Practice targeted AMC-style multiple-choice questions on abdominal imaging.
A 68-year-old male presents with abdominal distension, obstipation, and vomiting. He has a history of prior abdominal surgery. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?
A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to her back, associated with nausea, vomiting, and subjective fever. On examination, she is febrile (38.5°C) and has marked tenderness and guarding in the right upper quadrant. Her vital signs are otherwise stable. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is subsequently performed. Considering the patient's clinical presentation and the findings demonstrated in the provided imaging, what is the most appropriate definitive management strategy?
A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most likely underlying cause?
A 72-year-old male with a history of smoking and hyperlipidemia presents for a health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed as part of a screening protocol. An axial view is shown. Besides optimizing medical management, 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 2 days. Her vital signs are: BP 130/80 mmHg, HR 105 bpm, Temp 38.5°C, RR 18 bpm, SpO2 98% on room air. An abdominal CT scan with contrast is performed, and a slice is shown. What is the MOST appropriate next step in management?
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 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 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 with a history of chronic hepatitis C presents to his general practitioner for a routine check-up. He reports no new symptoms. His liver function tests from 6 months ago were within normal limits. However, recent blood work reveals an elevated alpha-fetoprotein (AFP) level of 600 ng/mL (normal <10 ng/mL). The GP orders a contrast-enhanced ultrasound of the liver, the images from which are shown. Based on the ultrasound findings and the patient's history, what is the MOST appropriate next step in management?
A 62-year-old male presents to the emergency department with right upper quadrant abdominal pain, weight loss, and increasing jaundice over the past month. He has a history of chronic hepatitis C infection and heavy alcohol use. His vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations show elevated bilirubin, alkaline phosphatase, and gamma-glutamyl transferase (GGT). Alpha-fetoprotein (AFP) is significantly elevated. A CT scan of the abdomen with and without contrast is performed, as shown. Based on the clinical presentation and imaging findings, what is the MOST appropriate next step in management?
A 35-year-old presents with colicky abdominal pain and vomiting. An X-ray is performed. What is the MOST likely finding on subsequent CT imaging?
A 68-year-old male presents to the ED with severe groin pain and a palpable mass. He reports constipation and inability to pass flatus for 24 hours. Examination reveals tenderness and erythema. A CT scan is performed. What is the MOST appropriate next step in management?
A 63-year-old woman with a 20-year history of Crohn's disease presents with worsening abdominal pain, bloating, and occasional post-prandial vomiting. She is currently managed with mesalazine and budesonide. Physical examination reveals mild right lower quadrant tenderness. Laboratory tests show a slightly elevated CRP. Given her presentation and the provided imaging, what is the most appropriate next step in her management?
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, with slightly decreased skin turgor. His weight is below the 5th percentile for his age. An abdominal X-ray is unremarkable. Given the clinical presentation, the physician orders further imaging, the results of which are shown. What is the MOST appropriate next step in the management of this patient?
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 step in management?
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 63-year-old male with a history of mild dysphagia and iron deficiency anemia presents for further evaluation. He denies any recent weight loss or hematemesis. An abdominal CT scan with contrast is performed, the axial view is shown. What is the MOST likely underlying cause of his anemia?
A 4-year-old with abdominal pain and hypertension has this CT. 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 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 32-year-old male presents to the emergency department with a 3-day history of worsening abdominal pain, primarily localized to the right lower quadrant. He reports associated nausea and decreased appetite but denies vomiting or diarrhea. His past medical history is significant for Crohn's disease, diagnosed 8 years ago, managed with intermittent courses of oral corticosteroids and azathioprine. He admits to poor adherence to his azathioprine regimen over the past year. On examination, he is afebrile with a heart rate of 92 bpm, blood pressure of 120/80 mmHg, and oxygen saturation of 98% on room air. Abdominal examination reveals tenderness to palpation in the right lower quadrant with guarding. Bowel sounds are normoactive. Laboratory investigations reveal a white blood cell count of 11,500/µL with neutrophilia, a C-reactive protein (CRP) of 45 mg/L, and normal liver function tests. A CT scan of the abdomen and pelvis with IV contrast is performed, the relevant images of which are shown. Given the patient's presentation and imaging findings, which of the following is the MOST appropriate next step in management?
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 68-year-old male presents to the ED with colicky abdominal pain, nausea, and vomiting. He reports no bowel movements for 3 days. His abdomen is distended and tender. An X-ray is performed. Given the findings, what is the MOST likely underlying cause of this patient's condition?
A 75-year-old male with a history of a reducible groin hernia presents with acute abdominal pain. The provided image was taken. What is the most likely complication?
A 63-year-old male presents with postprandial vomiting and persistent retrosternal discomfort. He reports feeling full quickly after eating only small amounts. An abdominal CT scan is performed, the axial view is shown. What is the MOST likely underlying mechanism contributing to this patient's symptoms?
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 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 male presents with intermittent abdominal pain and melena. The provided image was obtained. What associated cutaneous finding is most likely?
A 3-week-old male presents with 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 68-year-old male presents to the ED with abdominal distension, obstipation, and vomiting. He reports a history of multiple abdominal surgeries. An upright abdominal X-ray is performed. Based on the image, what is the MOST appropriate next step in management?
A 3-week-old male infant is brought to the emergency department by his parents. They report that he has been experiencing projectile vomiting after every feed for the past week. The vomiting is non-bilious. He appears dehydrated, with sunken fontanelles and decreased skin turgor. His weight has decreased since his last check-up. An abdominal X-ray is ordered, the results of which are shown. What is the most appropriate next step in the management of this patient?
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 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. Considering the clinical context and the radiographic findings, what is the MOST likely underlying cause of this presentation?
A 62-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and nausea for 3 days. His WBC count is 14,000. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?
A 68-year-old male with a history of multiple abdominal surgeries presents to the emergency department complaining of abdominal pain, distension, and obstipation for the past 3 days. 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 radiographic findings, which demonstrate significant intraluminal gas accumulation proximal to the likely site of obstruction, what is the predominant source of this gas?
A 68-year-old male presents with a 3-day history of abdominal pain, distension, and obstipation, with a background of multiple abdominal surgeries. Vitals show HR 110, BP 110/70, T 37.8°C. Physical exam reveals a distended abdomen with high-pitched bowel sounds. An upright abdominal X-ray is shown. Considering the clinical findings and the radiographic appearance, which of the following potential complications is the MOST critical to evaluate for urgently?
A 72-year-old male with a history of diverticulitis presents with severe abdominal pain, vomiting, and inability to pass flatus for 24 hours. An upright abdominal X-ray is performed. Based on the image, what is the MOST likely underlying cause?
A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and nausea for 3 days. His WBC count is 14,000. A CT scan of the abdomen and pelvis is performed, the axial view is shown. 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 70-year-old male presents with a painful groin mass and constipation. The provided image was taken. What is the most appropriate next step?
A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, well-controlled with medication. 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 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). A CT scan of the abdomen is performed, the results of which are shown. What is the MOST appropriate next step in management?
A 65-year-old male with chronic hepatitis C cirrhosis undergoes routine surveillance imaging. He has no new symptoms. Liver function tests are stable. Alpha-fetoprotein is mildly elevated. The provided images are obtained. 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 65-year-old male presents with acute LLQ pain. The provided image was obtained. What dietary advice is most appropriate upon resolution of acute symptoms?
A 58-year-old male, on chronic immunosuppressants, presents with vague abdominal pain. The images are shown. What is the MOST likely causative organism?
A 31-year-old woman presents with pelvic pain and bloating for 3 months. Her periods are regular. Pelvic exam reveals mild adnexal tenderness. A CT scan is performed, with a relevant image shown. What is the MOST appropriate next step?
A 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. What is the MOST appropriate next step in the management of this patient?
A 42-year-old male presents to the emergency department with a 3-day history of colicky abdominal pain, nausea, and vomiting. He reports that he has not had a bowel movement in 2 days and has noticed some blood in his vomit. He has a known history of multiple cutaneous hemangiomas since childhood. On examination, his abdomen is distended and tympanic, with tenderness to palpation in all quadrants. Bowel sounds are high-pitched and infrequent. Vitals are stable. A CT scan of the abdomen and pelvis is performed, and a representative image is shown. What is the MOST likely underlying cause of the patient's acute presentation, considering his history and the imaging findings?