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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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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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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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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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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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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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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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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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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 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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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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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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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 persistent non-bilious vomiting after feeding. He appears hungry and has lost weight since birth. Examination reveals visible peristaltic waves across the abdomen. An abdominal ultrasound is performed, as shown. What is the most likely acid-base disturbance seen in this patient?

A. Metabolic alkalosis
B. Respiratory acidosis
C. Normal acid-base balance
D. Respiratory alkalosis
E. Metabolic acidosis
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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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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 45-year-old female presents to the emergency department with a 3-day history of right upper quadrant pain, nausea, and subjective fevers. She reports that the pain is constant and worsened by eating. She has no significant past medical history and takes no medications. On examination, she is noted to be uncomfortable, with a temperature of 38.2°C, heart rate of 110 bpm, blood pressure of 130/80 mmHg, and an oxygen saturation of 99% on room air. Abdominal examination reveals marked tenderness to palpation in the right upper quadrant with guarding. Murphy's sign is positive. Laboratory investigations reveal a white blood cell count of 15,000/µL with neutrophilic predominance, total bilirubin of 1.8 mg/dL, alkaline phosphatase of 280 U/L, ALT of 160 U/L, and AST of 130 U/L. The provided image was obtained. Considering the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in management?

A. Order a hepatobiliary iminodiacetic acid (HIDA) scan
B. Administer analgesics and antiemetics, and discharge home with outpatient follow-up
C. Perform an ERCP to rule out choledocholithiasis
D. Initiate intravenous antibiotics and observe for 48 hours
E. Surgical consultation for cholecystectomy
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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 abdominal examination. What is the most appropriate next step in management?

A. Obtain a stool sample to rule out infection
B. Reassurance and observation
C. Order an abdominal ultrasound to assess for bowel obstruction
D. Initiate treatment for gastroesophageal reflux
E. Referral to a pediatric surgeon for elective repair
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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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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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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. Elective laparoscopic cholecystectomy alone.
B. Immediate endoscopic retrograde cholangiopancreatography (ERCP).
C. Initiate medical dissolution therapy with ursodeoxycholic acid and review in 3 months.
D. Observation with regular clinical follow-up and repeat abdominal ultrasound in 6 months.
E. Elective endoscopic retrograde cholangiopancreatography (ERCP) followed by elective laparoscopic cholecystectomy.
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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. Advise watchful waiting and review if symptoms recur.
B. Schedule elective Endoscopic Retrograde Cholangiopancreatography (ERCP) for stone extraction.
C. Proceed directly to laparoscopic cholecystectomy.
D. Prescribe ursodeoxycholic acid to dissolve the stone.
E. Arrange Magnetic Resonance Cholangiopancreatography (MRCP) to further evaluate the biliary tree.
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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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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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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. 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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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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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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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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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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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. An abdominal ultrasound is performed (image attached). What is the MOST appropriate next step in management?

A. Initiate a proton pump inhibitor
B. Surgical consultation for pyloromyotomy
C. Reassurance and close follow-up
D. Upper endoscopy with biopsy
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 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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