computed tomography (CT)
Practice targeted AMC-style multiple-choice questions on computed tomography (CT).
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A 32-year-old woman presents to the ED with acute lower abdominal pain and nausea. She reports her last menstrual period was 6 weeks ago, and home pregnancy test was negative yesterday. Vitals are stable. A CT scan of the abdomen and pelvis is performed, the relevant image is shown. What is the MOST appropriate next step in management?
A 3-year-old child is brought to the paediatric clinic by their parents due to a 2-month history of increasing abdominal distension, poor appetite, and occasional constipation. On physical examination, a firm, irregular mass is palpable in the upper abdomen, crossing the midline. Vital signs are stable. Initial blood tests, including full blood count and liver function tests, are within normal limits. An abdominal CT scan is performed (image provided). Considering the findings demonstrated in the image, which of the following investigations represents the most appropriate next step in establishing a definitive diagnosis and guiding further management?
A 68-year-old male presents to the emergency department complaining of abdominal pain, distension, and obstipation for the past 3 days. He reports a history of multiple abdominal surgeries for adhesions. His vital signs are: HR 110 bpm, BP 110/70 mmHg, RR 22 breaths/min, SpO2 97% on room air, and temperature 37.8°C. Physical examination reveals a distended abdomen with high-pitched bowel sounds. An upright abdominal X-ray is performed, as shown. Given the clinical context and the findings on the imaging, what is the MOST appropriate next imaging investigation to guide management?
A 4-year-old boy presents with a 3-week history of decreased appetite, lethargy, and intermittent abdominal pain. His parents note his abdomen seems larger. Vitals are stable. On examination, a firm, irregular mass is palpable in the upper abdomen. Blood work shows mild anaemia. The provided image is an axial CT slice of the abdomen. Considering the clinical presentation and the findings demonstrated in the image, which of the following investigations is the MOST appropriate initial step to support the suspected diagnosis?
A 72-year-old male with a history of hypertension and hyperlipidemia presents for a routine follow-up. He is asymptomatic. A contrast-enhanced CT scan of the abdomen was performed as part of a screening protocol. An axial view is shown. What is the MOST appropriate next step?
A 75-year-old male with a history of atrial fibrillation on warfarin presents to the emergency department with acute onset shortness of breath and right-sided chest pain. His vital signs are stable. His INR is found to be 7.2. A chest CT is performed (image attached). Based on the clinical presentation and imaging findings, what is the MOST appropriate immediate management step?
A 63-year-old man presents with dysphagia and early satiety. His BMI is 21. A CT scan is performed. Based on the image, and assuming conservative measures have failed, what surgical approach is MOST appropriate?
A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few months despite being on maintenance therapy with azathioprine. A CT scan of the abdomen and pelvis is performed, as shown. Based on the imaging findings, which of the following is the MOST appropriate next step in management?
A 68-year-old male presents with new onset constipation and abdominal pain. The provided CT was obtained. What is the MOST likely long-term complication?
A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). The provided image was obtained as part of his staging workup. Which of the following is the MOST appropriate next step in management?
A 62-year-old male presents to the emergency department complaining of left lower quadrant abdominal pain for the past three days. He describes the pain as constant and sharp, rating it an 8 out of 10. He also reports nausea, decreased appetite, and subjective fevers. His past medical history is significant for hypertension and hyperlipidemia, both well-controlled with medications. He denies any recent travel or sick contacts. On physical examination, his abdomen is tender to palpation in the left lower quadrant with guarding. Bowel sounds are present but diminished. The remainder of his examination is unremarkable. His vital signs are: Temperature 38.2°C, Heart Rate 98 bpm, Blood Pressure 140/90 mmHg, Respiratory Rate 18 breaths per minute, and Oxygen Saturation 98% on room air. Laboratory results show a white blood cell count of 14,000/µL with a neutrophilic predominance. A CT scan of the abdomen and pelvis with intravenous contrast is performed, and a representative image is shown. Assuming the patient has no allergies, what is the MOST appropriate initial management strategy?
A 45-year-old male with a known history of Blue Rubber Bleb Naevus Syndrome, characterised by recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions, presents to the emergency department with acute onset severe, colicky abdominal pain, nausea, and vomiting. On examination, his abdomen is distended and diffusely tender with reduced bowel sounds. Vital signs are within normal limits. An urgent abdominal CT scan is performed. Considering the patient's history, acute presentation, and the findings on the abdominal CT scan, what is the most appropriate immediate management strategy?
A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals intact language function and no cognitive deficits. A CT angiogram was performed, followed by endovascular coiling. The provided image shows a post-operative angiogram. Despite the intervention, the patient's hemianopia persists, and her weakness has slightly worsened. What is the MOST appropriate next step in the management of this patient?
A 68-year-old male presents with dysphagia and weight loss. Gastroscopy and biopsy confirm gastric adenocarcinoma. Staging CT imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?
A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?
A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, managed with lisinopril. He denies any abdominal pain, back pain, or lower extremity claudication. Physical exam is unremarkable. A contrast-enhanced CT scan of the abdomen is performed, the axial view is shown. What is the MOST appropriate next step in management?
A 62-year-old woman presents with a 4-month history of increasing abdominal distension, bloating, and a sensation of early fullness after eating. She has also noticed a gradual increase in her waist circumference and reports feeling more fatigued than usual. Her medical history includes well-controlled type 2 diabetes mellitus and hypercholesterolaemia, managed with metformin and atorvastatin respectively. She is post-menopausal, having completed menopause 10 years ago. On physical examination, her vital signs are stable: blood pressure 128/78 mmHg, heart rate 68 bpm, respiratory rate 14/min, and temperature 36.6°C. Abdominal examination reveals moderate distension and a firm, irregular mass is palpable extending from the pelvis into the lower abdomen. Bowel sounds are present and normal. A recent transvaginal ultrasound was inconclusive due to the size of the mass, prompting a CT scan of the abdomen and pelvis, an axial image from which is shown. Given the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?
A 72-year-old woman presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unintentional weight loss of 4 kg. She reports feeling increasingly tired. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable. Abdominal examination is soft, non-tender, with no palpable masses. Digital rectal examination reveals no palpable lesion. Blood tests show a haemoglobin of 108 g/L, MCV 78 fL, and ferritin 12 µg/L. A colonoscopy was performed, and the image provided was captured during the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, which of the following investigations is most crucial for determining the extent of disease and guiding definitive treatment planning within the multidisciplinary team framework?
A 28-year-old immunocompetent patient presents with a chronic cough and low-grade fever. Initial investigations, including sputum microscopy, are negative. A PET-CT scan was performed (image shown). What is the MOST appropriate next step?
A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 105 bpm, BP 130/80 mmHg, Temp 38.5°C. Physical exam reveals marked tenderness on palpation of the right upper quadrant. An abdominal CT scan is performed, as shown. What is the MOST appropriate next step in management?
A 70-year-old male with known gastric MANEC presents with worsening jaundice and ascites. The provided CT scan was performed. Which of the following serum markers would be MOST useful in monitoring disease progression in this patient?
A 55-year-old woman presents with 24 hours of severe right upper quadrant pain, fever, and nausea. Examination reveals RUQ tenderness and a positive Murphy's sign. Vitals: T 38.5°C, HR 105, BP 130/80, RR 18, SpO2 98% RA. Labs: WCC 16, CRP 120, LFTs normal. An urgent abdominal CT is performed. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate definitive management strategy for this patient?
A 63-year-old man presents with dysphagia and epigastric discomfort. A CT scan is performed, as shown. What is the MOST likely long-term complication?
A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. Considering the clinical presentation and the imaging findings, what is the MOST appropriate next step in the management of this patient?
A 78-year-old male on warfarin for atrial fibrillation presents with acute severe dyspnoea and right-sided pleuritic chest pain. Vitals: T 36.8°C, HR 95, BP 110/70, RR 24, SpO2 92% RA. Exam: decreased breath sounds, dullness right hemithorax. A CT scan of the chest is performed. Considering the patient's presentation, history, and the imaging findings, which is the most appropriate immediate management?
A 63-year-old man presents to his general practitioner with a several-year history of worsening symptoms. He describes significant heartburn and regurgitation, particularly when lying down, which is only partially relieved by high-dose proton pump inhibitors. He has also noticed increasing difficulty swallowing solid food and occasionally liquids, sometimes accompanied by coughing fits after eating. He reports feeling full very quickly after starting a meal and has lost approximately 5 kg unintentionally over the past year. His past medical history includes osteoarthritis and benign prostatic hyperplasia. He is a non-smoker and drinks alcohol occasionally. Physical examination is unremarkable. Routine blood tests, including full blood count, electrolytes, and liver function tests, are within normal limits. A CT scan of the chest and upper abdomen was performed as part of the workup for his symptoms, and a representative axial image is shown. Considering the clinical presentation and the findings demonstrated in the image, which of the following represents the MOST appropriate definitive management strategy for this patient?
A 78-year-old male presents to the emergency department with a 6-hour history of sudden onset, severe pain and swelling in his right groin. He reports nausea but no vomiting. On examination, there is a tender, firm, non-reducible lump in the right inguinal region. Bowel sounds are present. Vitals are stable: BP 130/80, HR 75, Temp 36.8°C. A CT scan of the pelvis is performed, shown in the image. Integrating the patient's symptoms, physical examination, and the findings shown in the image, what is the most appropriate immediate next step?
A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. He reports occasional regurgitation of undigested food. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?
A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical presentation and the findings on the provided image, which of the following investigations is most appropriate to recommend for this patient *after* resolution of the acute episode?
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 3-year-old boy presents to the emergency department with a one-week history of abdominal pain, decreased appetite, and irritability. His parents also report that he has been increasingly tired and pale. On examination, the child is noted to have a palpable abdominal mass. A CT scan of the abdomen is performed, the axial view is shown. Based on the image and clinical presentation, which of the following is the MOST appropriate next step in management?
A 68-year-old male presents to the ED with a painful lump in his groin that has been present for 3 days. He reports nausea but denies vomiting. His vital signs are stable. An abdominal CT is performed, and a slice is shown. What is the MOST appropriate next step in management?
A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 110, BP 130/80, Temp 38.5°C. An abdominal CT scan is performed (image attached). What is the MOST appropriate next step in management?
A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical context and the findings demonstrated in the provided image, what is the most appropriate recommendation regarding subsequent investigation of the colon following resolution of the acute symptoms?
A 58-year-old male with a 15-year history of chronic hepatitis B infection and established cirrhosis presents for a routine surveillance appointment. He reports feeling generally well, with no significant weight loss, abdominal pain, or jaundice. He denies alcohol use. On examination, his vital signs are stable. He has mild palmar erythema but no ascites or peripheral oedema. Liver span is normal. Recent blood tests show platelet count 120 x 10^9/L, albumin 35 g/L, INR 1.2, total bilirubin 20 µmol/L, ALT 40 U/L, AST 55 U/L, creatinine 80 µmol/L. Alpha-fetoprotein (AFP) has risen from 50 µg/L six months ago to 450 µg/L today. A triphasic CT scan of the abdomen was performed as part of the surveillance protocol, axial views of which are provided. Considering the patient's clinical history, laboratory trends, and the findings demonstrated on the provided imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?
A 78-year-old male on warfarin for atrial fibrillation presents to the emergency department with sudden onset of severe dyspnoea and right-sided pleuritic chest pain. He denies trauma. On examination, he is tachypnoeic, oxygen saturation is 92% on room air. Blood pressure 110/70 mmHg, heart rate 95 bpm. Chest examination reveals decreased breath sounds on the right. A CT scan of the chest is performed. Considering the patient's clinical presentation, medical history, and the findings demonstrated in the provided image, which of the following represents the most appropriate immediate management strategy?
A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the MOST appropriate next step in management?
A 35-year-old male presents to the ED with intermittent abdominal pain, nausea, and melena. He has multiple cutaneous hemangiomas. A CT scan is performed, as shown. What is the MOST appropriate next step in management?
A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are irregular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?
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 62-year-old male presents to the emergency department complaining of worsening abdominal pain, fatigue, and a 10kg unintentional weight loss over the past 3 months. He reports a history of peptic ulcer disease treated with long-term proton pump inhibitors. Physical examination reveals mild hepatomegaly and trace ascites. Initial laboratory investigations show elevated alkaline phosphatase and gamma-glutamyl transferase (GGT), with normal bilirubin and transaminases. A CT scan of the abdomen and pelvis with contrast is performed, and relevant images are shown. Given the clinical presentation and the findings on the imaging, which of the following is the MOST appropriate next step in management?
A 2-year-old child is evaluated for a 6-week history of increasing abdominal girth, decreased appetite, and occasional bone pain. Physical examination reveals a large, firm, irregular mass in the upper abdomen that appears fixed and crosses the midline. Vital signs are within normal limits for age. Initial investigations show mild anaemia and elevated serum lactate dehydrogenase. An abdominal CT scan is performed (image provided). Given the findings demonstrated in the image and the clinical context, which of the following molecular or genetic analyses is considered a critical determinant of risk stratification and influences treatment intensity for the most likely underlying malignancy?
A 35-year-old male presents with a two-month history of fatigue, unintentional weight loss, and a persistent dry cough. He denies fever or night sweats. A PET-CT scan of the chest was performed (image shown). What is the MOST appropriate next step in management?
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 32-year-old woman presents with pelvic pain and bloating. Her periods are regular. An abdominal CT scan is performed. Based on the image, what is the MOST appropriate next step in management?
A 68-year-old man presents with 3 days of worsening left lower quadrant pain, fever, and nausea. He has a history of diverticulosis. On examination, he is tachycardic (HR 105), afebrile (37.5°C), and has localised tenderness with guarding in the left iliac fossa. His blood tests show a WCC of 16 x 10^9/L and CRP 150 mg/L. He is commenced on intravenous antibiotics. A CT scan is performed (image provided). Considering the clinical context and the findings on the image, what is the most appropriate next step in management?
An asymptomatic 70-year-old male undergoes a CT scan of the abdomen as part of an investigation for mild, intermittent lower back pain. His vital signs are stable, and physical examination is unremarkable. Considering the findings on the provided image, what is the most appropriate next step in this patient's management?
A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?