Gastric Ultrasound — MCQs
Which of the following is best assessed by FAST USG?
FAST USG focuses on all of the following areas except-
Gold standard investigation for diagnosing GERD:
Modified Mallampati grading is used in assessment of -
The gold standard investigation for gastro-esophageal reflux disease is:
The Barium Swallow examination shows a filling defect in the esophagus. What is the most probable diagnosis?
Which of the following diagnostic tests is most useful in confirming the presence of ascites?
In an ultrasound of the abdomen, which structure is best seen posterior to the stomach?
Which complication is most commonly associated with prepyloric ulcers?
Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:
Gastric Ultrasound Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is best assessed by FAST USG?
- A. Liver
- B. Pericardium (Correct Answer)
- C. Spleen
- D. Pleural cavity
Explanation: ***Pericardium*** - FAST USG is **most clinically significant** for detecting **pericardial effusions** and **cardiac tamponade** in trauma patients. - The **subxiphoid view** provides **excellent direct visualization** of the heart and pericardial space with minimal interference. - **Small volumes** of pericardial fluid (as little as 50-100 mL) are **clinically significant** and potentially life-threatening, requiring immediate intervention. - Cardiac tamponade is an **immediately reversible cause of shock** that demands urgent diagnosis and pericardiocentesis. - **Sensitivity >90%** for clinically significant pericardial effusions in the trauma setting. *Liver* - FAST assesses the **hepatorenal space (Morison's pouch)** for free fluid, not the liver parenchyma itself. - Requires **larger volumes of free fluid** (>200-500 mL) to be reliably detected in the peritoneal cavity. - Detailed assessment of actual liver injury requires **contrast-enhanced CT imaging**. *Spleen* - FAST evaluates the **splenorenal recess** for free fluid surrounding the spleen, not splenic parenchymal injury. - Detection depends on adequate volume of free fluid being present. - **CT scanning** is superior for defining splenic lacerations, hematomas, and grading injury severity. *Pleural cavity* - While Extended FAST (eFAST) can assess **pleural spaces** for effusion or pneumothorax, this is an **extension** of the standard 4-view FAST protocol. - Standard FAST focuses on the **four primary windows**: pericardial, perihepatic, perisplenic, and pelvic. - **Chest X-ray** and **CT** remain primary modalities for comprehensive thoracic assessment.
Question 2: FAST USG focuses on all of the following areas except-
- A. Splenic
- B. Pleura (Correct Answer)
- C. Hepatic
- D. Pelvic
Explanation: ***Pleura*** - While pleural assessment is included in **extended FAST (E-FAST)** for detecting pneumothorax and hemothorax, the **traditional FAST protocol** focuses specifically on detecting **free fluid** in the **peritoneal** and **pericardial** spaces in trauma patients. - The pleura is not one of the standard **four views** of traditional FAST USG, though it is assessed in the expanded E-FAST protocol. *Splenic* - The **splenorenal recess** (left upper quadrant space between the spleen and left kidney) is one of the four key regions in FAST USG to detect **free fluid**. - Fluid accumulation in this area can indicate injury to the spleen or other abdominal organs. *Hepatic* - The **hepatorenal recess (Morison's pouch)** between the liver and right kidney is a critical view in FAST USG for identifying **free fluid**. - This is often the first place fluid collects in the peritoneum in supine patients and is the most sensitive area for detecting intraperitoneal fluid. *Pelvic* - The **pouch of Douglas** (rectovesical in males or rectouterine in females) is a standard view in FAST USG to detect **free fluid** in the pelvis. - Fluid here can indicate significant abdominal or pelvic injury.
Question 3: Gold standard investigation for diagnosing GERD:
- A. 24 hour pH monitoring (Correct Answer)
- B. USG
- C. HIDA
- D. Manometry
Explanation: ***24 hour pH monitoring*** - This is considered the **gold standard** for diagnosing GERD because it directly measures the frequency and duration of **acid reflux events** into the esophagus. - It helps correlate symptoms with reflux episodes, providing objective evidence for the diagnosis and guiding treatment. *USG* - **Ultrasound (USG)** is primarily used for imaging abdominal organs like the **gallbladder**, liver, and kidneys, not for directly assessing esophageal acid reflux. - While it can sometimes detect complications, it cannot diagnose the presence or severity of GERD itself. *HIDA* - **HIDA scan** (hepatobiliary iminodiacetic acid scan) is used to diagnose problems of the **gallbladder** and bile ducts, such as cholecystitis or biliary obstruction. - It is not relevant for the diagnosis of gastroesophageal reflux disease. *Manometry* - **Esophageal manometry** measures the **pressure and coordination of esophageal muscle contractions**, assessing motility disorders [1]. - While it can identify related conditions like achalasia or ineffective peristalsis, it does not directly measure acid reflux and therefore is not the gold standard for GERD diagnosis.
Question 4: Modified Mallampati grading is used in assessment of -
- A. Difficulty of intubation (Correct Answer)
- B. Obstruction of the airway
- C. Aspiration-related death
- D. Endotracheal intubation procedure
Explanation: ***Difficulty of intubation*** - The **Modified Mallampati score** assesses the visibility of pharyngeal structures, which directly correlates with the ease or difficulty of performing **direct laryngoscopy** and **endotracheal intubation**. - A higher Mallampati class (e.g., III or IV) indicates less visibility of the soft palate, uvula, and pillars, suggesting a more difficult airway and increased likelihood of a challenging intubation. *Obstruction of the airway* - While a high Mallampati score might indirectly indicate potential for **airway obstruction** during anesthesia due to anatomical features, its primary purpose is not to diagnose or quantify existing airway obstruction. - Airway obstruction is more directly assessed by monitoring breathing sounds, respiratory effort, and oxygen saturation. *Aspiration-related death* - The **Mallampati score** helps predict the difficulty of securing the airway but does not directly assess the risk of **aspiration**. - Aspiration risk is evaluated based on factors like gastric contents, gag reflex, and patient positioning. *Endotracheal intubation procedure* - The **Modified Mallampati score** helps in **planning the intubation procedure** by identifying potential difficulties but is not a measure of the intubation procedure itself. - It is a **pre-procedure assessment tool** to gauge airway anatomy, not a description or evaluation of the steps involved in endotracheal intubation.
Question 5: The gold standard investigation for gastro-esophageal reflux disease is:
- A. Measurement of length of lower esophageal sphincter
- B. Esophageal manometry
- C. 24-hour pH recording (Correct Answer)
- D. Endoscopy
Explanation: ***24-hour pH recording*** - This is considered the **gold standard** because it directly measures the frequency and duration of **acid reflux** into the esophagus. - It correlates symptoms with reflux episodes, providing objective evidence for the diagnosis of **GERD**. *Measurement of length of lower esophageal sphincter* - While the **lower esophageal sphincter (LES)** dysfunction is central to GERD, simply measuring its length is not a diagnostic gold standard. - Reduced LES pressure or transient relaxations are more significant than static length measurement. *Esophageal manometry* - This test measures the **pressure and coordination** of esophageal muscle contractions and LES pressure. - It is primarily used to evaluate **motility disorders** and locate the LES, not as a primary diagnostic for GERD itself. *Endoscopy* - **Endoscopy** is useful for assessing complications of GERD such as esophagitis, strictures, or Barrett's esophagus, and to **rule out other pathologies**. - However, many patients with GERD symptoms have a normal endoscopic examination, making it less specific for the diagnosis of reflux itself.
Question 6: The Barium Swallow examination shows a filling defect in the esophagus. What is the most probable diagnosis?
- A. Esophageal Carcinoma (Correct Answer)
- B. Esophageal Ring
- C. Esophageal Tear
- D. Achalasia Cardia
Explanation: ***Esophageal Carcinoma*** - A filling defect on a barium swallow study, especially with irregular borders and luminal narrowing, is highly suggestive of an **esophageal carcinoma**. - The image appears to show an **irregular, obstructing lesion** that displaces the barium column, characteristic of a mass. *Esophageal Ring* - An esophageal ring, such as a **Schatzki ring**, typically presents as a thin, circumferential narrowing of the distal esophagus, forming a smooth, shelf-like indentation, which is not seen here. - Esophageal rings usually cause **intermittent dysphagia** to solids but do not present as a large, irregular filling defect. *Esophageal Tear* - An esophageal tear (e.g., **Mallory-Weiss tear**) is a mucosal laceration that would present with **hematemesis** and would typically appear as a linear defect or streak on a barium swallow if visible, not a filling defect. - A tear is not usually associated with a persistent mass effect or irregular luminal obstruction seen in the image. *Achalasia Cardia* - **Achalasia** is characterized by the failure of the lower esophageal sphincter to relax and **absent peristalsis** in the esophageal body, leading to a classic "bird's beak" or "rat tail" appearance on barium swallow due to distal narrowing and proximal dilation. - While it causes luminal narrowing, it does not typically present as an irregular filling defect within the lumen, but rather as a smooth tapering of the distal esophagus.
Question 7: Which of the following diagnostic tests is most useful in confirming the presence of ascites?
- A. Ultrasound (Correct Answer)
- B. CT scan
- C. Liver function tests
- D. Abdominal X-ray
Explanation: ***Ultrasound*** - **Ultrasound** is highly sensitive and specific for detecting even small amounts of **ascitic fluid** and can differentiate it from other abdominal masses or fluid collections. - It also allows for assessment of underlying organ pathology (e.g., **liver cirrhosis**) that may be causing the ascites and can guide **paracentesis**. *CT scan* - While a **CT scan** can detect ascites, it exposes the patient to **ionizing radiation** and is generally more expensive than an ultrasound. - It is often reserved for complex cases or when additional information about solid organ pathology is needed, beyond what ultrasound can provide. *Liver function tests* - **Liver function tests (LFTs)** assess liver function and can indicate the presence of **liver disease**, which is a common cause of ascites. - However, LFTs do not directly confirm the presence of **ascitic fluid** in the abdominal cavity but rather point to an underlying cause. *Abdominal X-ray* - An **abdominal X-ray** is very insensitive for detecting small to moderate amounts of **ascites** and is not typically used for this purpose. - It may show a **ground-glass appearance** or flank bulging in cases of massive ascites, but it lacks the detail and specificity of ultrasound or CT.
Question 8: In an ultrasound of the abdomen, which structure is best seen posterior to the stomach?
- A. Pancreas (Correct Answer)
- B. Gallbladder
- C. Spleen
- D. Liver
Explanation: ***Pancreas*** - The **pancreas** is retroperitoneal and lies transversely across the posterior abdominal wall, making it located directly posterior to the stomach. - In ultrasound, the stomach, when filled with fluid, can act as an acoustic window to visualize the pancreas behind it. *Gallbladder* - The **gallbladder** is typically nestled in a fossa on the inferior surface of the liver, anterior to the duodenum and often anterior or inferior to the stomach [1]. - It is not positioned directly posterior to the stomach, but rather more to the right and inferior [1]. *Spleen* - The **spleen** is located in the left upper quadrant, superior and posterior to the stomach, but typically more lateral and posterior than directly behind it. - While it has a close relationship with the stomach, it is usually not considered "best seen posterior to the stomach" in the same straight-on fashion as the pancreas. *Liver* - The **liver** is primarily located in the right upper quadrant, largely anterior and superior to the stomach. - While a small portion of the left lobe of the liver can be anterior to the stomach, the bulk of the liver is not posterior to it.
Question 9: Which complication is most commonly associated with prepyloric ulcers?
- A. Bleeding (Correct Answer)
- B. Gastric outlet obstruction
- C. Penetration
- D. Perforation
Explanation: ***Bleeding*** - **Upper gastrointestinal bleeding** is the most common and often the most life-threatening complication of prepyloric ulcers. - This can manifest as **hematemesis** (vomiting blood) or **melena** (black, tarry stools). *Penetration* - This occurs when the ulcer erodes through the gastric wall into an adjacent organ, such as the pancreas or liver. - While a serious complication, it is **less common** than bleeding. *Gastric outlet obstruction* - This complication typically results from chronic inflammation, scarring, or edema at or near the pylorus. - While possible with severe prepyloric ulcers, it is **not the most frequent** presentation of a complication. *Perforation* - This involves the ulcer creating a hole through the entire wall of the stomach, leading to the leakage of gastric contents into the abdominal cavity. - While a life-threatening emergency, **perforation is less common** than bleeding.
Question 10: Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:
- A. Apple juice can be taken at 10 PM previous night
- B. Milk can be taken at 7 AM in morning (Correct Answer)
- C. Can take sips of water up to 6 AM in morning
- D. Rice can be consumed at 11 PM previous night
Explanation: **Milk can be taken at 7 AM in morning** - For an 8-year-old undergoing elective surgery at 8 AM, **milk is considered a solid or heavy fluid** and should be stopped at least **6 hours pre-operatively**. - Taking milk at 7 AM, just one hour before surgery, significantly increases the risk of **pulmonary aspiration** during anesthesia. *Apple juice can be taken at 10 PM previous night* - **Clear liquids**, such as apple juice, can generally be consumed up to **2 hours before surgery** in children. - Taking apple juice at 10 PM the night before for an 8 AM surgery falls well within the safe fasting window for clear liquids. *Can take sips of water up to 6 AM in morning* - **Sips of water** are considered a clear liquid and can be consumed up to **2 hours before surgery** in children. - Allowing water until 6 AM for an 8 AM surgery is appropriate and helps prevent dehydration without increasing aspiration risk. *Rice can be consumed at 11 PM previous night* - **Solid foods**, like rice, require a longer fasting period, typically at least **6-8 hours before surgery**. - Consuming rice at 11 PM the night before, for an 8 AM surgery, allows for sufficient gastric emptying and is generally safe.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free