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ARDMS Abdomen Sonography Examination Sample Questions (Q119-Q124):

NEW QUESTION # 119
How are portal veins differentiated from hepatic veins?

A. Hepatic veins have more echogenic walls
B. Portal veins branch horizontally
C. Hepatic veins are oriented towards the porta hepatis
D. Portal veins vary in size during respiration

Answer: B

Explanation:
Portal veins course horizontally within the liver and have echogenic walls due to their fibrous sheath. In contrast, hepatic veins course vertically toward the IVC and lack echogenic walls. Hepatic veins also demonstrate a triphasic waveform.
According to Rumack's Diagnostic Ultrasound:
"Portal veins course horizontally within the liver and are easily recognized by their echogenic walls." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Liver Ultrasound, 2020.
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NEW QUESTION # 120
Which disease process causes exudative ascites?

A. Liver failure
B. Infection
C. Renal failure
D. Hypoproteinemia

Answer: B

Explanation:
Exudative ascites is characterized by high protein content and cellular debris, typically resulting from infections (e.g., peritonitis, tuberculosis), malignancy, or inflammatory conditions. Transudative ascites is more commonly seen in conditions such as liver failure, renal failure, and hypoproteinemia due to changes in hydrostatic or oncotic pressure.
According to Light's Criteria:
"Infection and malignancy are common causes of exudative ascites, distinguished by high protein content and elevated LDH." Reference:
Light RW. Pleural Diseases. 6th ed. Lippincott Williams & Wilkins, 2013.
AASLD Guidelines for the Evaluation of Ascites, 2021.
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NEW QUESTION # 121
Which sections of the liver are divided by the structure indicated by the arrow on this image?

A. Right anterior and posterior
B. Left superior and inferior
C. Right and left lobes
D. Left medial and lateral

Answer: C

Explanation:
The ultrasound image shows the liver in a transverse view with the arrow pointing to the middle hepatic vein (MHV). The MHV is a key sonographic landmark that anatomically divides the right and left lobes of the liver.
According to Couinaud's segmental anatomy, which is the basis for surgical and radiological liver segmentation:
* The middle hepatic vein runs within the main lobar fissure.
* It separates the right lobe (segments V-VIII) from the left lobe (segments II-IV).
* This division is crucial in liver surgery and interventional procedures.
Comparison of answer choices:
* A. Right anterior and posterior segments are divided by the right hepatic vein, not the middle hepatic vein.
* B. Right and left lobes - Correct. The middle hepatic vein, shown by the arrow, defines this boundary.
* C. Left medial and lateral segments are divided by the left hepatic vein or falciform ligament.
* D. Left superior and inferior is not a standard anatomic division in liver segmentation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Couinaud C. Liver anatomy: portal (and hepatic) segmentation. In: Trans. Assoc. Am. Physicians. 1957.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

NEW QUESTION # 122
Which adjustment would most likely improve visualization of a small superficial tubular structure such as a peripheral artery?

A. Decreasing frame rate
B. Decreasing transducer wavelength
C. Decreasing power output
D. Decreasing slice width

Answer: D

Explanation:
Reducing slice (section) width improves spatial resolution, particularly elevational resolution, which enhances visualization of small, superficial structures. Lower slice width reduces off-axis beam artifacts and blurring.
Wavelength depends on transducer frequency, not adjustable directly during scanning.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Reduction in slice thickness improves imaging of small superficial structures by minimizing volume averaging and improving elevational resolution." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Vascular Ultrasound, 2021.
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NEW QUESTION # 123
Which diagnosis is most consistent with this image from a patient with acute scrotal pain?

A. Testicular torsion
B. Scrotal abscess
C. Epididymitis
D. Testicular rupture

Answer: A

Explanation:
The grayscale ultrasound image demonstrates a uniformly enlarged, hypoechoic (dark), and heterogeneous testis without signs of surrounding scrotal wall thickening or a discrete fluid collection. This pattern is highly suggestive of testicular torsion in the setting of acute scrotal pain.
Sonographic features of testicular torsion on grayscale imaging:
* Enlarged testis
* Diffusely hypoechoic parenchyma
* Loss of normal homogeneity
* Absence of internal vascular flow on Doppler imaging (not shown here but critical in confirming diagnosis) Testicular torsion occurs due to twisting of the spermatic cord, leading to vascular compromise and eventual infarction if not promptly corrected. It is a surgical emergency and typically presents in adolescent males with sudden-onset, severe unilateral testicular pain.
Comparison of answer choices:
* A. Scrotal abscess appears as a complex fluid collection with irregular margins and posterior enhancement.
* B. Testicular rupture would show discontinuity of the tunica albuginea, heterogeneous texture, and often a hematocele.
* C. Testicular torsion - Correct. The enlarged, hypoechoic, heterogeneous testis is characteristic, particularly in the acute phase.
* D. Epididymitis typically shows an enlarged, hypervascular epididymis and may extend to the testis (epididymo-orchitis), but vascularity is usually increased rather than absent.
References:
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Scrotal Ultrasound Examination (2021).

NEW QUESTION # 124
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ARDMS Abdomen Sonography Examination Sample Questions (Q119-Q124):

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