Q 1. What is the most appropriate next step?
- Exploratory laparotomy is indicated
- Start water soluble oral contrast immediately and perform CT 1 hour later
- Don’t bother with oral prep, perform abdominal CT ASAP with V. contrast only
- Perform FAST US and observe if no free fluid found
A 1. What is the most appropriate next step?
- Exploratory laparotomy is indicated
- Start water soluble oral contrast immediately and perform CT 1 hour later
- Don’t bother with oral prep, perform abdominal CT ASAP with I.V. contrast only
- Perform FAST US and observe if no free fluid found
Q 2. What is the most appropriate next step?
- Exploratory laparotomy is now indicated
- Acquire delayed phase (5 to 7 min) CT series
- Take patient off CT table immediately and call IR team
- Recommend admission and observation, performing serial bedside US exams tomonitor amount of free fluid
A 2. What is the most appropriate next step?
- Exploratory laparotomy is now indicated
- Acquire delayed phase (5 to 7 min) CT series
- Take patient off CT table immediately and call IR team
- Recommend admission and observation, performing serial bedside US exams to monitor amount of free fluid
Q 3. What is the most likely diagnosis for the hyperattenuating focus in the spleen?
- Vascular lesion (likely pseudoaneurysm)
- Active extravasation of contrast-enhanced blood
- Incidental finding (likely hemangioma)
- Preexisting intrasplenic aneurysm
A. 3 What is the most likely diagnosis for the hyperattenuating focus in the spleen?
- Vascular lesion (likely pseudoaneurysm)
- Active extravasation of contrast-enhanced blood
- Incidental finding (likely hemangioma)
- Preexisting intrasplenic aneurysm
Q 4. What is the most appropriate next step for this patient?
- Laparatomy and splenectomy are now indicated
- Recommend selective angiography and embolization with coils
- Admit to surgical ward for close observation
- Discharge with detailed indications to return immediately to hospital should acute symptoms develop
A 4. What is the most appropriate next step for this patient?
- Laparatomy and splenectomy are now indicated
- 2Recommend selective angiography and embolization with coils
- Admit to surgical ward for close observation
- Discharge with detailed indications to return immediately to hospital should acute symptoms develop
Q 5. What is the most appropriate next step?
- Exploratory laparotomy is indicated
- Start water soluble oral contrast immediately and repeat CT 1 hour later
- Measure attenuation of free fluid in the pelvis
- Perform DPL
A 5. What is the most appropriate next step?
- Exploratory laparotomy is indicated
- Start water soluble oral contrast immediately and repeat CT 1 hour later
- Measure attenuation of free fluid in the pelvis
- Perform DPL
Q 6. What is your recommendation for management?
- Exploratory laparotomy is indicated
- Monitor amount of intraperitoneal fluid with serial US performed every 2 hours, recommend laparotomy only if fluid increases
- Perform DPL
- Admit for observation and repeat CT with oral contrast in 8 to 12 hours, or earlier if abdominal symptoms develop
A 6. What is your recommendation for management?
- Exploratory laparotomy is indicated
- Monitor amount of intraperitoneal fluid with serial US performed every 2 hours, recommend laparotomy only if fluid increases
- Perform DPL
- Admit for observation and repeat CT with oral contrast in 8 to 12 hours, or earlier if abdominal symptoms develop
Q 7. What is the next step to confirm a bile leak?
- Perform paracentesis
- HIDA scan
- ERCP
- MR with hepato-biliary contrast agent
A 7. What is the next step to confirm a bile leak?
- Perform paracentesis
- HIDA scan
- ERCP
- MR with hepato-biliary contrast agent
Q 8. What is the recommendation for definitive therapy?
- Schedule multiple paracentesis
- Operative repair of laceration
- Conservative management unless signs of infection develop
- ERCP and temporary stent placement
A 8. What is the recommendation for definitive therapy?
- Schedule multiple paracentesis
- Operative repair of laceration
- Conservative management unless signs of infection develop
- ERCP and temporary stent placement
Q 9. Most likely diagnosis?
- Crohn’s disease
- Perforation by foreign body
- Ischemia and perforation
- Diverticulitis
- Scleroderma (systemic sclerosis)
A 9. Most likely diagnosis?
- Crohn’s disease
- Perforation by foreign body
- Ischemia and perforation
- Diverticulitis
- Scleroderma (systemic sclerosis)
Q 10. What is the likely diagnosis?
- Amebic abscess
- Renal tumor
- Renal abscess
- Psoas muscle hematoma
- None of the above
A 10. What is the likely diagnosis?
- Amebic abscess
- Renal tumor
- Renal abscess
- Psoas muscle hematoma
- None of the above
Q 11. What is the next step to make the diagnosis?
- Measure serum tumor markers
- Laparoscopy
- Full imaging workup for suspected metastatic tumor
- Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
- Obtain a detailed history about medications administered
A 11. What is the next step to make the diagnosis?
- Measure serum tumor markers
- Laparoscopy
- Full imaging workup for suspected metastatic tumor
- Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
- Obtain a detailed history about medications administered
Q 12. What is the most likely diagnosis?
- Actinomycosis
- Endometriosis
- Pelvic carcinomatosis
- Bacterial pelvic inflammatory disease (PID)
- Tuberculosis
A 12. What is the most likely diagnosis?
- Actinomycosis
- Endometriosis
- Pelvic carcinomatosis
- Bacterial pelvic inflammatory disease (PID)
- Tuberculosis
Q 13. Diagnosis?
- Acute diverticulitis
- Perforation by foreign body
- Ischemia and perforation
- Crohn’s disease exacerbation
- Acute appendicitis
A 13. Diagnosis?
- Acute diverticulitis
- Perforation by foreign body
- Ischemia and perforation
- Crohn’s disease exacerbation
- Acute appendicitis (IN MALROTATION)
Q 14. Diagnosis for finding in liver?
- Active extravasation
- Contained vascular injury (pseudoaneurysm)
- Hemangioma
- No true lesion in the liver
- Calcification
A 14. Diagnosis for finding in liver?
- Active extravasation
- Contained vascular injury (pseudoaneurysm)
- Hemangioma
- No true lesion in the liver (SVC obstruction, flow through collateral circulation)
- Calcification
Q 15. Most likely diagnosis?
- Crohn’s disease
- Perforation by foreign body
- Ischemia and perforation
- Diverticulitis
- Scleroderma (systemic sclerosis)
A 15. Most likely diagnosis?
- Crohn’s disease
- Perforation by foreign body
- Ischemia and perforation
- Diverticulitis
- Scleroderma (systemic sclerosis)
Q 16. What is the likely diagnosis?
- Amebic abscess
- Renal tumor
- Renal abscess
- Psoas muscle hematoma
- None of the above
A 16. What is the likely diagnosis?
- Amebic abscess
- Renal tumor
- Renal abscess
- Psoas muscle hematoma
- None of the above
Q 17. What is the next step to make the diagnosis?
- Measure serum tumor markers
- Laparoscopy
- Full imaging workup for suspected metastatic tumor
- Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
- Obtain a detailed history about medications administered
A 17. What is the next step to make the diagnosis?
- Measure serum tumor markers
- Laparoscopy
- Full imaging workup for suspected metastatic tumor
- Detailed physical examination looking for hirsutism and other signs of polycystic ovaries
- Obtain a detailed history about medications administered
Q 18. What is the most likely cause of the symptoms and CT findings?
- Ischemia
- Bacterial enteritis
- Medications
- Crohn’s disease
- Tuberculosis
A 18. What is the most likely cause of the symptoms and CT findings?
- Ischemia
- Bacterial enteritis
- Medications: angiotensin converting enzyme (ACE) inhibitors
- Crohn’s disease
- Tuberculosis
Q 19. Diagnosis?
- Pancreatic contusion
- Pancreatic laceration, main duct injury
- Retroperitoneal hematoma
- Active extravasation of blood
- No pancreatic injury
A 19. Diagnosis?
- Pancreatic contusion
- Pancreatic laceration, main duct injury
- Retroperitoneal hematoma
- Active extravasation of blood
- No pancreatic injury
Q 20. What is the most likely diagnosis?
- Internal hernia
- Adhesive band causing small bowel obstruction
- Small bowel volvulus
- Transmesenteric internal hernia
- Focal ileus
A 20. What is the most likely diagnosis?
- Internal hernia
- Adhesive band causing small bowel obstruction
- Small bowel volvulus
- Transmesenteric internal hernia
- Focal ileus