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ARDMS Abdomen Sonography Examination Sample Questions (Q41-Q46):

NEW QUESTION # 41
Which sections of the liver are divided by the structure indicated by the arrow on this image?

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

Answer: A

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 # 42
Elevation of alpha-fetoprotein levels is a characteristic finding in which tumor?

A. Hepatoma
B. Adenoma
C. Focal nodular hyperplasia
D. Cholangiocarcinoma

Answer: A

Explanation:
Alpha-fetoprotein (AFP) is commonly elevated in patients with hepatocellular carcinoma (hepatoma), particularly in those with underlying cirrhosis or chronic hepatitis B/C. AFP is not typically elevated in adenomas, cholangiocarcinoma, or FNH.
According to Rumack's Diagnostic Ultrasound:
"Serum AFP levels are elevated in 50-70% of patients with hepatocellular carcinoma." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AASLD Guidelines for HCC Surveillance, 2018.
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NEW QUESTION # 43
Which condition is demonstrated in this image?

A. Gastritis
B. Intussusception
C. Hydronephrosis
D. Pyloric stenosis

Answer: D

Explanation:
The ultrasound image clearly demonstrates a thickened and elongated pyloric muscle with a visible channel, which is characteristic of hypertrophic pyloric stenosis (HPS). This condition is most commonly seen in male infants between 2 and 8 weeks of age who present with non-bilious projectile vomiting, dehydration, and a palpable "olive-like" mass in the right upper quadrant.
Ultrasound is the imaging modality of choice and is highly sensitive and specific for diagnosing pyloric stenosis.
Key sonographic criteria for HPS:
* Muscle thickness >3 mm
* Pyloric channel length >15-17 mm
* "Target sign" or "doughnut sign" on transverse imaging (concentric rings)
* "Cervix" or "railroad track sign" on longitudinal imaging (elongated canal with echogenic center) Differentiation from other options:
* A. Intussusception: Also shows a target sign, but it occurs in the right lower quadrant or periumbilical region, not in the gastric antrum.
* C. Hydronephrosis: Refers to dilation of the renal pelvis and calyces - not gastrointestinal.
* D. Gastritis: May show gastric wall thickening but lacks the distinct elongated, thickened pyloric muscle seen here.
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.
AIUM Practice Parameter for the Performance of a Pediatric Abdominal Ultrasound Examination, 2020.

NEW QUESTION # 44
Which exam type would be most beneficial for evaluating an elderly male patient who is complaining of dysuria and nocturia?

A. Penile Doppler
B. Pelvis limited
C. Renal Doppler
D. Scrotal

Answer: B

Explanation:
In elderly men, dysuria and nocturia often suggest lower urinary tract symptoms such as benign prostatic hyperplasia (BPH). A pelvis limited ultrasound is most appropriate to evaluate the bladder and prostate for enlargement, residual urine volume, or other causes of obstructive symptoms.
According to AIUM Practice Guidelines:
"Pelvic ultrasound can evaluate bladder volume, post-void residual, and prostate size in men with lower urinary tract symptoms." Reference:
AIUM Practice Parameter for the Performance of Ultrasound of the Prostate, 2020.
Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
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NEW QUESTION # 45
Which liver neoplasm is associated with use of oral contraceptives and is most often seen in women under the age of 40?

A. Adenoma
B. Hepatoma
C. Cavernous hemangioma
D. Hepatoblastoma

Answer: A

Explanation:
Hepatic adenomas are benign liver tumors strongly associated with long-term use of oral contraceptives and are most frequently found in women under 40. Hepatoblastoma is seen in children; hepatoma (HCC) is a malignant tumor typically found in cirrhotic livers. Cavernous hemangioma is unrelated to oral contraceptives.
According to Rumack's Diagnostic Ultrasound:
"Hepatic adenomas occur predominantly in young women with a history of oral contraceptive use." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Tumours of the Digestive System, 5th ed., IARC, 2019.
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NEW QUESTION # 46
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ARDMS Abdomen Sonography Examination Sample Questions (Q41-Q46):

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