Pneumoperitoneum: inspect the stripe

Question 1What is the enhanced peritoneal stripe sign?

1. aNormal lung sliding
2. bAn unusually bright peritoneal line caused by free air against it
3. cA renal stone with twinkle
4. dA thickened gallbladder wall

Question 2How does bowel gas differ from free air?

1. aBowel gas never causes a shadow
2. bBowel gas always moves into the chest
3. cFree air is always completely black
4. dA normal thin peritoneal line stays on top, with the gas deeper inside the bowel

Question 3Why scan dynamically?

1. aFree air and its artefact may change with the angle or the patient's position
2. bA frozen image shows more movement
3. cColour Doppler is required
4. dThe peritoneum appears only in expiration

Question 4Does a normal scan exclude a perforation?

1. aNo
2. bYes, if one image over the liver is normal
3. cOnly in children
4. dYes, after recent surgery

Question 5A septic patient with peritonism has a bright peritoneal stripe with reverberation. What should happen?

1. aUrgent escalation, with definitive imaging or surgical management
2. bRepeat the same image for an hour
3. cReassurance, because ultrasound is non-invasive
4. dRoutine outpatient follow-up