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abdominal ultrasound

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

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Umbilical hernia
Image by Ibrahim Husain Meraj CC BY-SA 4.0 · Source

A 2-year-old child is brought to the GP by their parents who are concerned about the appearance of their child's abdomen. The child is asymptomatic, feeding well, and has no history of vomiting or pain. On examination, vital signs are normal. Considering the clinical presentation and the finding shown in the image, what is the most appropriate initial management?

A. Arrange an urgent abdominal ultrasound.
B. Urgent surgical referral for repair.
C. Application of an abdominal binder or tape.
D. Prescription of paracetamol and review in 3 months.
E. Observation and reassurance, advising review if symptomatic or persistent beyond age 4-5 years.
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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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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 3-year-old boy presents with colicky abdominal pain and non-bilious vomiting. Physical exam reveals a palpable abdominal mass in the RUQ. An ultrasound is performed, revealing the finding shown. What is the MOST likely lead point?

A. Polyp
B. Appendix
C. Lymphoma
D. Ileocolic valve
E. Meckel's diverticulum
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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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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 woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Considering the clinical presentation and imaging findings, what is the recommended timing for definitive surgical management?

A. Only if symptoms fail to improve with antibiotics
B. Immediately upon diagnosis
C. Following a trial of ursodeoxycholic acid
D. Within 24-48 hours of admission
E. After 6-8 weeks following resolution of acute inflammation
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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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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 58-year-old male presents with vague abdominal pain and unintentional weight loss. He has a history of working on a sheep farm. The provided imaging was obtained. Which of the following serological tests is MOST appropriate?

A. Amoebic serology
B. Hepatitis B surface antigen
C. Echinococcus IgG antibody
D. Strongyloides IgG antibody
E. Alpha-fetoprotein
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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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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 3-week-old male infant is brought to the emergency department by his parents due to persistent, non-bilious vomiting after each feeding for the past week. The vomiting has become increasingly forceful. The infant appears mildly dehydrated, and his weight has remained stable since birth. On examination, an olive-shaped mass is palpated in the epigastric region when the infant is not actively vomiting. An upper GI series is performed, and the image is shown. What is the most appropriate next step in the management of this patient?

A. Initiate a trial of thickened feeds
B. Surgical pyloromyotomy
C. Administer intravenous ondansetron and observe
D. Start erythromycin to stimulate gastric emptying
E. Perform an upper endoscopy with biopsy
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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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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. Order a CT scan of the abdomen with IV contrast
B. Referral for liver transplant evaluation
C. Initiate systemic chemotherapy
D. Begin palliative care
E. Perform a percutaneous 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 4-year-old boy presents to the emergency department with a 12-hour history of intermittent abdominal pain. His mother reports that the pain seems to come in waves, during which he cries and pulls his legs towards his chest. Between episodes, he appears relatively comfortable and plays normally. He has vomited once. His bowel movements have been normal, but his mother noticed a small streak of blood in his diaper this morning. On examination, the child is alert and playful. His abdomen is soft and non-tender to palpation. Bowel sounds are present. Given the history, the physician orders an abdominal ultrasound, the image is shown. What is the MOST likely underlying cause of this patient's condition?

A. Meckel's diverticulum
B. Viral gastroenteritis with reactive lymphadenopathy
C. Appendicitis
D. Idiopathic telescoping of the bowel
E. Henoch-Schönlein purpura
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 68-year-old male with known Hepatitis B related cirrhosis and a history of alcohol excess presents for routine surveillance. His alpha-fetoprotein (AFP) level, which has been stable at 15 ng/mL for the past two years, is now noted to be 185 ng/mL. A screening ultrasound performed three months prior was reported as showing diffuse parenchymal changes consistent with cirrhosis but no focal lesions. Due to the elevated AFP, a repeat ultrasound was performed, which identified a 2.5 cm nodule in segment VIII. To further characterise this lesion, a contrast-enhanced ultrasound (CEUS) was performed, and the images provided are representative findings from this study. The patient has well-compensated cirrhosis (Child-Pugh A) and no significant comorbidities. His liver function tests are within normal limits except for a slightly elevated GGT. Given the clinical context and the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A. Referral to a multidisciplinary liver tumour board for consideration of curative treatment options.
B. Proceed directly to percutaneous biopsy of the lesion for histological confirmation.
C. Refer the patient to a general gastroenterologist for further investigation.
D. Initiate systemic therapy with a tyrosine kinase inhibitor such as sorafenib.
E. Schedule a repeat contrast-enhanced ultrasound in three months to assess for interval change.
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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 and vomiting. Stool examination reveals a positive occult blood test. An ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Air enema
B. Appendectomy
C. Laparotomy
D. Stool culture
E. IV antibiotics
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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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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 72-year-old woman presents with 3 days of worsening right upper quadrant pain, nausea, and vomiting. She has a history of dyspepsia. On examination, she is afebrile (37.2°C), heart rate 95 bpm, blood pressure 130/80 mmHg. Abdominal examination reveals tenderness in the right upper quadrant without guarding or rebound. Bowel sounds are present. Her white cell count is 11 x 10^9/L, CRP 80 mg/L. Liver function tests are normal. The provided imaging was obtained. Considering the clinical presentation and the findings demonstrated in the provided imaging, which of the following complications is this patient at increased risk of developing?

A. Acute appendicitis
B. Acute pancreatitis
C. Diverticulitis
D. Gallstone ileus
E. Ascending cholangitis
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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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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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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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An incarcerated inguinal hernia as seen on CT
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 59-year-old male presents with a painful right groin bulge that has progressively worsened over the past week. He denies fever, chills, nausea, or vomiting. Vitals are stable. The provided image was obtained. What is the MOST appropriate next step?

A. Prescribe analgesics and discharge with surgical follow-up
B. Order a bowel preparation
C. Attempt manual reduction with sedation
D. Initiate broad-spectrum antibiotics
E. Surgical consultation for operative management
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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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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 secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is 600 ng/mL. A contrast-enhanced ultrasound is performed. What is the MOST appropriate next step in confirming the diagnosis and guiding management?

A. Repeat AFP in 3 months
B. Initiate sorafenib therapy
C. Liver biopsy
D. Administer systemic chemotherapy
E. Perform a diagnostic paracentesis
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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 45-year-old male presents to the ED with left flank pain that started suddenly 6 hours ago. He describes the pain as a sharp, cramping sensation radiating to his groin. He also reports nausea and one episode of vomiting. His vital signs are stable: BP 120/80 mmHg, HR 78 bpm, RR 16 breaths/min, Temp 37.1°C. Urine dipstick shows 2+ blood. A renal ultrasound is performed, and the image is shown. Assuming the patient's pain is not controlled with oral analgesics, what is the MOST appropriate next step?

A. Consult urology for emergent ureteroscopy
B. Start intravenous fluids at 250 mL/hr
C. Order a non-contrast CT scan of the abdomen and pelvis
D. Discharge home with tamsulosin and analgesics
E. Administer intravenous ketorolac
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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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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 infant presents to the emergency department with a 3-day history of non-bilious, projectile vomiting after each feed. He is otherwise well-appearing and afebrile. His mother reports that he is feeding well but seems increasingly hungry after vomiting. On examination, the infant is alert and active, with slightly dry mucous membranes. Abdominal examination is unremarkable, with no palpable masses. An ultrasound of the abdomen is performed, the image of which is shown. What is the most appropriate next step in the management of this patient?

A. Surgical consultation for pyloromyotomy
B. Administer intravenous ondansetron and observe
C. Upper gastrointestinal endoscopy with biopsy
D. Discharge home with instructions for frequent small-volume feeds
E. Initiate a 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 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, non-bilious vomiting, and decreased activity. Parents report redcurrant jelly stool. On exam, a palpable mass is noted. Vitals are stable. An ultrasound is performed (shown above). Considering the clinical picture and the image findings, which non-surgical intervention is indicated?

A. Urgent surgical exploration
B. Barium enema reduction
C. Pneumatic reduction under fluoroscopic guidance
D. Intravenous fluid resuscitation and observation
E. Administration of broad-spectrum antibiotics
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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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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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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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Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan
Image by morning2k CC BY 2.5 · Source

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Non-contrast CT of the abdomen and pelvis
B. Perform intravenous pyelogram
C. Insert a Foley catheter
D. Administer intravenous antibiotics
E. Discharge with analgesics and follow-up with urology
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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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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 5-week-old male infant presents with a 10-day history of non-bilious, forceful vomiting after every feed. His parents report decreased wet nappies and lethargy. On examination, he is pale, weighs 3.2 kg (birth weight 3.5 kg), has sunken eyes, and poor skin turgor. Vital signs: HR 170, RR 45, Temp 37.0, BP 80/50. Initial bloods show Na 132, K 3.1, Cl 88, HCO3 30. An imaging study is performed, shown in the image. Considering the clinical presentation and the findings demonstrated in the imaging study, what is the most appropriate immediate management priority for this infant?

A. Administer intravenous ondansetron to control vomiting.
B. Arrange urgent surgical consultation for definitive operative management.
C. Initiate intravenous fluid resuscitation with 0.9% sodium chloride and potassium supplementation.
D. Obtain a repeat imaging study using abdominal ultrasound.
E. Insert a nasogastric tube for gastric decompression and feeding.
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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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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 sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. His vital signs are stable. On examination, he is pale. An abdominal ultrasound is performed, shown in the image. Based on the clinical presentation and imaging findings, what is the most appropriate next step in management?

A. Admission for intravenous fluids and observation
B. Urgent laparotomy for surgical reduction
C. Administer intravenous broad-spectrum antibiotics
D. Pneumatic reduction under fluoroscopic guidance
E. Obtain a CT scan of the abdomen and pelvis
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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 inconsolable crying and drawing up his legs. Stool sample is positive for blood. The ultrasound is shown. What is the next step?

A. Observation
B. Air enema
C. IV antibiotics
D. Stool culture
E. Appendectomy
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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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