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ARDMS Abdomen Sonography Examination Sample Questions (Q13-Q18):

NEW QUESTION # 13
Which sonographic finding is most consistent with this image of the abdominal aorta?

A. Occlusion
B. Stenosis
C. Dissection
D. Aneurysm

Answer: D

Explanation:
The ultrasound image provided shows a transverse view of the abdominal aorta, with a clearly measured aortic diameter of 5.71 cm. A normal adult abdominal aorta should measure less than 3.0 cm in anterior- posterior diameter. Any measurement exceeding this threshold is defined as an abdominal aortic aneurysm (AAA).
In this case, the dilation is well beyond the 3.0 cm threshold, confirming the presence of an aneurysm. The rounded, anechoic/heterogeneous central lumen surrounded by echogenic arterial wall layers further supports this diagnosis.
Comparison of answer choices:
* A. Stenosis: Would show a narrowed lumen with turbulent, aliasing flow on Doppler, not a dilated aorta.
* B. Dissection: Typically shows an echogenic intimal flap separating true and false lumens; no flap is visible here.
* C. Aneurysm: Correct. The aorta's transverse diameter (5.71 cm) confirms the presence of an aneurysm.
* D. Occlusion: Would appear as a lack of flow with thrombus or echogenic content filling the lumen, not dilation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Society for Vascular Surgery Guidelines: Management of Abdominal Aortic Aneurysms (Chaikof et al., J Vasc Surg, 2018).
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

NEW QUESTION # 14
During a renal artery Doppler study, which vessel should also be sampled to verify patency?

A. Portal vein
B. Main renal vein
C. Iliac vein
D. Inferior vena cava

Answer: B

Explanation:
The main renal vein should be assessed in addition to the renal arteries during renal Doppler exams. Venous thrombosis may coexist with arterial abnormalities and can impact renal perfusion. Evaluation of both arterial inflow and venous outflow ensures a comprehensive assessment of renal vascular patency.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Renal vein assessment should be performed during renal artery Doppler studies to exclude venous thrombosis or outflow obstruction." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Artery Duplex Sonography, 2020.
-

NEW QUESTION # 15
Which structure is indicated by the arrow on this image?

A. Lymph node
B. Esophagus
C. Paraganglioma
D. Parathyroid

Answer: B

Explanation:
The ultrasound image shows a transverse view of the lower neck region at the thyroid level. The arrow is pointing to a round-to-oval structure located posterior and slightly to the left of the thyroid gland. The structure has a characteristic "target" or "bull's-eye" appearance with a hypoechoic outer ring and echogenic central mucosal interface - this is classic for the esophagus when seen in transverse view.
Key sonographic features of the esophagus:
* It lies posterior to the left lobe of the thyroid.
* It demonstrates a layered wall structure ("target" or "bull's-eye" appearance).
* It may change shape or move during swallowing, and occasionally air bubbles or movement of fluid may be observed.
Comparison of answer choices:
* A. Parathyroid glands are small, homogeneous, hypoechoic, and located posterior to the thyroid - but do not have this layered target appearance.
* B. Lymph nodes have a hypoechoic cortex and echogenic hilum and are typically oval or bean-shaped, without the concentric ring appearance.
* C. Esophagus - Correct. The location, appearance, and structure are consistent with the cervical esophagus.
* D. Paragangliomas are highly vascular and more commonly located in the carotid body or adrenal region, not in this location or with this sonographic pattern.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Grant EG, Tessler FN, Hoang JK, et al. Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR TI- RADS Committee. J Am Coll Radiol. 2015.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

NEW QUESTION # 16
Which technique would best assist the sonographer to verify the finding in this image obtained from the right upper quadrant?

A. Use compound imaging
B. Ask patient to perform Valsalva
C. Assess for sonographic Murphy sign
D. Change the patient's position

Answer: C

Explanation:
The image demonstrates a gallbladder with a possible echogenic focus (likely a gallstone) and posterior acoustic shadowing. This is suggestive of cholelithiasis. To differentiate uncomplicated gallstones from acute cholecystitis, the most effective technique is to assess for a positive sonographic Murphy sign.
A positive sonographic Murphy sign refers to the presence of focal tenderness over the gallbladder when it is directly palpated with the ultrasound transducer. It is a strong indicator of acute cholecystitis when combined with other features such as gallbladder wall thickening, pericholecystic fluid, and gallstones.
Sonographic Murphy sign - key points:
* Assessed during real-time scanning
* Localized tenderness when pressure is applied over the gallbladder
* Highly sensitive for acute cholecystitis (especially in the presence of stones) Differentiation from other options:
* A. Use compound imaging: Improves image quality by reducing artifacts but does not verify tenderness or confirm acute inflammation.
* B. Change the patient's position: Helpful to confirm mobility of gallstones, but not diagnostic of inflammation.
* C. Ask patient to perform Valsalva: Used primarily in vascular studies (e.g., assessing for varicocele or venous reflux), not relevant here.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gallbladder and Biliary System, pp. 148-152.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.
Radiopaedia.org. Sonographic Murphy sign:https://radiopaedia.org/articles/sonographic-murphy-sign

NEW QUESTION # 17
Which finding is indicated by the arrow in this image of the right upper quadrant?

A. Mirror image
B. Retroperitoneal hemorrhage
C. Pleural effusion
D. Ascites

Answer: C

Explanation:
The image provided is a right upper quadrant (RUQ) ultrasound-typically performed during a FAST (Focused Assessment with Sonography in Trauma) exam or for abdominal assessment. The arrow points to an anechoic (black) fluid collection seen above the diaphragm and posterior to the liver.
This fluid collection lies within the thoracic cavity, confirming the diagnosis of a pleural effusion. Pleural effusions are seen sonographically as an anechoic or hypoechoic area superior to the diaphragm in the thoracic cavity and often appear triangular or crescent-shaped. The diaphragm is visualized as a curvilinear echogenic structure separating the liver (or spleen) below from the lung space above.
Comparison of answer choices:
* A. Retroperitoneal hemorrhage would be seen in the posterior abdomen, not above the diaphragm.
* B. Pleural effusion is correct-anechoic fluid above the diaphragm is classic for this condition.
* C. Mirror image artifact occurs when liver echoes are mirrored across the diaphragm and lung-this is not a mirror artifact.
* D. Ascites collects inferior to the diaphragm and around the abdominal organs, not in the thoracic cavity.
References:
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound, 3rd ed. McGraw-Hill; 2014.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-757.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

NEW QUESTION # 18
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