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abdominal swelling

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

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

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?

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

A 3-year-old child is brought to the GP by their parents who are worried about the appearance of their child's abdomen, as shown in the image. The child is otherwise well, active, and has no pain, vomiting, or changes in bowel habits. On examination, the finding is soft and easily reducible. Vital signs are normal. Based on this presentation and the image, what is the most appropriate initial management?

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A 1-month-old baby has a palpable mass in the right flank and abdominal swelling. An ultrasound reveals a solid mass in the kidney. What is the most likely diagnosis?

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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 58-year-old male presents to your GP clinic complaining of a dragging sensation in his right groin, particularly when standing for long periods. He denies any pain, nausea, or vomiting. On examination, you note the finding in the image. Palpation reveals a soft, reducible mass. What is the MOST appropriate next step in management?

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A 62-year-old male presents to his general practitioner with a six-month history of a painless swelling in his right groin. He reports that the swelling becomes more prominent when he strains or coughs and reduces when he lies down. On examination, a soft, reducible bulge is palpable in the right inguinal region. The bulge is felt to emerge medial to the inferior epigastric vessels. Which of the following is the most appropriate next step in management, according to current Australian guidelines?

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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 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed, the axial view is shown. What is the most appropriate next step in management?

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

A 1-year-old presents with the abdominal exam shown. It is easily reducible. What is the most appropriate management?

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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 58-year-old male with known alcoholic cirrhosis undergoes surveillance. AFP is 600 ng/mL. The provided image was obtained. What is the next step?

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Diverticular disease
Image by James Heilman, MD CC BY-SA 4.0 · Source

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?

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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 65-year-old male with known alcoholic cirrhosis presents for routine HCC screening. His AFP is 25 ng/mL. A CT scan with IV contrast is performed (image attached). What is the MOST appropriate next step in management?

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents with increasing postprandial fullness. The provided image was obtained. What is the MOST appropriate next step in management?

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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

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A 2-week-old baby is brought to the clinic with abdominal distension and bilious vomiting. On examination, the abdomen is tense and tender. What is the most likely diagnosis?

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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

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?

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An incarcerated inguinal hernia as seen on CT
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male presents with a painful, irreducible right groin mass. He reports vomiting and abdominal distension. His vitals are: HR 110, BP 100/60, RR 22, SpO2 96% RA. The provided image was obtained. What is the next step?

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

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?

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

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?

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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 70-year-old male presents with jaundice and abdominal distension. The provided image was obtained. What is the MOST likely underlying cause of the jaundice?

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A 6-month-old baby has abdominal swelling and vomiting. An abdominal X-ray shows a 'double bubble' sign. What is the most likely diagnosis?

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A neonate, born at 38 weeks gestation, presents with bilious vomiting starting 12 hours after birth. Antenatal ultrasound revealed polyhydramnios. On examination, the baby is active and has a distended upper abdomen but a scaphoid lower abdomen. An abdominal X-ray shows a 'double bubble' sign. Which of the following is the most appropriate next step in the management of this neonate, considering potential associated complications?

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

A 6-month-old male infant is brought to the emergency department by his parents. They report that they have noticed a bulge on his abdomen that seems to get larger when he cries. The infant is otherwise healthy, feeding well, and has normal bowel movements. On examination, the infant is afebrile, and his vital signs are within normal limits. The abdomen is soft and non-tender. Palpation reveals a soft, reducible mass at the umbilicus, as shown in the image. What is the MOST appropriate next step in the management of this patient?

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and bone pain. An abdominal CT is performed (image attached). Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

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Upright X-ray demonstrating small bowel obstruction
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents with abdominal distension and obstipation. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

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A neonate is born at term following an uneventful pregnancy. Immediately after birth, the baby develops bilious vomiting. Abdominal examination reveals epigastric distension, but the rest of the abdomen is scaphoid. An abdominal X-ray is performed. Which of the following findings on the abdominal X-ray would be most consistent with the likely diagnosis?

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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. AFP is elevated. The provided image was obtained. What is the MOST appropriate next step in management?

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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and vague pain. Vitals are stable. An abdominal CT is performed (image attached). Elevated levels of HVA and VMA are noted in the urine. What is the MOST likely origin of the primary lesion?

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A newborn has abdominal swelling and scrotal swelling. On examination, the swelling is soft and reducible. What is the most likely diagnosis?

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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old presents with abdominal distension and bone pain. The provided image was obtained. What is the MOST likely source of the elevated urine HVA and VMA?

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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?

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

A 6-month-old presents for a well-child check. The image shows the abdominal exam. Parents report it enlarges when crying. What is the most appropriate next step?

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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, accentuated during crying. The infant 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?

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A 50-year-old woman presents with increasing abdominal swelling and early satiety. Examination reveals ascites. Which investigation is most crucial to guide initial management?

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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 image, what is the most appropriate next step in management?

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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 62-year-old male presents with a 6-month history of a painless swelling in his right groin, visible especially when standing. Examination reveals the finding in the image. The mass reduces when lying down. What is the MOST appropriate initial management?

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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

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?

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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small

bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F CC BY 2.0 · Source

A 45-year-old patient with a long history of recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions presents with acute onset severe abdominal pain, nausea, and distension. Physical examination reveals a distended, mildly tender abdomen. Bowel sounds are reduced. Vital signs are stable. Imaging is performed. Considering the patient's presentation and the findings demonstrated in the image, which of the following represents the most appropriate initial management approach?

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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated at 450 ng/mL. The provided image was obtained. What is the MOST appropriate next step in management?

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Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 60-year-old man presents with a 6-month history of intermittent aching discomfort in his right groin, exacerbated by standing and lifting. He reports noticing a bulge in the area, similar to the appearance shown, which usually disappears when he lies down. On examination, the bulge is reducible. Vital signs are normal. Considering the clinical presentation and the image, which anatomical structure is the most likely primary site of the fascial defect?

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