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ARDMS Abdomen Sonography Examination Sample Questions (Q97-Q102):
NEW QUESTION # 97
Which condition presents sonographically as an anechoic mass between the umbilicus and the bladder?
- A. Urinoma
- B. Bladder abscess
- C. Mesenteric cyst
- D. Urachal cyst
Answer: D
Explanation:
A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.
According to Rumack's Diagnostic Ultrasound:
"A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pelvis, 2020.
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NEW QUESTION # 98
Which vessel is most likely to display hepatofugal flow in the presence of portal hypertension?
- A. Inferior epigastric vein
- B. Splenic vein
- C. Inferior vena cava
- D. Coronary vein
Answer: D
Explanation:
The coronary vein (left gastric vein) is a common collateral pathway in portal hypertension. It often becomes dilated and may demonstrate hepatofugal (reversed) flow as blood diverts from the high-pressure portal system into systemic collaterals.
According to Zwiebel's Introduction to Vascular Ultrasound:
"The left gastric (coronary) vein is a frequent site of hepatofugal flow in portal hypertension, reflecting collateral development." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Portal Venous Doppler Ultrasound, 2020.
NEW QUESTION # 99
Which scanning approach was utilized to obtain this image?
- A. Left coronal
- B. Right coronal
- C. Anterior
- D. Posterior
Answer: B
Explanation:
The ultrasound image provided shows the liver and diaphragm imaged in a coronal plane with characteristic rib shadows and costophrenic angles. The orientation of the image and the structures visualized suggest that the transducer is placed in the right mid-axillary line, with the sound beam directed coronally - this is a classic right coronal scanning approach.
Key features supporting this:
* The liver appears superiorly in the image.
* Multiple echogenic lines (representing the ribs) run obliquely, casting acoustic shadows.
* The diaphragm and adjacent lung base are seen clearly, which is commonly imaged through the right intercostal spaces in a coronal plane.
Comparison of answer choices:
* A. Anterior: Would show a more transverse view of the liver and not typically image the diaphragm and lung this way.
* B. Posterior: Not used for upper abdominal scanning due to shadowing from the spine and posterior ribs.
* C. Left coronal: Would show the spleen and left kidney - not the liver as seen here.
* D. Right coronal - Correct. This image was obtained using the right coronal (intercostal) approach through the right flank.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum (2020).
NEW QUESTION # 100
Which portion of the biliary system is last to become dilated with biliary obstruction at the ampulla of Vater?
- A. Cystic duct
- B. Common bile duct
- C. Common hepatic duct
- D. Peripheral bile ducts
Answer: D
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.
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NEW QUESTION # 101
Which condition is most likely to develop after splenic trauma?
- A. Splenule
- B. Splenosis
- C. Hamartoma
- D. Target lesion
Answer: B
Explanation:
Splenosis refers to autotransplantation of splenic tissue following splenic trauma or splenectomy. After rupture, splenic fragments may implant throughout the peritoneal cavity and vascularize, forming multiple nodules of functional splenic tissue. Splenosis is typically asymptomatic and discovered incidentally on imaging.
Splenule (A) is a congenital accessory spleen, not related to trauma.
Hamartoma (C) is a benign primary splenic lesion.
Target lesion (D) generally refers to sonographic appearance seen in metastases or infections, not post-trauma.
Reference Extracts:
Mortele KJ, et al. "Multimodality imaging of splenic lesions and the spleen." Radiographics. 2004;24(4):1137-
1163.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 102
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