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ARDMS Abdomen Sonography Examination Sample Questions (Q122-Q127):

NEW QUESTION # 122
A patient with hepatocellular carcinoma presents for a paracentesis. Which lab value is the most pertinent to the procedure?

• A. Alpha fetoprotein
• B. Alanine aminotransferase
• C. International normalized ratio
• D. Total bilirubin

Answer: C

Explanation:
Before performing a paracentesis, assessment of the patient's coagulation status is crucial to minimize bleeding risk. The International Normalized Ratio (INR) is the standard lab value used to assess coagulation.
Elevated INR may increase the risk of bleeding complications during the procedure. ALT, AFP, and bilirubin levels evaluate liver function or cancer progression but are not directly relevant to bleeding risk for this procedure.
As per AASLD and SIR guidelines:
"An INR and platelet count should be evaluated before paracentesis to assess bleeding risk. Minor elevations in INR (<1.5) may not contraindicate the procedure." (AASLD Practice Guidance, 2021; SIR Consensus Guidelines, 2019).
Reference:
American Association for the Study of Liver Diseases (AASLD), Management of Ascites, 2021.
Society of Interventional Radiology (SIR) Consensus Guidelines for Coagulation Parameters in Image- Guided Procedures, 2019.

 

NEW QUESTION # 123
Which area of the spleen is not covered by visceral peritoneum?

• A. Hilum
• B. Gastric surface
• C. Capsule
• D. Inferior border

Answer: A

Explanation:
The spleen is almost entirely covered by visceral peritoneum, except at the hilum where vessels, nerves, and lymphatics enter and exit. This area lacks peritoneal covering to allow vascular connection to the splenic artery and vein.
According to Moore's Clinically Oriented Anatomy:
"The spleen is entirely covered by visceral peritoneum except at its hilum where the vascular structures enter." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
-

 

NEW QUESTION # 124
Which vessel is indicated by the arrow on this image?

• A. Proper hepatic artery
• B. Superior mesenteric artery
• C. Right renal artery
• D. Left renal vein

Answer: B

Explanation:
The ultrasound image demonstrates a transverse view of the abdominal vasculature, where the arrow is pointing to a circular vascular structure anterior to the aorta and posterior to the body of the pancreas - consistent with the superior mesenteric artery (SMA).
The SMA originates from the anterior aspect of the abdominal aorta just below the level of the celiac trunk and courses anterior to the left renal vein and uncinate process of the pancreas. On transverse ultrasound, it is often seen in cross-section as a round, pulsatile structure with echogenic walls, situated just anterior to the aorta. This appearance is known as the "target sign" or "bull's-eye" appearance.
Vessel Position Landmarks (transverse plane):
* Aorta: Posterior and central
* SMA: Just anterior to the aorta
* Left renal vein: Passes between the aorta and SMA (nutcracker location)
* Right renal artery: Courses posterior to the IVC toward the right kidney Differentiation from other options:
* A. Proper hepatic artery: Typically visualized within the liver hilum (portal triad), not in this anatomic location.
* C. Left renal vein: Seen in transverse as a longer, oval structure crossing anterior to the aorta and posterior to the SMA.
* D. Right renal artery: Arises laterally from the aorta and courses posterior to the IVC - not visualized in this axial midline location.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Vascular Anatomy and Abdominal Vessels, pp. 471-475.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.
Radiopaedia.org. Superior mesenteric artery: https://radiopaedia.org/articles/superior-mesenteric-artery
-

 

NEW QUESTION # 125
Which condition puts the patient at greatest risk for a hematoma as a result of biopsy?

• A. Liver disease
• B. Hypertension
• C. Acute renal failure
• D. Infection

Answer: A

Explanation:
Patients with liver disease often have coagulopathy due to impaired synthesis of clotting factors. This places them at greater risk for bleeding or hematoma formation after biopsy. While hypertension may increase bleeding risk slightly, liver disease presents a significantly higher risk due to impaired coagulation.
According to the Society of Interventional Radiology (SIR) guidelines:
"Liver dysfunction is a significant risk factor for post-biopsy hemorrhage due to associated coagulopathy." Reference:
SIR Consensus Guidelines for Coagulation Parameters in Image-Guided Procedures, 2019.
American Association for the Study of Liver Diseases (AASLD), Practice Guidance, 2021.
-

 

NEW QUESTION # 126
Which laboratory value stays elevated longest and is considered the most reliable in diagnosing pancreatitis?

• A. Lipase
• B. Amylase
• C. Somatostatin
• D. Trypsin

Answer: A

Explanation:
Lipase is the most sensitive and specific laboratory marker for diagnosing acute pancreatitis. It rises earlier, remains elevated longer (up to 14 days), and is more pancreas-specific than amylase. Amylase may normalize within 48-72 hours and may also be elevated in non-pancreatic conditions.
According to ACG (American College of Gastroenterology) Guidelines:
"Serum lipase is preferred over amylase due to its higher sensitivity, specificity, and prolonged elevation in pancreatitis." Reference:
American College of Gastroenterology (ACG) Clinical Guideline: Management of Acute Pancreatitis, 2013.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
-

 

NEW QUESTION # 127
......

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