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Practice targeted AMC-style multiple-choice questions on ultrasound.

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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?

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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 48-year-old woman presents with acute onset severe left flank pain radiating to the groin, associated with nausea. She denies fever or dysuria. Vitals are stable. Urinalysis shows haematuria. Serum creatinine is 75 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most appropriate next diagnostic step?

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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A 3-year-old boy presents to the emergency department with a 24-hour history of intermittent, severe abdominal pain. His mother reports episodes where he cries inconsolably, draws his knees to his chest, and then seems to recover briefly before the pain returns. He has also passed a stool mixed with mucus and blood, described as 'red currant jelly'. On examination, the child is afebrile, but appears pale and lethargic. Abdominal palpation reveals a sausage-shaped mass in the right upper quadrant. An ultrasound is performed, and a representative image is shown. Assuming the diagnosis is confirmed, what is the MOST appropriate next step in 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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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 denies fever or dysuria. Vitals are stable. A point-of-care ultrasound is performed, with the image shown. Assuming no contraindications, what is the MOST appropriate next step in management?

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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A 3-year-old boy presents to the emergency department with a 12-hour history of sudden onset, severe, colicky abdominal pain, drawing his legs up, and non-bilious vomiting. His parents report he has been listless between episodes and had a small amount of red jelly-like stool earlier. Vitals: T 37.2°C, HR 110, RR 24, BP 95/60, Sats 98% on air. Abdominal examination reveals tenderness in the right upper quadrant and a palpable mass. Bowel sounds are diminished. A point-of-care ultrasound is performed. Based on the clinical presentation and the findings demonstrated in the provided ultrasound image, what is the most appropriate initial management step for this patient?

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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 man presents with sudden onset severe left flank pain radiating to the groin, associated with nausea. He is afebrile, blood pressure 140/90 mmHg, heart rate 95 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following best explains the mechanism of the patient's pain?

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A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It feels smooth, mobile, and non-tender. No family history of breast cancer. On examination, a 2cm, firm, mobile mass is noted. Considering Australian guidelines for a palpable breast lump in this age group, what is the most appropriate initial investigation?

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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 35-year-old male presents with left flank pain and dysuria. An ultrasound is performed. What is the MOST appropriate next step in management?

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A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It is slightly tender, especially before her period. On examination, it is mobile, firm, and about 2 cm. No skin changes or nipple discharge. What is the most appropriate initial investigation?

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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 increasing frequency of non-bilious vomiting after feeds for the past week. He is otherwise well, afebrile, and has wet nappies. On examination, he is alert and interactive. Abdominal examination is unremarkable. Vitals are stable. You order an ultrasound, which is shown. Based on the clinical presentation and the provided image, what is the most appropriate immediate next step in management?

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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. Considering the clinical presentation and the findings in the image, what is the most appropriate initial management step?

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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 emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

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A 42-year-old woman presents with a new, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

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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?

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Hypertrophic pyloric stenosis
Image by Adityagupta95 CC0 1.0 · Source

A 6-week-old male infant presents with a 2-week history of progressively worsening projectile non-bilious vomiting after feeds. He has lost weight and appears lethargic. Initial bloods show a hypochloremic, hypokalaemic metabolic alkalosis. After fluid resuscitation, the image is obtained. What is the most appropriate definitive management for this patient?

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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 woman presents with acute onset left flank pain, radiating to the groin. She reports dysuria and hematuria. Vitals: HR 88, BP 130/80, Temp 37.1°C. A bedside ultrasound is performed, as shown. What is the MOST appropriate next step?

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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 woman presents with sudden onset, severe left flank pain radiating to her groin. She reports associated nausea but denies fever or dysuria. On examination, she is afebrile, blood pressure 125/75 mmHg, heart rate 80 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most likely underlying mechanism causing the patient's pain?

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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 to the emergency department with a 2-week history of progressively worsening non-bilious vomiting, which has become projectile over the past few days. His parents report he is feeding eagerly but vomits most feeds shortly after completion. He has had fewer wet nappies than usual and appears more lethargic. On examination, he is irritable but consolable. His weight is below the 3rd percentile, having dropped from the 10th percentile at birth. Vital signs are: Temperature 36.8°C, Heart Rate 155 bpm, Respiratory Rate 40 bpm, Blood Pressure 85/50 mmHg, Oxygen Saturation 98% on room air. Capillary refill time is 3 seconds. Abdominal examination reveals a soft, non-distended abdomen with active bowel sounds; no palpable masses are appreciated. Initial blood gas shows pH 7.52, pCO2 40 mmHg, Bicarbonate 32 mmol/L, Na+ 132 mmol/L, K+ 3.0 mmol/L, Cl- 88 mmol/L. A point-of-care ultrasound was performed, and the image provided was obtained. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this infant?

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A 70-year-old man with a history of atrial fibrillation presents with sudden onset of severe pain, pallor, and coldness in his left leg. On examination, the leg is cool below the knee, distal pulses are absent, and sensation is diminished. Which of the following is the most appropriate initial diagnostic investigation?

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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 infant presents with a 1-week history of increasing frequency of non-bilious, projectile vomiting occurring shortly after feeds. He has lost some weight since his last check-up. Examination is otherwise unremarkable. An ultrasound is performed, shown in the image. Based on the clinical presentation and the provided image, which of the following electrolyte abnormalities is the most likely consequence if this condition remains untreated?

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A 45-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. She has no family history of breast cancer. On examination, the lump is firm, mobile, and approximately 2 cm. What is the most appropriate initial investigation?

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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale but haemodynamically stable. Abdominal examination reveals a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). What is the most appropriate next step in management?

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A 70-year-old man with a history of atrial fibrillation presents with sudden onset of severe pain, pallor, and coldness in his left leg, extending below the knee. On examination, the leg is cool to touch, pale, and distal pulses (popliteal, dorsalis pedis, posterior tibial) are absent. Sensation is diminished below the ankle, but he can still move his toes slightly. Capillary refill is delayed. Which of the following is the most appropriate initial diagnostic investigation?

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A 35-year-old woman presents with a 2cm, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

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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 40-year-old male presents with acute, severe left flank pain. An ultrasound is performed. What is the MOST likely underlying cause of the finding on the image?

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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 infant presents with a 1-week history of increasing non-bilious projectile vomiting after feeds. He is otherwise well, afebrile, and has wet nappies. Examination is unremarkable. An ultrasound is performed, shown in the image. Considering the clinical presentation and the findings in the provided image, what is the most appropriate definitive surgical intervention for this condition?

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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 55-year-old man presents to the emergency department with sudden onset, severe left flank pain radiating to his groin, associated with nausea. He is afebrile, blood pressure 130/80 mmHg, heart rate 85 bpm. Urinalysis shows 20-30 red blood cells per high-power field. Serum creatinine is within normal limits. An ultrasound is performed. Considering the clinical context and the findings demonstrated in the provided image, which of the following is the most appropriate immediate management step?

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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 assessment with sonography for trauma (FAST) exam is performed, with a view obtained as shown. What is the MOST appropriate next step in management?

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A 50-year-old woman presents with a newly discovered, firm, mobile lump in her left breast, approximately 2 cm in size. She has no family history of breast cancer. She is post-menopausal. On examination, the lump is palpable in the upper outer quadrant, appears well-defined, and is non-tender. There are no skin changes or nipple discharge. Axillary nodes are not palpable. Considering the Australian guidelines for breast lump assessment, which of the following is the most appropriate initial investigation?

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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 severe abdominal pain, vomiting, and lethargy. On examination, he is afebrile with a soft but slightly distended abdomen. An ultrasound is performed (image provided). Based on the clinical presentation and the image findings, what is the most appropriate next step in the management of this patient?

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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard CC BY-SA 3.0 · Source

A 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale but haemodynamically stable. Abdominal examination reveals a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). What is the most appropriate next step in management?

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

A 70-year-old male with known cirrhosis secondary to NAFLD is undergoing routine surveillance. A new 3 cm lesion was identified in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Based on the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?

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