Question Bank – Gallbladder (Basic)

The common bile duct is measured

A 34 year old female presents with vague epigastric pain which seems worse after meals.  She reports a gnawing pain in her stomach currently that has not improved despite famotidine and antacids.  You perform a bedside RUQ ultrasound and report 

The following RUQ sono demonstrates

The upper limit of normal for gallbladder wall thickness is

Recommended strategies when trying to distinguish if a nodular finding in a gallbladder seen on sonogram is a polyp vs. a stone include:

The gallbladder wall should be measured

A new intern brings you the following RUQ sonogram image and asks for your help with interpretation. This image demonstrates:

The upper limit of normal for the diameter of the common bile duct is:

Which of the following is a potential cause of gallbladder wall thickening

When viewed in short axis, the common bile duct is this structure in 80% of people

The following right upper quadrant sonogram shows

The WES (wall-echo-shadow) sign refers to the appearance of

The following clip demonstrates the presence of 

The following clip of a 45 year old male with epigastric pain 2 hours post-prandial demonstrates

The following is an example of a 

An 18 year old male presents with vague right upper pain. A bedside ultrasound demonstrates

You are seeing a patient with two days of constant upper abdominal pain and vomiting. Here is the results of your POCUS. What is the next best step for this patient?

What is approximate sensitivity and specificity of gall bladder POCUS for cholelithiasis?

What is the importance of the exclamation point sign when scanning the gall bladder?

Which one of these is a scan of a gallbladder?

Which one of these is a scan of a gallbladder?

If you cannot visualize the gall bladder under the costal margin when the patient is in the supine position, you could do which of the following troubleshooting techniques?

What are the most important sonographic questions when doing POCUS of the gallbladder?

If you are unable to find the gall bladder with the patient supine, what position should the patient move to?

An ultrasound is not necessarily needed for the diagnosis of biliary colic, since often history, physical, and/or labs can make the definitive diagnosis.

You are seeing a patient with postprandial epigastric abdominal pain. She has tried an H2 Blocker over the past  2 weeks without much change in her symptoms. Her POCUS is above. What are the best next steps for her treatment at this point?

A 45 year old female G5P4 with a history of obesity, presents for her 4th visit for upper abdominal pain.  She says it gets worse after she eats.  She was treated with omeprazole and ranitidine as well as treated for H. Pylori however her symptoms have not improved.  Her vital signs are normal.

After performing your physical exam, your bedside ultrasound of the RUQ shows the following.  Upon visualizing this finding, gentle pressure applied causes the patient discomfort.

What is the most appropriate next step in patient management?

A 52 year old female with a history of obesity and diabetes, presents for the 3rd time for upper abdominal pain.  She says it gets worse after she eats.  She was treated with omeprazole and ranitidine as well as treated for H. Pylori however her symptoms have not improved.  Her vital signs are normal.  Her labs show a mild elevation aspartate transaminase (AST) and alanine transaminase (ALT) of 110, 115 respectively and her WBC count is normal.

After performing your physical exam, your bedside ultrasound of the RUQ shows the following.  Upon visualizing this finding, gentle pressure applied causes the patient discomfort.

What is the most likely diagnosis?

The only vessel seen in the liver with hyperechoic (white) walls is:

What are the most important sonographic questions when ultrasounding the gallbladder?

A 55 year old female sees you in clinic after several weeks of right upper quadrant pain with meals. She denies fevers, chills, nausea, vomiting. The ultrasound below suggests?

If you are unable to find the gall bladder with a supine patient, what should you do?

Identify the structure highlighted below in the right upper quadrant:

Identify the structure that the arrow is pointing in the right upper quadrant:

Identify the structure highlighted in the image below:

Identify the structure highlighted below:

Per the literature, how does the sensitivity and specificity of POCUS for gall bladder compare with radiology-performed gall bladder ultrasound?

To obtain a positive sonographic Murphy’s sign, you should:

You are seeing a patient who is complaining of intermittent epigastric abdominal pain for the past two weeks without nausea, vomiting or fever. She has had minimal relief from an H2 blocker.  You perform a POCUS of the Gallbladder and see the image below.  What would be the best next step for this patient?

What is the clinical significance of gallbladder wall thickening?

A 34 year old female presents at 13 weeks gestation with epigastric pain after eating which hasn’t resolved with Tums. Ultrasound is consistent with which of the following? 

The presence of which additional finding would help distinguish cholecystitis from biliary colic in this patient with post prandial abdominal pain? 

A 52 year old male presents with persistent right upper quadrant pain, vomiting, and fever. Which of the following is true about this ultrasound clip?

Right upper quadrant ultrasound is performed in a 55 year old male with no known medical history who presents with shaking chills and epigastric abdominal pain. Which of the following is true?

Which of the following findings raises suspicion for cholecystitis in a patient for whom the following RUQ clip is obtained?

Gallstones in this case are:

Findings in this RUQ clip are most consistent with which of the following conditions?

Which of the following is the next best step in management in this 52 year old male with jaundice and weight loss but no fever?

Which of the following is seen in this 28 year old male with epigastric pain?

Findings in this RUQ clip are most consistent with which of the following conditions?

A 62 year old female presents with ongoing abdominal pain after eating, with this episode unresolved after 3 hours and multiple antacids. The following clip demonstrates?

This sonographic gallbladder finding can be seen in which of the following conditions?

A 36 year old female presents with right upper quadrant pain which is persistent and severe. Which of the following is the next best step in management?