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ARDMS Abdomen Sonography Examination Sample Questions (Q140-Q145):

NEW QUESTION # 140
Which clinical finding is most likely associated with the pathology in this image?

• A. Fever of unknown origin
• B. Red currant jelly stools
• C. Olive-shaped palpable mass
• D. Bilious vomiting

Answer: C

Explanation:
The ultrasound image shows a classic longitudinal view of a markedly thickened pyloric muscle with an elongated pyloric channel. This finding is consistent with hypertrophic pyloric stenosis (HPS), a condition most commonly seen in male infants between 2 and 8 weeks of age.
The most characteristic clinical finding associated with HPS is an "olive-shaped" palpable mass in the right upper quadrant or epigastric region, which represents the hypertrophied pylorus.
Clinical presentation of HPS includes:
* Non-bilious projectile vomiting (due to gastric outlet obstruction)
* Dehydration and weight loss
* A palpable "olive" mass on physical exam
* Visible peristalsis may be noted on the abdominal wall
Sonographic diagnostic criteria for HPS:
* Pyloric muscle thickness # 3 mm
* Pyloric channel length # 15-17 mm
* "Cervix sign" or "target sign" (transverse view)
* Failure of gastric contents to pass through the pylorus on real-time imaging Differentiation from other options:
* B. Fever of unknown origin: Not characteristic of HPS.
* C. Red currant jelly stools: Classic for intussusception.
* D. Bilious vomiting: Seen in distal duodenal or jejunal obstruction, not in pyloric stenosis (vomiting is non-bilious in HPS).
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gastrointestinal Tract, pp. 474-479.
American College of Radiology (ACR). Appropriateness Criteria - Vomiting in Infants Up to 3 Months of Age.
Radiopaedia.org. Hypertrophic pyloric stenosis:https://radiopaedia.org/articles/hypertrophic-pyloric-stenosis

 

NEW QUESTION # 141
Beginning at the renal artery, what is the correct sequence of arterial branching?

• A. Segmental, interlobar, arcuate
• B. Interlobar, arcuate, segmental
• C. Segmental, arcuate, interlobar
• D. Arcuate, segmental, interlobar

Answer: A

Explanation:
The correct sequence of renal arterial branching is: renal artery # segmental arteries # interlobar arteries # arcuate arteries # interlobular arteries. This branching pattern is important for understanding renal perfusion and evaluating vascular disorders.
According to Moore's Clinically Oriented Anatomy:
"Renal arteries divide into segmental branches, which give rise to interlobar arteries, then arcuate arteries, and finally interlobular arteries." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
-

 

NEW QUESTION # 142
Which of the following must be sterile for a percutaneous procedure?

• A. Transducer
• B. Gel within transducer cover
• C. Machine controls
• D. Transducer cover

Answer: B

Explanation:
In percutaneous procedures such as biopsies or drainages, maintaining a sterile field is critical to avoid introducing infection. While the transducer is covered by a sterile cover, the gel placed inside this cover (between the probe and the cover) must also be sterile, as it contacts the sterile field. The transducer itself and machine controls are not sterile but are handled appropriately to avoid field contamination.
According to the AIUM Guidelines:
"Sterile coupling gel must be used inside the sterile probe cover during all invasive or percutaneous procedures." (AIUM Guidelines for Cleaning and Preparing Ultrasound Transducers, 2021).
Reference:
AIUM Guidelines for Cleaning and Preparing Ultrasound Transducers and Equipment for Reuse, 2021.
ACR Practice Parameter for Performing Ultrasound-Guided Procedures, 2020.
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NEW QUESTION # 143
Which portion of the biliary system is last to become dilated with biliary obstruction at the ampulla of Vater?

• A. Common hepatic duct
• B. Cystic duct
• C. Peripheral bile ducts
• D. Common bile duct

Answer: C

Explanation:
In biliary obstruction (such as at the ampulla of Vater), dilation begins proximally and progresses peripherally. The intrahepatic peripheral bile ducts are the last to dilate because backpressure takes time to propagate. Early dilation is typically seen in the common bile duct and common hepatic duct.
According to Rumack's Diagnostic Ultrasound:
"The intrahepatic peripheral bile ducts dilate last in the setting of progressive biliary obstruction." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Abdominal Ultrasound, 2020.
-

 

NEW QUESTION # 144
Identify the congenital anomaly.
Using your mouse, place the cursor on the appropriate region of the image and then left-click the mouse button to indicate your selection.

Answer:

Explanation:

Explanation:
An ultrasound of a fetus AI-generated content may be incorrect.

The ultrasound image shows a transverse (axial) view of the fetal abdomen. Notably, there is abnormal continuity of renal parenchyma across the midline anterior to the aorta, forming a U- or horseshoe-shaped structure. This is characteristic of a congenital anomaly known as a horseshoe kidney.
Horseshoe kidney is the most common fusion anomaly of the kidneys, occurring in approximately 1 in 400-
600 live births. It results from fusion of the lower poles of both kidneys during fetal development. On prenatal ultrasound, this anomaly can be suspected when the kidneys appear closer to the midline than usual and are connected by an isthmus of renal tissue or fibrous band that crosses anterior to the spine and great vessels.
Typical sonographic findings include:
* Abnormally located kidneys, often lower than expected
* Renal fusion across the midline (usually at the lower poles)
* Possible associated hydronephrosis or malrotation
Comparison to other anomalies:
* This is not consistent with polycystic kidney disease (which would show diffusely echogenic kidneys with poor corticomedullary differentiation).
* Duplex kidney would show duplicated collecting systems but not fusion across the midline.
* Renal agenesis would demonstrate absence of renal tissue.
* Posterior urethral valves would show a distended bladder with bilateral hydronephrosis, not midline fusion.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Callen PW. Ultrasonography in Obstetrics and Gynecology, 6th ed. Elsevier; 2016.
Nyberg DA, McGahan JP, Pretorius DH, Pilu G. Diagnostic Imaging of Fetal Anomalies. Lippincott Williams
& Wilkins; 2003.

 

NEW QUESTION # 145
......

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