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abdominal ultrasound

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

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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for follow-up after experiencing intermittent episodes of right upper quadrant colicky pain over the past year, which have since resolved. She denies any current pain, fever, jaundice, or changes in bowel habits. Physical examination is unremarkable, and recent liver function tests are within normal limits. An elective abdominal ultrasound was performed, yielding the image shown. Considering the clinical context and the findings demonstrated, what is the most appropriate next step in her management?

A. Discharge with advice to return if symptoms recur
B. ERCP for stone extraction
C. Initiate ursodeoxycholic acid therapy
D. MRCP to further delineate the biliary anatomy
E. Elective laparoscopic cholecystectomy
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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 a history of hepatitis C presents with new onset jaundice and ascites. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Initiate systemic chemotherapy
B. Referral for liver transplant evaluation
C. Order a triple-phase CT scan of the abdomen
D. Perform a percutaneous liver biopsy
E. Start sorafenib therapy
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 70-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next diagnostic step?

A. Quadruple-phase CT scan of the abdomen
B. Initiate systemic chemotherapy
C. Repeat ultrasound in 3 months
D. MRI of the abdomen with hepatobiliary contrast
E. Liver biopsy
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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 intermittent abdominal pain, vomiting, and bloody stools. An ultrasound is performed, the image is shown. What is the MOST appropriate next step in the management of this patient?

A. Stool culture
B. Surgical resection
C. Observation and analgesia
D. Air enema
E. Appendectomy
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman with a history of intermittent, self-resolving right upper quadrant pain presents for evaluation. She denies fever, chills, or jaundice, and her physical examination is unremarkable. Routine blood tests, including liver function tests and amylase, are within normal limits. An abdominal ultrasound was performed, and a representative image is shown. Based on the findings in this image and her clinical presentation, what is the most appropriate next step in management?

A. Laparoscopic cholecystectomy alone
B. Prescribe oral analgesics and advise dietary modification
C. Elective endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction
D. Referral for urgent surgical common bile duct exploration
E. Observation with regular clinical review
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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 intermittent abdominal pain, vomiting, and currant jelly stools. An ultrasound is performed, revealing the finding shown. What is the MOST appropriate next step in the management of this patient?

A. Appendectomy
B. Exploratory laparotomy
C. Air enema
D. Stool culture
E. Observation and intravenous fluids
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for review in the outpatient clinic. She reports a history of intermittent, self-resolving episodes of right upper quadrant colicky pain over the past year, but is currently asymptomatic. She denies fever, jaundice, or other systemic symptoms. Her physical examination is unremarkable, and recent liver function tests are within the normal reference range. An elective abdominal ultrasound was performed, yielding the image shown. Based on the clinical presentation and the findings demonstrated, what is the most appropriate next step in her management?

A. Trial of ursodeoxycholic acid
B. Reassurance and discharge with advice to return if symptoms recur
C. Elective laparoscopic cholecystectomy
D. Further investigation with CT abdomen
E. Referral for endoscopic retrograde cholangiopancreatography (ERCP)
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 6-week-old male presents with projectile vomiting after feeds. He is otherwise well-appearing, with normal vital signs and no abdominal distension. An ultrasound was performed, and an image is shown. What is the MOST appropriate next step in management?

A. Barium swallow study
B. Upper endoscopy with biopsy
C. Surgical consultation for pyloromyotomy
D. Initiate erythromycin therapy
E. Trial of thickened feeds
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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 previously well 3-year-old boy presents to the emergency department with a 12-hour history of sudden onset, intermittent, severe, colicky abdominal pain, associated with non-bilious vomiting. Between episodes, he appears lethargic and pale. His vital signs are stable: HR 110, BP 90/60, RR 24, Temp 37.2. Abdominal examination reveals mild distension and tenderness, but no guarding or rebound. Bowel sounds are present. A point-of-care ultrasound is performed by the emergency physician. Considering the clinical presentation, the patient's current stable vital signs, and the specific findings demonstrated in the provided ultrasound image, which of the following represents the single most appropriate immediate next step in the management of this patient in an Australian tertiary paediatric centre?

A. Proceed directly to surgical exploration.
B. Attempt pneumatic or hydrostatic reduction under fluoroscopic guidance.
C. Obtain a CT scan of the abdomen and pelvis.
D. Administer IV fluids and observe for resolution.
E. Discharge home with pain relief and follow-up.
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 5-week-old male presents with projectile vomiting. Ultrasound (shown). What electrolyte abnormality is MOST likely?

A. Hyperchloremic metabolic acidosis
B. Hyperkalemia
C. Hyponatremia
D. Hypophosphatemia
E. Hypochloremic metabolic alkalosis
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 6-week-old presents with projectile vomiting after feeds. An ultrasound is performed (shown). What is the MOST appropriate next step in management?

A. Trial of thickened feeds
B. Upper endoscopy with biopsy
C. Reassurance and close follow-up
D. Start erythromycin
E. Surgical consultation for pyloromyotomy
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Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 65-year-old male presents to the emergency department with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical findings and the provided imaging, what is the most appropriate next step in the management of this patient?

A. Laparoscopic cholecystectomy within 24-72 hours
B. Urgent endoscopic retrograde cholangiopancreatography (ERCP)
C. Percutaneous cholecystostomy insertion
D. Repeat abdominal CT scan in 24 hours
E. Continue medical management with intravenous antibiotics and analgesia only
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman with past colicky pain has the ultrasound shown. LFTs are normal. What is the MOST appropriate next investigation?

A. Hepatobiliary Iminodiacetic Acid (HIDA) scan
B. Endoscopic ultrasound (EUS)
C. MRCP
D. Repeat ultrasound in 3 months
E. CT Abdomen
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have since resolved. An abdominal ultrasound, as shown, was performed. Liver function tests are normal. Which of the following is the MOST appropriate next step in management?

A. HIDA scan to assess gallbladder function
B. Ursodeoxycholic acid therapy
C. ERCP with sphincterotomy
D. Referral for elective cholecystectomy
E. Observation with repeat ultrasound in 6 months
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Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to the back, associated with nausea, vomiting, and subjective fever. On examination, she is tachycardic (HR 105 bpm) and febrile (38.5°C), with marked tenderness and guarding in the right upper quadrant. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is obtained. Considering the patient's clinical status and the findings on the provided imaging, which of the following represents the most appropriate definitive management strategy?

A. Early laparoscopic cholecystectomy (within 24-72 hours)
B. Delayed laparoscopic cholecystectomy (after 6-8 weeks)
C. Urgent ERCP to relieve obstruction
D. Percutaneous cholecystostomy tube insertion
E. Continue medical management with antibiotics and analgesia only
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have resolved spontaneously. She denies any current pain, jaundice, fever, or changes in bowel habits. Her physical examination is unremarkable, with a soft, non-tender abdomen. Liver function tests are within normal limits. An abdominal ultrasound, as shown, was performed. Given the clinical context and the ultrasound findings, what is the MOST appropriate next step in management?

A. Recommend a high-fibre diet and analgesics as needed
B. Referral for endoscopic retrograde cholangiopancreatography (ERCP)
C. Schedule a repeat ultrasound in 6 months
D. Prescribe ursodeoxycholic acid and monitor liver function tests
E. Order a hepatobiliary iminodiacetic acid (HIDA) scan
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An incarcerated inguinal hernia as seen on CT
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents with right groin pain and a palpable mass. He reports constipation and mild nausea. Vitals are stable. The provided image was obtained. What is the MOST appropriate next step in management?

A. Manual reduction attempt
B. Stool softeners and observation
C. Broad-spectrum antibiotics
D. Surgical consultation for emergent repair
E. Increase oral fluid intake and monitor
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old male presents to the emergency department complaining of sudden onset, severe left flank pain that radiates to his groin. He reports associated nausea and vomiting. He denies any fever, dysuria, or hematuria. His vital signs are: Temperature 37.0°C, Heart Rate 88 bpm, Blood Pressure 130/80 mmHg, Respiratory Rate 16 breaths/min, and SpO2 98% on room air. A urine dipstick is positive for blood. An ultrasound is performed, and the image is shown. Given the clinical presentation and the ultrasound findings, what is the MOST appropriate next step in management?

A. Administer intravenous ketorolac and discharge with outpatient urology follow-up
B. Consult nephrology for possible percutaneous nephrostomy
C. Order a non-contrast CT scan of the abdomen and pelvis
D. Insert a Foley catheter to monitor urine output
E. Start intravenous antibiotics for presumed pyelonephritis
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An incarcerated inguinal hernia as seen on CT
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 65-year-old male presents with groin pain and vomiting. The provided image was taken. What is the most appropriate next step in management?

A. Discharge with stool softeners
B. Administer intravenous antibiotics
C. Apply ice packs to the groin
D. Start a clear liquid diet
E. Surgical consultation for possible bowel resection
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 4-week-old male presents with persistent non-bilious vomiting after feeding. He is mildly dehydrated, but otherwise active. An ultrasound is performed, as shown. What is the MOST likely acid-base disturbance?

A. Metabolic acidosis
B. Normal acid-base balance
C. Respiratory acidosis
D. Respiratory alkalosis
E. Metabolic alkalosis
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents with a history of intermittent RUQ pain. She denies jaundice or fever. An abdominal ultrasound was performed, as shown. What is the MOST appropriate next step in management?

A. Observation with repeat ultrasound in 6 months
B. Hepatobiliary iminodiacetic acid (HIDA) scan
C. Trial of ursodeoxycholic acid
D. Endoscopic retrograde cholangiopancreatography (ERCP)
E. Referral for surgical evaluation
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 58-year-old male with cirrhosis secondary to alcohol abuse presents for routine surveillance. His AFP is 25 ng/mL. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. MRI of the abdomen with contrast
B. Repeat AFP in 3 months
C. CT of the abdomen with contrast
D. Liver biopsy
E. Initiate sorafenib
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 70-year-old male with known cirrhosis secondary to non-alcoholic fatty liver disease is undergoing routine surveillance. His recent surveillance ultrasound identified a new 3 cm lesion in segment VIII. His alpha-fetoprotein level is 45 ng/mL (previously normal). A contrast-enhanced ultrasound is performed, with representative images shown. Based on the clinical context and the findings demonstrated in the images, what is the most appropriate immediate next step in this patient's management?

A. Initiate systemic chemotherapy with sorafenib
B. Repeat the contrast-enhanced ultrasound in 3 months
C. Referral to a multidisciplinary liver tumour board for staging and treatment planning
D. Schedule a follow-up appointment with the GP in 4 weeks
E. Perform an immediate percutaneous biopsy of the lesion
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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 3-week-old male infant presents with persistent, non-bilious projectile vomiting after each feed. He appears hungry and eagerly accepts the bottle, but vomits shortly after. On examination, mild dehydration is noted. An abdominal X-ray is ordered, the relevant image is attached. What is the MOST appropriate next step in management?

A. Perform an upper endoscopy
B. Administer intravenous ondansetron
C. Initiate a course of erythromycin
D. Surgical pyloromyotomy
E. Start a trial of thickened feeds
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 65-year-old male with known alcoholic cirrhosis undergoes surveillance. The provided contrast-enhanced ultrasound was obtained. What is the MOST appropriate next step?

A. Repeat ultrasound in 3 months
B. Liver biopsy
C. Initiate sorafenib
D. Ablation therapy
E. Triphasic CT or MRI
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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 sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on the clinical presentation and the image, what is the most appropriate next step in management?

A. Pneumatic reduction under fluoroscopy
B. Urgent surgical exploration
C. CT scan of the abdomen and pelvis
D. Admission for observation and IV fluids
E. Administration of broad-spectrum antibiotics
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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 6-month-old infant presents for a routine check-up. The mother reports the infant is feeding well and has normal bowel movements. On examination, the infant is active and alert with normal vital signs. The abdomen is soft and non-tender. The image shows a finding on the abdominal exam. What is the most appropriate next step in management?

A. Application of an abdominal binder
B. Empiric antibiotic treatment
C. Initiation of diuretic therapy
D. Reassurance and observation
E. Immediate surgical referral
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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 58-year-old male presents with left lower quadrant abdominal pain and a low-grade fever. The provided image was obtained. What is the most likely diagnosis?

A. Ovarian cyst
B. Sigmoid volvulus
C. Diverticulitis
D. Appendicitis
E. Ulcerative colitis
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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 38-year-old male presents to the emergency department complaining of sudden onset, severe left flank pain that radiates to his groin. He reports associated nausea and vomiting. He denies any fever, dysuria, or hematuria. His vital signs are stable: blood pressure 120/80 mmHg, heart rate 88 bpm, respiratory rate 16 breaths/min, and temperature 37.0°C. A urinalysis reveals microscopic hematuria. A point-of-care ultrasound is performed, and the image is shown. Given the clinical presentation and ultrasound findings, what is the MOST appropriate next step in management?

A. Consult nephrology for possible percutaneous nephrostomy
B. Insert a Foley catheter to monitor urine output
C. Prescribe oral antibiotics for presumed pyelonephritis
D. Order a non-contrast CT scan of the abdomen and pelvis
E. Administer intravenous ketorolac and discharge with outpatient urology follow-up
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Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 58-year-old male presents to the emergency department complaining of severe, constant right upper quadrant pain for the past 12 hours. He reports associated nausea and several episodes of non-bilious vomiting. He denies any fever or chills. His past medical history includes type 2 diabetes mellitus and hypertension, both managed with oral medications. On examination, the patient is alert and oriented. His vital signs are: temperature 37.2°C, heart rate 105 bpm, blood pressure 150/90 mmHg, respiratory rate 20 breaths/min, and SpO2 97% on room air. Abdominal examination reveals significant tenderness to palpation in the right upper quadrant, with guarding. Murphy's sign is positive. Laboratory investigations reveal a white blood cell count of 14,000/µL with neutrophilic predominance, total bilirubin of 2.5 mg/dL, alkaline phosphatase of 250 U/L, ALT of 150 U/L, and AST of 120 U/L. The provided image was obtained. Given the clinical scenario and the findings on the image, which of the following is the MOST appropriate initial management strategy?

A. Initiate intravenous antibiotics and schedule laparoscopic cholecystectomy within 72 hours
B. Start ursodeoxycholic acid and advise a low-fat diet
C. Perform endoscopic retrograde cholangiopancreatography (ERCP) to rule out choledocholithiasis
D. Order a hepatobiliary iminodiacetic acid (HIDA) scan to confirm the diagnosis
E. Administer intravenous fluids and analgesics, and discharge home with oral antibiotics and outpatient surgical follow-up
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 65-year-old male with Hepatitis C cirrhosis is undergoing routine surveillance. A liver lesion was identified on initial ultrasound, prompting a contrast-enhanced ultrasound study. Considering the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A. Repeat ultrasound in 3 months
B. Refer for urgent liver transplant assessment
C. Prescribe antibiotics for suspected abscess
D. Liver biopsy for histological confirmation
E. Initiate palliative care
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 58-year-old male with cirrhosis presents for routine surveillance. His AFP is 8. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Repeat ultrasound in 3 months
B. Start sorafenib
C. Liver biopsy
D. MRI of the abdomen with contrast
E. CT of the abdomen with contrast
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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 a history of hepatitis C presents with new onset jaundice and abdominal distension. Ascites is confirmed on examination. The patient denies alcohol use. An ultrasound with contrast is performed, as shown. What is the MOST appropriate next step in management?

A. Referral for liver transplant evaluation
B. Order a triple-phase CT scan of the abdomen
C. Initiate empiric antibiotic therapy for spontaneous bacterial peritonitis
D. Administer intravenous albumin and diuretics
E. Paracentesis for diagnostic and therapeutic purposes
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 5-week-old male presents with non-bilious projectile vomiting. An ultrasound is performed (shown). What acid-base disturbance is MOST likely?

A. Hypochloremic metabolic alkalosis
B. Hyperchloremic metabolic acidosis
C. Respiratory acidosis
D. Respiratory alkalosis
E. Normal acid-base balance
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have since resolved. An abdominal ultrasound, as shown, was performed. Liver function tests are normal. Which of the following is the MOST appropriate next step in management?

A. Ursodeoxycholic acid therapy
B. Hepatobiliary iminodiacetic acid (HIDA) scan
C. Referral for elective cholecystectomy
D. Observation with repeat ultrasound in 6 months
E. ERCP with sphincterotomy
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 6-week-old male infant presents with a 1-week history of progressively worsening non-bilious vomiting, often projectile, occurring shortly after feeds. His parents report he is constantly hungry and irritable but has had poor weight gain. On examination, he is alert but appears thin. Vital signs are stable. Abdominal examination is soft, non-tender, with no palpable mass. An abdominal ultrasound is performed, the image of which is shown. Considering the clinical presentation and the findings depicted, what is the most appropriate initial management strategy?

A. Referral to a paediatric gastroenterologist for further investigation
B. Discharge home with advice on smaller, more frequent feeds
C. Urgent upper gastrointestinal contrast study
D. Surgical pyloromyotomy after fluid and electrolyte correction
E. Trial of antiemetic medication and thickened feeds
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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 48-year-old man with multiple cutaneous hemangiomas presents with crampy abdominal pain and guaiac-positive stools. The provided image was obtained. What is the MOST appropriate initial diagnostic test to identify the source of bleeding?

A. Tagged red blood cell scan
B. Upper endoscopy
C. Barium swallow
D. Colonoscopy
E. Capsule endoscopy
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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 a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Referral for liver transplant evaluation
B. Initiate sorafenib therapy
C. Perform a percutaneous liver biopsy
D. Schedule a follow-up ultrasound in 3 months
E. Order a CT scan of the abdomen with IV contrast
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Pyloric stenosis as seen on ultrasound in a 6 week old
Image by Dr Laughlin Dawes CC BY-SA 4.0 · Source

A 6-week-old male infant presents with a 1-week history of progressively worsening non-bilious vomiting, often projectile, occurring shortly after feeds. His parents report he is constantly hungry and irritable but has had poor weight gain. On examination, he is alert but appears thin. Vital signs are stable. Abdominal examination is soft, non-tender, with no palpable mass. An abdominal ultrasound is performed, the image of which is shown. Considering the clinical presentation and the findings depicted, what is the most appropriate definitive management strategy after initial fluid and electrolyte correction?

A. Trial of antiemetic medication
B. Laparoscopic pyloromyotomy
C. Barium meal study
D. Discharge home with feeding advice
E. Endoscopic balloon dilation
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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 previously healthy 2-year-old boy presents to the emergency department with a 1-day history of colicky abdominal pain. His parents report that the pain occurs in episodes, during which he cries intensely and pulls his legs up to his chest. Between episodes, he appears relatively comfortable. He has had one episode of vomiting. His parents also noticed a small amount of blood in his stool this morning. On examination, the child is alert but irritable. His abdomen is soft, but a palpable mass is noted in the right upper quadrant. An ultrasound is performed, with a representative image shown. What is the MOST appropriate initial management strategy?

A. Air enema under fluoroscopic guidance
B. Surgical exploration
C. Appendectomy
D. Observation with intravenous fluids
E. Barium enema
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman reports intermittent RUQ pain. She denies jaundice or fever. An abdominal ultrasound was performed, image shown. Besides referral for surgery, what is the MOST appropriate next step in management?

A. Start prophylactic antibiotics
B. Repeat ultrasound in 6 months
C. Administer ursodeoxycholic acid
D. Prescribe a low-fat diet
E. Arrange an MRCP
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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 imaging, what is the MOST appropriate next step in management?

A. Flexible sigmoidoscopy to rule out malignancy
B. Stool culture to identify infectious etiology
C. Surgical resection of the affected bowel segment
D. IV antibiotics and bowel rest
E. High-fiber diet and increased fluid intake
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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, what is the most appropriate initial therapeutic intervention?

A. Intravenous fluid resuscitation and pain control
B. Administer a nasogastric tube for decompression and observe
C. Air or hydrostatic enema under fluoroscopic guidance
D. Obtain a CT scan of the abdomen
E. Urgent surgical exploration
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman reports past episodes of transient right upper quadrant pain, now resolved. She is currently asymptomatic with normal liver function tests. An abdominal ultrasound was performed as part of her evaluation. Based on the findings from this imaging study and her clinical history, what is the most appropriate management recommendation?

A. Medical dissolution therapy with ursodeoxycholic acid
B. Observation and symptomatic management as needed
C. Magnetic resonance cholangiopancreatography (MRCP) for further evaluation
D. Endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction
E. Elective cholecystectomy
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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 sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale but haemodynamically stable. Abdominal examination reveals a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). What is the most appropriate next step in management?

A. Admission for observation and IV fluids
B. Air or hydrostatic enema reduction
C. Urgent surgical exploration
D. Abdominal CT scan with contrast
E. Intravenous antibiotics
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, but denies any current pain, jaundice, or fever. An abdominal ultrasound is performed, the image is shown. What is the MOST appropriate next step in management?

A. Administer ursodeoxycholic acid
B. Discharge with reassurance
C. Initiate a low-fat diet
D. Referral for elective cholecystectomy
E. Order a HIDA scan
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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 sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on this finding, what is the most appropriate next step in management?

A. Pneumatic or hydrostatic enema reduction
B. Immediate surgical exploration
C. Abdominal CT scan with contrast
D. Observation with IV fluids and analgesia
E. Barium swallow study
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Elective abdominal ultrasonography of a 64 year old woman with past colicky pain but no current pain. It shows a mildly dilated common bile duct with what appears to be a gallstone (black arrow). The green and blue dots are blood flow, since the exam is done as a Doppler ultrasound to distinguish the bile duct from blood vessels.
Image by Mikael Häggström CC0 1.0 · Source

A 64-year-old woman presents for follow-up after experiencing episodes of right upper quadrant pain several months ago, which resolved spontaneously. She denies fever, jaundice, or current abdominal discomfort. Routine blood tests including LFTs are within normal limits. An abdominal ultrasound was performed, with a representative image provided. Considering her history and the imaging findings, what is the most appropriate next step in management?

A. Observation with repeat imaging if symptoms recur.
B. Elective laparoscopic cholecystectomy.
C. Endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction.
D. Urgent open surgical exploration of the common bile duct.
E. Medical dissolution therapy with ursodeoxycholic acid.
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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 sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. Examination reveals a pale child with a soft abdomen. Vitals are stable. An abdominal ultrasound is performed (image provided). What is the most appropriate next step in management?

A. Admission for observation and serial abdominal exams
B. Intravenous antibiotics and fluid resuscitation
C. CT abdomen/pelvis with contrast
D. Pneumatic reduction under fluoroscopy
E. Urgent surgical exploration
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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 intermittent abdominal pain, vomiting, and currant jelly stools. An ultrasound is performed, revealing the image shown. What is the MOST appropriate next step in management?

A. Observation and supportive care
B. Surgical resection
C. IV antibiotics
D. Appendectomy
E. Air enema
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