy

C. Observation with serial imaging

D. Transarterial chemoembolization (TACE)

E. Surgical resection of the liver lesions

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Image by Jmarchn — CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Urgent upper gastrointestinal endoscopy to assess for malignancy.

B. Initiation of high-dose proton pump inhibitor therapy.

C. Prescription of iron supplements and dietary advice.

D. Barium swallow study to further characterise the anatomy.

E. Referral for surgical assessment and consideration of operative repair.

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abdominal discomfort

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