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ARDMS Abdomen Sonography Examination Sample Questions (Q155-Q160):

NEW QUESTION # 155
Beginning at the renal artery, what is the correct sequence of arterial branching?

A. Segmental, interlobar, arcuate
B. Arcuate, segmental, interlobar
C. Interlobar, arcuate, segmental
D. Segmental, arcuate, interlobar

Answer: A

Explanation:
The correct sequence of renal arterial branching is: renal artery # segmental arteries # interlobar arteries # arcuate arteries # interlobular arteries. This branching pattern is important for understanding renal perfusion and evaluating vascular disorders.
According to Moore's Clinically Oriented Anatomy:
"Renal arteries divide into segmental branches, which give rise to interlobar arteries, then arcuate arteries, and finally interlobular arteries." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 156
A patient presents with right lower quadrant pain and fever. Which condition is most likely indicated by the arrow on this image?

A. Intussusception
B. Bowel obstruction
C. Enlarged lymph node
D. Ruptured appendix

Answer: D

Explanation:
The ultrasound image demonstrates a tubular, non-compressible, blind-ending structure located in the right lower quadrant (RLQ) with associated echogenic periappendiceal fat and possibly adjacent fluid or phlegmon.
These features are consistent with appendicitis. Given the clinical history of fever and RLQ pain, along with the irregular borders and complex periappendiceal findings, the diagnosis of a ruptured appendix is most likely.
Key sonographic features of ruptured appendicitis include:
* Non-visualization or distortion of the normal appendiceal wall architecture
* Periappendiceal fluid collection or abscess
* Disruption of the echogenic submucosal layer
* Surrounding fat stranding (hyperechoic inflammatory changes)
* Clinical correlation with fever and peritonitis
Comparison of answer choices:
* A. Bowel obstruction typically shows dilated bowel loops with air-fluid levels, not a tubular structure like the appendix.
* B. Intussusception presents with a target or "donut" sign in a transverse view, not a linear tubular structure.
* C. Enlarged lymph nodes are usually round or oval and hypoechoic with a central echogenic hilum, without a tubular appearance.
* D. Ruptured appendix - Correct. The ultrasound features and clinical presentation match.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Jeffrey RB, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology.
1988;167(2):327-329.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of the Ultrasound Examination for Appendicitis (2020).

NEW QUESTION # 157
Where is the main pancreatic duct located?

A. Medial to the superior mesenteric vein
B. Ventral to the pancreatic body
C. Dorsal to the common bile duct
D. Dorsal to the superior mesenteric artery

Answer: A

Explanation:
The main pancreatic duct (duct of Wirsung) runs through the central portion of the pancreas, medial and slightly posterior to the superior mesenteric vein (SMV). It converges with the common bile duct near the ampulla of Vater.
According to Moore's Clinically Oriented Anatomy:
"The main pancreatic duct runs centrally within the gland and lies medial to the superior mesenteric vein." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 158
Which technique best differentiates a bladder mass from a hematoma?

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

Answer: D

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 # 159
Based on this image, what is the most likely clinical indication for the examination?

A. Abnormal prenatal ultrasound
B. Red currant jelly stools
C. Projectile vomiting
D. Neonatal hyperbilirubinemia

Answer: C

Explanation:
The ultrasound image demonstrates findings consistent with hypertrophic pyloric stenosis (HPS). This condition typically affects infants between 2 and 8 weeks of age and presents clinically with non-bilious projectile vomiting, weight loss, and dehydration.
In the ultrasound image, the classic "target" or "donut" sign can be seen in the transverse view of the hypertrophied pyloric muscle. Key sonographic criteria for HPS include:
* Pyloric muscle thickness #3 mm
* Pyloric channel length #15-18 mm
This imaging appearance strongly correlates with the clinical presentation of projectile vomiting (Choice D), which is the hallmark symptom of HPS.
Comparison of answer choices:
* A. Abnormal prenatal ultrasound (Choice A) is not typically associated with HPS, which develops postnatally.
* B. Neonatal hyperbilirubinemia (Choice B) is not an indication for a pyloric ultrasound and affects liver
/biliary imaging.
* C. Red currant jelly stools (Choice C) are indicative of intussusception, not HPS.
* D. Projectile vomiting (Choice D) is the most common clinical indication leading to an ultrasound exam that reveals HPS.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pyloric Region in Infants (2014).
Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. 2003;227(2):319-331.

NEW QUESTION # 160
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