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ARDMS Abdomen Sonography Examination Sample Questions (Q143-Q148):

NEW QUESTION # 143
Which condition is most consistent with the findings in the image below?

A. Porcelain gallbladder
B. Adenomyomatosis
C. Gangrenous cholecystitis
D. Emphysematous cholecystitis

Answer: D

Explanation:
The ultrasound image shows echogenic foci with dirty shadowing and reverberation artifacts within the gallbladder wall and lumen. These features are characteristic of emphysematous cholecystitis, a severe, life- threatening variant of acute cholecystitis caused by gas-forming organisms (e.g., Clostridium or E. coli) infecting the gallbladder wall.
Sonographic features of emphysematous cholecystitis:
* Echogenic gas within the gallbladder wall or lumen
* Reverberation or "dirty" shadowing artifacts
* May show intramural gas bubbles or "ring-down" artifact
* Often seen in diabetic or immunocompromised patients
* No gallstones may be present ("acalculous cholecystitis")
Clinical context:
* More common in elderly men and diabetics
* Presents with right upper quadrant pain, fever, and leukocytosis
* Surgical emergency due to risk of perforation and sepsis
Differentiation from other options:
* A. Adenomyomatosis: Involves gallbladder wall thickening with "comet tail" artifacts due to Rokitansky-Aschoff sinuses, not intramural gas.
* B. Porcelain gallbladder: Shows curvilinear calcification of the gallbladder wall - dense echogenic rim with posterior shadowing.
* C. Gangrenous cholecystitis: May show wall irregularity, intraluminal membranes, and absence of Doppler flow but lacks intramural gas.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gallbladder and Biliary System, pp. 155-160.
American College of Radiology (ACR). Appropriateness Criteria for Right Upper Quadrant Pain, 2022.
Radiopaedia.org. Emphysematous cholecystitis: https://radiopaedia.org/articles/emphysematous-cholecystitis

NEW QUESTION # 144
Which technique best differentiates a bladder mass from a hematoma?

A. Change patient position
B. Fill the bladder
C. Obtain post-void image
D. Use harmonic imaging

Answer: A

Explanation:
Changing the patient's position allows evaluation of lesion mobility. Blood clots and hematomas are often mobile, while true bladder wall masses remain fixed. This technique helps differentiate between solid masses and non-adherent debris.
According to Rumack's Diagnostic Ultrasound:
"Changing patient position may distinguish between mobile blood clots and fixed bladder wall masses." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.

NEW QUESTION # 145
Which sonographic finding is associated with normal postprocedural Doppler of a transjugular intrahepatic portosystemic shunt (TIPS)?

A. Hepatofugal flow in the intrahepatic portal venous branches
B. Hepatopetal flow in the intrahepatic portal venous branches
C. Triphasic flow throughout stent
D. Low-velocity flow throughout stent

Answer: B

Explanation:
After successful TIPS placement, the intrahepatic portal venous branches continue to exhibit hepatopetal (toward the liver) flow, while the stent itself shows continuous, relatively high-velocity monophasic flow.
Hepatofugal flow in intrahepatic branches may indicate shunt dysfunction.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Normal post-TIPS Doppler shows hepatopetal flow in the intrahepatic portal veins and continuous high- velocity flow within the stent." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for the Performance of Portal Venous Ultrasound, 2020.
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NEW QUESTION # 146
Which patient maneuver would best aid in identifying the pathology demonstrated in this image?

A. Turn from side to side
B. Stand upright
C. Breathe quietly
D. Drink water

Answer: A

Explanation:
The ultrasound image demonstrates a classic example of ascites, shown by the anechoic (dark) fluid located between bowel loops or surrounding abdominal organs. In this case, there appears to be a small fluid collection in the peritoneal cavity.
One of the key maneuvers used to differentiate free fluid (such as ascites) from loculated fluid or other structures is to reposition the patient. Asking the patient to "turn from side to side" (Option D) can help in assessing whether the fluid shifts position - a hallmark feature of free intraperitoneal fluid. This positional change is highly useful in confirming the diagnosis and distinguishing ascites from other potential mimics (e.
g., cystic masses, lymphoceles, or bowel wall thickening).
In contrast:
* Drinking water (A) is often used in imaging the urinary bladder or gastrointestinal tract but not for fluid characterization.
* Standing upright (B) may shift fluid but is less practical during real-time ultrasound.
* Breathing quietly (C) doesn't significantly aid in visualizing peritoneal fluid mobility.
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 Diagnostic and Screening Ultrasound Examinations of the Abdomen and/or Retroperitoneum (2020).

NEW QUESTION # 147
Which liver neoplasm is associated with use of oral contraceptives and is most often seen in women under the age of 40?

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

Answer: D

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 # 148
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