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abdominal swelling

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

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents with abdominal distension, obstipation, and vomiting. He has a history of prior abdominal surgery. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

A. Colonoscopy
B. Surgical consultation
C. Barium enema
D. Stool softeners
E. Oral antibiotics
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 3-year-old child is brought to the GP by their parents who are worried about the appearance of their child's abdomen, as shown in the image. The child is otherwise well, active, and has no pain, vomiting, or changes in bowel habits. On examination, the finding is soft and easily reducible. Vital signs are normal. Based on this presentation and the image, what is the most appropriate initial management?

A. Application of a binder or tape over the area.
B. Advise strict bed rest to prevent worsening.
C. Request an abdominal ultrasound to assess contents.
D. Reassurance and observation for spontaneous closure.
E. Urgent surgical referral for repair.
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 1-year-old child is presented to the general practitioner by their parents who are concerned about the appearance of their child's umbilicus, as depicted in the accompanying image. The parents report the bulge is more prominent with crying but is easily reducible. The child is otherwise well, feeding normally, and has no history of pain, vomiting, or constipation. Physical examination reveals normal vital signs and a soft, non-tender abdomen. Considering the clinical presentation and the finding shown, what is the most appropriate advice to give the parents regarding initial management?

A. Recommend an abdominal ultrasound scan to rule out incarceration or other complications.
B. Instruct the parents on how to apply a binder or tape to the area to help it close faster.
C. Provide reassurance that this is a common condition in infants and toddlers that often resolves spontaneously, advising observation.
D. Explain that surgical repair is typically required and arrange a referral to a paediatric surgical service.
E. Advise investigation for potential underlying genetic syndromes or metabolic disorders.
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A 1-month-old baby has a palpable mass in the right flank and abdominal swelling. An ultrasound reveals a solid mass in the kidney. What is the most likely diagnosis?

A. Neuroblastoma
B. Polycystic kidney disease
C. Hydronephrosis
D. Renal cell carcinoma
E. Wilms tumor
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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 58-year-old male presents to your GP clinic complaining of a dragging sensation in his right groin, particularly when standing for long periods. He denies any pain, nausea, or vomiting. On examination, you note the finding in the image. Palpation reveals a soft, reducible mass. What is the MOST appropriate next step in management?

A. Referral to a general surgeon for elective repair
B. Referral to physiotherapy for core strengthening exercises
C. Urgent referral to the emergency department
D. Prescription of a truss for symptomatic relief
E. Reassurance and watchful waiting
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A 62-year-old male presents to his general practitioner with a six-month history of a painless swelling in his right groin. He reports that the swelling becomes more prominent when he strains or coughs and reduces when he lies down. On examination, a soft, reducible bulge is palpable in the right inguinal region. The bulge is felt to emerge medial to the inferior epigastric vessels. Which of the following is the most appropriate next step in management, according to current Australian guidelines?

A. Referral to a physiotherapist for core strengthening exercises.
B. Referral to a general surgeon for elective open or laparoscopic inguinal hernia repair.
C. Urgent referral to an emergency department for assessment of possible strangulation.
D. Reassurance and watchful waiting, with advice on lifestyle modifications.
E. Prescription of a truss to support the hernia.
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Diverticulitis in the left lower quadrant. There is outpouching of the colonic wall, wall thickening, and surrounding fat stranding.
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?

A. Order a barium enema to assess for fistula
B. Prescribe oral antibiotics and a high-fiber diet
C. Perform a colonoscopy to rule out malignancy
D. Schedule elective sigmoid colectomy
E. Initiate intravenous antibiotics and bowel rest
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 1-year-old presents with the abdominal exam shown. It is easily reducible. What is the most appropriate management?

A. Referral for physiotherapy
B. Trial of abdominal binder
C. Reassurance and observation
D. Order abdominal ultrasound
E. Surgical referral now
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 58-year-old male with known alcoholic cirrhosis undergoes surveillance. AFP is 600 ng/mL. The provided image was obtained. What is the next step?

A. Administer systemic chemotherapy
B. Initiate sorafenib
C. Repeat AFP in 3 months
D. Liver biopsy
E. Refer for liver transplant evaluation
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Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 68-year-old male presents with new onset constipation and abdominal pain. The provided CT was obtained. What is the MOST likely long-term complication?

A. Toxic megacolon
B. Abscess formation
C. Stricture formation
D. Perforation
E. Fistula formation
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 65-year-old male with known alcoholic cirrhosis presents for routine HCC screening. His AFP is 25 ng/mL. A CT scan with IV contrast is performed (image attached). What is the MOST appropriate next step in management?

A. MRI of the abdomen with contrast
B. Repeat AFP in 3 months
C. Initiate sorafenib
D. Surgical resection
E. Referral for liver transplant evaluation
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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. The provided image was obtained. What is the MOST appropriate next step in management?

A. Barium swallow study
B. Surgical repair
C. PPI therapy
D. Endoscopic surveillance
E. H. pylori testing
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

A. Repeat AFP in 3 months
B. Initiate sorafenib therapy
C. MRI of the abdomen with contrast
D. Percutaneous liver biopsy
E. Referral for liver transplant evaluation
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A 2-week-old baby is brought to the clinic with abdominal distension and bilious vomiting. On examination, the abdomen is tense and tender. What is the most likely diagnosis?

A. Hypertrophic pyloric stenosis
B. Necrotizing enterocolitis
C. Hirschsprung disease
D. Meconium ileus
E. Intestinal atresia
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?

A. Elevated urine homogentisic acid
B. Elevated urine vanillylmandelic acid (VMA)
C. Elevated serum lactate dehydrogenase (LDH)
D. Elevated serum amylase
E. Elevated serum alpha-fetoprotein (AFP)
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An incarcerated inguinal hernia as seen on CT
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male presents with a painful, irreducible right groin mass. He reports vomiting and abdominal distension. His vitals are: HR 110, BP 100/60, RR 22, SpO2 96% RA. The provided image was obtained. What is the next step?

A. Attempt manual reduction with sedation
B. Surgical consultation for emergent repair
C. Order a repeat CT scan with contrast in 6 hours
D. Start a clear liquid diet
E. Administer intravenous antibiotics
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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents to the emergency department complaining of abdominal pain, distension, and obstipation for the past 3 days. He reports a history of multiple abdominal surgeries for adhesions. His vital signs are: HR 110 bpm, BP 110/70 mmHg, RR 22 breaths/min, SpO2 97% on room air, and temperature 37.8°C. Physical examination reveals a distended abdomen with high-pitched bowel sounds. An upright abdominal X-ray is performed, as shown. Given the clinical context and the findings on the imaging, what is the MOST appropriate next step in management?

A. Insert a nasogastric tube and initiate intravenous fluid resuscitation
B. Prescribe oral laxatives and encourage increased fluid intake
C. Administer intravenous antibiotics and schedule an urgent CT scan with oral contrast
D. Order a barium enema to assess for colonic obstruction
E. Perform a flexible sigmoidoscopy to rule out sigmoid volvulus
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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents to the ED with abdominal distension, obstipation, and vomiting. He reports a history of multiple abdominal surgeries. An upright abdominal X-ray is performed. Based on the image, what is the MOST appropriate next step in management?

A. CT abdomen with contrast
B. Increase oral fluid intake
C. Stool softeners
D. Surgical consultation
E. Oral antibiotics
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 70-year-old male presents with jaundice and abdominal distension. The provided image was obtained. What is the MOST likely underlying cause of the jaundice?

A. Choledocholithiasis
B. Intrahepatic cholestasis
C. Primary sclerosing cholangitis
D. Gilbert's syndrome
E. Pancreatic head mass
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A 6-month-old baby has abdominal swelling and vomiting. An abdominal X-ray shows a 'double bubble' sign. What is the most likely diagnosis?

A. Pyloric stenosis
B. Duodenal atresia
C. Meconium ileus
D. Intussusception
E. Malrotation with volvulus.
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A neonate, born at 38 weeks gestation, presents with bilious vomiting starting 12 hours after birth. Antenatal ultrasound revealed polyhydramnios. On examination, the baby is active and has a distended upper abdomen but a scaphoid lower abdomen. An abdominal X-ray shows a 'double bubble' sign. Which of the following is the most appropriate next step in the management of this neonate, considering potential associated complications?

A. Immediately perform a contrast enema to rule out meconium ileus as a cause of the obstruction.
B. Initiate intravenous fluids, nasogastric decompression, and prepare for surgical intervention after stabilization.
C. Begin feeds with a hydrolysed formula to assess tolerance and rule out milk protein allergy.
D. Start the neonate on broad-spectrum antibiotics to cover potential bacterial translocation.
E. Perform an upper gastrointestinal endoscopy to visualize the obstruction and obtain biopsies.
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 6-month-old male infant is brought to the emergency department by his parents. They report that they have noticed a bulge on his abdomen that seems to get larger when he cries. The infant is otherwise healthy, feeding well, and has normal bowel movements. On examination, the infant is afebrile, and his vital signs are within normal limits. The abdomen is soft and non-tender. Palpation reveals a soft, reducible mass at the umbilicus, as shown in the image. What is the MOST appropriate next step in the management of this patient?

A. Urgent ultrasound to rule out incarceration
B. Application of an abdominal binder
C. Reassurance and observation
D. Immediate surgical referral for elective repair
E. Initiation of a high-fiber diet to prevent constipation
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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, drawing his legs up to his chest. He has vomited several times. His vital signs are stable: HR 110, BP 95/60, RR 24, Temp 37.2°C. On examination, he is irritable but comfortable between episodes of pain. His abdomen is soft but mildly distended. A focused abdominal ultrasound is performed, yielding the image provided. Based on the clinical presentation and the findings shown, which of the following non-surgical interventions is typically attempted first to resolve the underlying issue?

A. Nasogastric tube insertion for decompression and bowel rest
B. Pneumatic reduction under fluoroscopic guidance
C. Administration of intravenous opioids for pain control followed by observation
D. Intravenous fluid resuscitation and broad-spectrum antibiotics
E. Urgent surgical exploration and manual reduction
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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

A. Appendicitis
B. Diverticulitis
C. Volvulus
D. Adhesions from prior surgery
E. Pancreatitis
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and bone pain. An abdominal CT is performed (image attached). Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

A. Urine catecholamine metabolites
B. Liver function tests
C. Bone marrow biopsy
D. Alpha-fetoprotein level
E. Complete blood count
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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents with abdominal distension and obstipation. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

A. Stool softeners
B. Colonoscopy
C. Barium enema
D. Increase oral fluid intake
E. Surgical consultation
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A neonate is born at term following an uneventful pregnancy. Immediately after birth, the baby develops bilious vomiting. Abdominal examination reveals epigastric distension, but the rest of the abdomen is scaphoid. An abdominal X-ray is performed. Which of the following findings on the abdominal X-ray would be most consistent with the likely diagnosis?

A. Double-bubble sign
B. Multiple air-fluid levels throughout the abdomen
C. Free air under the diaphragm
D. Pneumatosis intestinalis
E. Ground glass appearance
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. AFP is elevated. The provided image was obtained. What is the MOST appropriate next step in management?

A. Schedule a follow-up ultrasound in 6 months
B. Initiate sorafenib therapy
C. Repeat AFP in 3 months
D. Referral for liver transplant evaluation
E. Order a CT scan of the abdomen with contrast
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and vague pain. Vitals are stable. An abdominal CT is performed (image attached). Elevated levels of HVA and VMA are noted in the urine. What is the MOST likely origin of the primary lesion?

A. Spleen
B. Pancreas
C. Liver
D. Adrenal gland
E. Kidney
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A newborn has abdominal swelling and scrotal swelling. On examination, the swelling is soft and reducible. What is the most likely diagnosis?

A. Hydrocele
B. Testicular torsion
C. Inguinal hernia
D. Epididymitis
E. Varicocele
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and bone pain. The provided image was obtained. What is the MOST likely source of the elevated urine HVA and VMA?

A. Hepatocytes
B. Adrenal cortical cells
C. Renal tubular cells
D. Neural crest cells
E. Pancreatic islet cells
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 9-month-old presents with a noticeable abdominal protrusion, more prominent when crying. The child is feeding well and has regular bowel movements. Examination reveals a soft, easily reducible bulge at the umbilicus, as shown. Parents are concerned about potential complications. What is the MOST appropriate parental advice?

A. Advise immediate surgical repair to prevent future complications like bowel strangulation.
B. Recommend applying a belly band to reduce the protrusion and promote closure.
C. Reassurance that most cases resolve spontaneously by age 5; surgical intervention is rarely needed unless incarcerated.
D. Suggest a high-fiber diet to prevent constipation and reduce intra-abdominal pressure.
E. Prescribe topical corticosteroids to reduce inflammation and promote skin closure.
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 6-month-old presents for a well-child check. The image shows the abdominal exam. Parents report it enlarges when crying. What is the most appropriate next step?

A. Immediate surgical exploration
B. Reassurance and observation
C. Initiation of diuretic therapy
D. Application of an abdominal binder
E. Surgical referral for elective repair
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 9-month-old presents with a noticeable abdominal protrusion, accentuated during crying. The infant is feeding well and has regular bowel movements. Examination reveals a soft, easily reducible bulge at the umbilicus, as shown. Parents are concerned about potential complications. What is the MOST appropriate parental advice?

A. Prescribe topical corticosteroids to reduce inflammation and promote skin retraction.
B. Recommend applying a belly band to reduce the hernia and promote closure.
C. Advise immediate surgical repair to prevent future complications like bowel strangulation.
D. Suggest a high-fiber diet to prevent constipation and reduce intra-abdominal pressure.
E. Reassurance that most cases resolve spontaneously by age 5; surgical intervention is rarely needed unless incarcerated.
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A 50-year-old woman presents with increasing abdominal swelling and early satiety. Examination reveals ascites. Which investigation is most crucial to guide initial management?

A. Diagnostic paracentesis
B. Complete blood count
C. Abdominal ultrasound
D. Liver function tests
E. Serum albumin and ascitic fluid protein
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Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?

A. Increase dietary fiber intake
B. Surgical resection of the affected bowel segment
C. Flexible sigmoidoscopy
D. IV antibiotics and bowel rest
E. Stool culture for C. difficile
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 14-month-old child is brought to the general practitioner for a routine check-up and immunisations. The parents express mild concern about a bulge they have noticed around the child's navel, which seems more prominent when the child is crying or straining. They report it is easily pushed back in and does not appear to cause the child any pain or discomfort. The child is otherwise thriving, with normal feeding, bowel movements, and developmental progress. On physical examination, the child is alert and interactive. Vital signs are within normal limits for age. Abdominal examination reveals no distension or tenderness. The finding shown in the image is noted. Based on this clinical presentation and examination finding, what is the most appropriate initial management plan?

A. Provide reassurance to the parents that spontaneous closure is likely and no immediate intervention is required.
B. Arrange an abdominal ultrasound to assess the size of the fascial defect and contents of the sac.
C. Schedule elective surgical repair within the next 6 months to prevent future complications.
D. Recommend applying a firm abdominal binder or tape over the area to facilitate closure.
E. Refer the child for urgent surgical consultation due to the risk of incarceration or strangulation.
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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 62-year-old male presents with a 6-month history of a painless swelling in his right groin, visible especially when standing. Examination reveals the finding in the image. The mass reduces when lying down. What is the MOST appropriate initial management?

A. Prescription of a truss support
B. Referral for physiotherapy
C. Referral for elective surgical repair
D. Urgent surgical consultation
E. Reassurance and observation
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 32-year-old woman presents with pelvic pain and bloating. Her periods are regular. An abdominal CT scan is performed. Based on the image, what is the MOST appropriate next step in management?

A. Oral contraceptive pills
B. CA-125 level
C. Repeat imaging in 6-12 weeks
D. Laparoscopic cystectomy
E. Referral to gynaecological oncology
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small

bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F CC BY 2.0 · Source

A 45-year-old patient with a long history of recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions presents with acute onset severe abdominal pain, nausea, and distension. Physical examination reveals a distended, mildly tender abdomen. Bowel sounds are reduced. Vital signs are stable. Imaging is performed. Considering the patient's presentation and the findings demonstrated in the image, which of the following represents the most appropriate initial management approach?

A. Urgent upper and lower endoscopy to identify bleeding source.
B. Initiation of systemic medical therapy targeting vascular malformations.
C. Further imaging with mesenteric angiography.
D. Laparotomy for reduction or resection of affected bowel segments.
E. Non-operative management with nasogastric tube decompression and intravenous fluids.
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

A. Repeat AFP in 3 months
B. Initiate sorafenib therapy
C. Schedule a follow-up CT scan in 6 months
D. Referral for liver transplant evaluation
E. Order a liver biopsy
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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 60-year-old man presents with a 6-month history of intermittent aching discomfort in his right groin, exacerbated by standing and lifting. He reports noticing a bulge in the area, similar to the appearance shown, which usually disappears when he lies down. On examination, the bulge is reducible. Vital signs are normal. Considering the clinical presentation and the image, which anatomical structure is the most likely primary site of the fascial defect?

A. External oblique aponeurosis
B. Femoral canal
C. Superficial inguinal ring
D. Hesselbach's triangle
E. Deep inguinal ring
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