{"id":9224,"date":"2026-02-04T00:02:37","date_gmt":"2026-02-04T08:02:37","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=9224"},"modified":"2026-06-30T14:21:49","modified_gmt":"2026-06-30T22:21:49","slug":"usmle-step-1-question-of-the-day-intraperitoneal-free-fluid","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Intraperitoneal free fluid"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a 26-year-old man in the ER after a car accident who reports dizziness, nausea, and pain on his left side. What&#8217;s the most likely diagnosis? Do you know the answer? Let&#8217;s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>26-year-old man<\/strong> is brought to the <strong>emergency department<\/strong> by <strong>local paramedics<\/strong> after a <strong>motor vehicle collision<\/strong>. He was wearing a <strong>seat belt<\/strong> while driving, and his car was hit by a truck from the <strong>left side<\/strong>. The patient reports <strong>severe abdominal pain radiating to the left shoulder<\/strong>, <strong>nausea<\/strong>, and <strong>dizziness<\/strong>. <strong>Temperature is 36.7\u00b0C (98\u00b0F)<\/strong>, <strong>pulse is 110\/min<\/strong>, <strong>respirations are 20\/min<\/strong> and <strong>blood pressure is 85\/50 mmHg<\/strong>. <strong>Physical examination<\/strong> shows an area of <strong>ecchymosis over the left lower chest wall<\/strong>, <strong>diffuse abdominal tenderness<\/strong>, and <strong>dullness to percussion over the left upper quadrant<\/strong>. <strong>Lungs are clear to auscultation bilaterally<\/strong>. <strong>Focused assessment with sonography for trauma (FAST)<\/strong> reveals <strong>intraperitoneal free fluid<\/strong>. <strong>CT scan with contrast of the abdomen and pelvis<\/strong> is performed, as shown below.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the most likely cause of this patient\u2019s presentation?<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"819\" height=\"819\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/image_4a4f81.png\" alt=\"\" class=\"wp-image-9228\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/image_4a4f81.png 819w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/image_4a4f81.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/image_4a4f81.png?resize=300,300 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/image_4a4f81.png?resize=768,768 768w\" sizes=\"auto, (max-width: 819px) 100vw, 819px\" \/><figcaption class=\"wp-element-caption\">Image reproduced from: Radiopedia<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Duodenal hematoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Abdominal aortic rupture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Liver laceration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Diaphragmatic injury<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Splenic laceration<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Splenic laceration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Duodenal hematoma<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Rapid compression of the abdomen against the vertebral column can crush the <strong>duodenum<\/strong>, potentially causing <strong>duodenal hematoma<\/strong>. It does not cause <strong>free intraperitoneal fluid<\/strong> as the bleeding remains confined to the <strong>duodenal wall<\/strong>. Moreover, this patient suffered <strong>trauma from the left side of his vehicle<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Abdominal aortic rupture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Abdominal aortic rupture<\/strong> is frequently fatal due to the <strong>profuse bleeding<\/strong> that results from the rupture, and many patients die <strong>before reaching the hospital<\/strong>. The minority of the patients who survive is most likely due to the <strong>containment of the blood in the retroperitoneal space<\/strong>. Moreover, a <strong>blunt trauma from the left side<\/strong> is less likely to cause <strong>aortic rupture<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Liver laceration<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Blunt force mechanisms<\/strong> such as <strong>motor vehicle accidents<\/strong> are a common cause of <strong>liver laceration<\/strong>, and <strong>FAST<\/strong> may show <strong>free intraperitoneal fluid<\/strong>. Tenderness, however, is located over the <strong>right upper quadrant<\/strong> (rather than <strong>LUQ<\/strong> as seen in this patient).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Diaphragmatic injury<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Diaphragmatic injury<\/strong> can occur after <strong>blunt trauma<\/strong> due to a sudden increase in <strong>intra abdominal pressure<\/strong>. <strong>Chest auscultation<\/strong> may reveal <strong>bowel sounds<\/strong>. <strong>Free intraperitoneal fluid on FAST<\/strong> in this patient is suggestive of <strong>splenic laceration<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>This patient<\/strong> suffered a <strong>blunt abdominal trauma (BAT)<\/strong> during a <strong>motor vehicle accident<\/strong>, has <strong>diffuse abdominal tenderness<\/strong>, <strong>left shoulder pain (Kehr\u2019s sign)<\/strong>, and <strong>signs of shock (hypotension, tachycardia)<\/strong>. This together with <strong>free intraperitoneal fluid<\/strong> on <strong>Focused assessment with Sonography for Trauma (FAST)<\/strong>, <strong>left lower chest ecchymosis<\/strong>, and <strong>left upper quadrant dullness to percussion<\/strong> is consistent with <strong>splenic laceration<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>spleen<\/strong> lies within the <strong>intraperitoneal cavity<\/strong> in close proximity to the <strong>stomach (intraperitoneal)<\/strong>, <strong>colon (transverse: intraperitoneal, descending: retroperitoneal)<\/strong>, <strong>left kidney<\/strong>, and <strong>pancreas (both retroperitoneal)<\/strong>. It is one of the <strong>most commonly injured intra-abdominal organs following blunt trauma<\/strong>. In most adults, the spleen does not extend inferiorly past the <strong>rib cage<\/strong>, unless it is otherwise <strong>enlarged<\/strong>. The spectrum of its injury can range from <strong>contusion<\/strong> or <strong>subcapsular hematoma<\/strong> to <strong>laceration<\/strong> and <strong>intraperitoneal bleeding<\/strong> (due to <strong>high vascularity<\/strong>).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients can present with <strong>abdominal pain<\/strong>, <strong>tenderness in the epigastrium<\/strong>, <strong>pain in the left flank<\/strong>, and <strong>sharp left shoulder pain<\/strong> in cases of <strong>minor injury<\/strong>. Whereas, a <strong>ruptured spleen<\/strong> may result in <strong>massive intra-abdominal bleeding<\/strong> and should therefore be treated as a <strong>medical emergency<\/strong>.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>spleen<\/strong> is an <strong>intraperitoneal organ<\/strong> and lies in close proximity to <strong>other major organs of the abdomen<\/strong>. The <strong>most common cause of a ruptured spleen<\/strong> is <strong>blunt abdominal trauma<\/strong>, such as in <strong>traffic collisions<\/strong>. The <strong>clinical features<\/strong> include <strong>abdominal pain<\/strong>, <strong>radiating pain to the left shoulder (Kehr&#8217;s sign)<\/strong>, <strong>nausea<\/strong>, <strong>lightheadedness<\/strong> and <strong>abdominal guarding<\/strong>. A <strong>ruptured spleen<\/strong> may result in <strong>massive intra-abdominal bleeding<\/strong> and should be treated as a <strong>medical emergency<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video: <\/strong><a href=\"https:\/\/www.osmosis.org\/answers\/ruptured-spleen\"><strong>Ruptured Spleen<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bjerke HS, Geibel J. <strong>Splenic rupture.<\/strong> In: Splenic rupture. New York, NY: WebMD. http:\/\/emedicine.medscape.com\/article\/432823-overview#a6. Updated November 24, 2014. Accessed December 5, 2016.<\/li>\n\n\n\n<li>S\u00f6y\u00fcnc\u00fc, S., Bekta\u015f, F., &amp; Cete, Y. (2012). <strong>Traditional Kehr&#8217;s sign: Left shoulder pain related to splenic abscess.<\/strong> Ulusal travma ve acil cerrahi dergisi= Turkish journal of trauma &amp; emergency surgery: TJTEConcannon L.G., &amp; Bhatti O.M., &amp; Fry A.L., &amp; Harrast M.A. (2019). Emergency assessment and care of the athlete. Mitra R(Ed.), Principles of Rehabilitation Medicine. McGraw-HillS, 18(1), 87-88.&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png?w=700\" alt=\"\" class=\"wp-image-4729\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/10\/Blog_Display_Ads_MOBILE3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> practice questions? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 26-year-old trauma patient with left shoulder pain, abdominal tenderness, and free fluid on FAST suggests splenic laceration. Recognize signs for timely management.<\/p>\n","protected":false},"author":204,"featured_media":9226,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[2637,2641,2636,440,2638,2644,2640,2635,2639,279,2634,2645,484,2643,2642],"class_list":["post-9224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-abdominal-injury","tag-abdominal-tenderness","tag-blunt-trauma","tag-emergency-medicine","tag-fast-exam","tag-hypovolemic-shock","tag-intraperitoneal-bleeding","tag-kehrs-sign","tag-motor-vehicle-accident","tag-patient-assessment","tag-splenic-laceration","tag-surgical-emergency","tag-trauma-care","tag-trauma-diagnosis","tag-trauma-imaging"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Intraperitoneal free fluid - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-intraperitoneal-free-fluid\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Intraperitoneal free fluid - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 26-year-old trauma patient with left shoulder pain, abdominal tenderness, and free fluid on FAST suggests splenic laceration. 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