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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 an elective abdominal ultrasound. Several months ago, she experienced a few episodes of intermittent, moderate-to-severe right upper quadrant pain that resolved spontaneously within a few hours each time. She denies any associated fever, chills, nausea, vomiting, or jaundice during those episodes or currently. She has no significant past medical history other than well-controlled hypertension. On examination today, she is afebrile, her vital signs are stable, and her abdomen is soft and non-tender. Routine blood tests performed prior to the ultrasound, including full blood count, liver function tests (bilirubin, alkaline phosphatase, AST, ALT, GGT), amylase, and lipase, are all within their respective normal reference ranges. The provided image is a representative view obtained during her ultrasound examination. Considering the patient's history, current clinical status, and the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Reassurance and discharge with advice to return if symptoms recur.
B. Magnetic resonance cholangiopancreatography (MRCP) for further evaluation.
C. Elective cholecystectomy alone.
D. Referral for elective endoscopic retrograde cholangiopancreatography (ERCP) or surgical consultation for stone extraction.
E. Urgent admission for intravenous antibiotics and pain relief.
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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 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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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. Vitals are stable. An ultrasound is performed, shown above. Based on the clinical presentation and the provided image, what is the most appropriate next step in the management of this patient?

A. Urgent surgical consultation for laparotomy
B. Administration of broad-spectrum antibiotics
C. CT scan of the abdomen and pelvis
D. Admission for observation and serial abdominal exams
E. Air enema reduction
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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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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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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. Given the clinical context and imaging findings, what is the most appropriate definitive management strategy?

A. Percutaneous cholecystostomy tube insertion
B. Medical management with IV antibiotics and analgesia only
C. Discharge home with oral antibiotics and outpatient follow-up
D. Laparoscopic cholecystectomy within 24-72 hours
E. Urgent ERCP to relieve obstruction
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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 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. Based on the clinical presentation and imaging findings, what is the most appropriate next step in management?

A. Continue medical management with IV antibiotics and analgesia
B. Laparoscopic cholecystectomy within 24-72 hours
C. Urgent endoscopic retrograde cholangiopancreatography (ERCP)
D. Repeat abdominal ultrasound in 24 hours
E. Percutaneous cholecystostomy tube insertion
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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 was performed, the image of which is shown. Liver function tests are within normal limits. Which of the following is the MOST appropriate next step in management?

A. Repeat ultrasound in 6 months
B. Prescribe ursodeoxycholic acid
C. Referral for elective cholecystectomy
D. Order a HIDA scan
E. Initiate a low-fat diet and monitor symptoms
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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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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 3-week-old male presents with projectile vomiting after feeds. An upper GI series is performed (image shown). What is the MOST appropriate next step in management?

A. Barium swallow study
B. Surgical pyloromyotomy
C. Medical management with erythromycin
D. Trial of thickened feeds
E. Upper endoscopy with biopsy
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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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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 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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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 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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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 68-year-old male with a history of chronic hepatitis C presents to the clinic complaining of right upper quadrant abdominal pain and unintentional weight loss of 10 kg over the past 6 months. His past medical history is significant for well-controlled hypertension and hyperlipidemia. Physical examination reveals mild hepatomegaly. Laboratory investigations show elevated alpha-fetoprotein (AFP) levels. A contrast-enhanced ultrasound of the liver is performed, and representative images are shown. Based on the imaging and clinical context, which of the following is the MOST appropriate next step in management?

A. Radiofrequency ablation of the lesion
B. Surveillance with serial AFP measurements and ultrasound every 3 months
C. Surgical resection of the lesion
D. Initiation of systemic chemotherapy with sorafenib
E. Referral for liver biopsy to confirm diagnosis and assess grade
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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 2-year-old boy presents with abdominal pain and vomiting. An ultrasound is performed, as shown. What is the MOST likely lead point for this condition?

A. Ileocolic junction
B. Polyp
C. Appendix
D. Meckel's diverticulum
E. Duodenal duplication cyst
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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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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 palpable mass. Vitals stable. Ultrasound performed. Based on the clinical presentation and the provided image, what is the most appropriate next step in management?

A. Urgent surgical exploration
B. Pneumatic reduction under fluoroscopy
C. Abdominal CT scan with contrast
D. Admission for observation and IV fluids
E. Administration of broad-spectrum antibiotics
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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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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 bloody stools. An ultrasound is performed. What is the MOST appropriate next step in management?

A. IV antibiotics
B. Appendectomy
C. Air enema
D. Stool culture
E. Observation
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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 after each feed for the past week. He is alert but appears dehydrated. An ultrasound is performed, as shown. What electrolyte abnormality is MOST likely present?

A. Hyperchloremic metabolic acidosis
B. Hyponatremia
C. Normal electrolytes
D. Hypochloremic metabolic alkalosis
E. Hyperkalemia
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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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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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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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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 had this ultrasound. LFTs are normal. What is the MOST appropriate next step?

A. ERCP
B. Referral for elective cholecystectomy
C. MRCP
D. Ursodeoxycholic acid
E. Observation and repeat ultrasound in 6 months
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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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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 4-week-old male presents with persistent projectile vomiting after each feed. He appears hungry and eagerly feeds, but vomits shortly after. An abdominal X-ray is ordered, the result of which is shown. What is the most appropriate next step in management?

A. Start a trial of hypoallergenic formula
B. Initiate intravenous antibiotics
C. Surgical pyloromyotomy
D. Administer antiemetics and observe
E. Upper endoscopy with biopsy
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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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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 colicky pain. An ultrasound was performed. What is the MOST appropriate next step in management?

A. Start a low-fat diet
B. Surgical consultation for cholecystectomy
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Administer ursodeoxycholic acid
E. Repeat ultrasound in 6 months
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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 to the emergency department 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 next step in the management of this patient?

A. Pneumatic reduction under fluoroscopy
B. Abdominal CT scan with contrast
C. Admission for observation and serial abdominal exams
D. Immediate surgical consultation for laparotomy
E. Administration of broad-spectrum intravenous 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 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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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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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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