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ARDMS Abdomen MOCK exam| 251 QUESTIONS|
WITH COMPLETE VERIFIED ANSWERS
Progression of which of the following abnormalities flattens the portal veins? Correct Answer: Biliary obstruction The wall thickness in a normal fasting gallbladder should not exceed Correct Answer: 3 mm This color Doppler sonogram is most likely demonstrating which of the following abnormalities? Correct Answer: Pseudoaneurysm This color Doppler image demonstrates turbulent swirling blood flow within a fluid collection, classic sonographic findings of a common femoral artery pseudoaneurysm. A patient presents with sudden onset of upper abdominal pain. Ultrasound demonstrates prominence in the stomach rugae. These findings are most suspicious for which of the following conditions? Correct Answer: Gastritis Prominence of the stomach rugae in a patient with upper abdominal pain is most suspicious for gastritis. Hypervascular, thick gastric walls are sonographic findings associated with gastric ulcers. Which of the following is a complication of acute pancreatitis? Correct Answer: Duodenal obstruction Complications of acute pancreatitis may include abscess formation, duodenal obstruction, hemorrhage, phlegmon, and pseudocyst formation. Cholecystitis is a possible etiology of acute pancreatitis.
A patient presents with a history of hematuria. The findings in this duplex image are most suspicious for which of the following pathologies? Correct Answer: Carcinoma A vascular echogenic mass is identified protruding from the posterior wall of the urinary bladder. Bladder carcinoma commonly presents with a history of painless hematuria. Based on the clinical history, the sonographic findings are suspicious for a malignant mass. A sagittal sonogram medial to the porta hepatis is demonstrating which of the following abnormalities? Correct Answer: Dilated common bile duct A hypoechoic mass identified by the calipers is obstructing the common bile duct resulting in dilatation. The mass is most likely a malignancy in the head of the pancreas. The pathology in this sonogram is most likely a/an Correct Answer: Pseudocyst A complex fluid collection is identified posterior to the tail of the pancreas. This is most likely a pancreatic pseudocyst. Phlegmons and islet cell tumors appear as hypoechoic masses on ultrasound. A pancreatic hemorrhage is a differential consideration but not the most likely pathology. Which of the following abnormalities is demonstrated in this transverse sonogram? Correct Answer: Stones in the duct of Wirsung Multiple stones are located in main pancreatic duct (duct of Wirsung). Which of the following is a clinical symptom of hypothyroidism? Correct Answer: Muscle cramps
The sonogram is demonstrating a patent paraumbilical vein. Note the liver parenchyma of the left lobe superior to the patent umbilical vein. Gastric varices are generally located to the left of midline. Splenomegaly is a consistent finding in which of the following pathologies? Correct Answer: Portal hypertension Splenomegaly is a consistent finding in cases of portal hypertension. A duplex image of the splenic vein is demonstrating Correct Answer: retrograde flow. That's correct! The splenic vein normally flows toward the transducer, displaying a waveform above the baseline (antegrade). In this case, the blood is flowing away from the transducer back toward the spleen (retrograde). Which of the following structures separates the subphrenic space into two compartments? Correct Answer: Falciform ligament The falciform ligament divides the subphrenic space into right and left compartments. The left coronary ligament suspends the left lobe of the liver from the diaphragm. An asymptomatic patient presents with a history of elevated liver function tests. Based on this clinical history, the sonogram most likely demonstrates Correct Answer: fatty infiltration Fatty infiltration is the most likely diagnosis in an asymptomatic patient demonstrating diffusely echogenic liver parenchyma. In addition, the portal veins are still clearly visible, consistent with fatty infiltration. The subhepatic space communicates with the lesser sac through the foramen of Correct Answer: Winslow
The foramen of Winslow allows communication between the subhepatic space and lesser sac. Which vascular structure courses posterior to the superior mesenteric artery and anterior to the abdominal aorta? Correct Answer: Left renal vein The left renal vein courses posterior to the superior mesenteric artery and anterior to the abdominal aorta. The celiac axis is located at Correct Answer: superior to the body of the pancreas The celiac axis is located superior to the body of the pancreas, superior mesenteric artery, and splenic vein; posterior to the left gastric vein; inferior to the gastroesophageal junction. A postsurgical patient presents with abdominal tenderness and leukocytosis. A sonogram demonstrates a superficial, ill-defined mass beneath the surgical incision. Based on the clinical history, the sonographic findings are most suspicious for Correct Answer: abscess An ill-defined superficial mass beneath a recent surgical incision in a patient with leukocytosis most likely represents a postsurgical abscess. Secretion of thyroid-stimulating hormone is controlled by the Correct Answer: pituitary gland The anterior pituitary gland controls secretion of thyroid-stimulating hormone. The coronary vein enters the venous system near the Correct Answer: superior border of the portosplenic confluence
A cake kidney is a variant of a horseshoe kidney. The entire medial aspects of the kidneys are fused. A cake kidney is typically located in the pelvis. Focal dilatation of the anterior wall of the abdominal aorta describes a Correct Answer: saccular aneurysm Focal outpouching of one arterial wall is characteristic of a saccular aneurysm. They are often a result of trauma or infection. Which of the following structures is most likely mistaken for the splenic artery? Correct Answer: Pancreatic duct The pancreatic duct and the splenic artery are most likely to be confused with each other. Color Doppler imaging is a quick method of verifying a vascular structure. This transverse sonogram of the right testicle is most likely demonstrating which of the following abnormalities? Correct Answer: Intratesticular calcifications Multiple small hyperechoic foci (microcalcifications) are demonstrated in the right testis. Intratesticular calcifications may be idiopathic or associated with chronic orchitis. The pathology in this sonogram is most consistent with Correct Answer: metastatic lesions The liver demonstrates a heterogenous parenchyma most suspicious for metastatic lesions. A palpable buttock mass identified is most consistent with which of the following? Correct Answer: Lipoma
A well circumscribed mass that does not demonstrate posterior acoustic enhancement is most consistent with a lipoma. Extended use of oral contraceptives is a predisposing factor in developing which of the following hepatic neoplasms? Correct Answer: Adenoma Extended use of oral contraceptives is linked to development of liver adenomas. Cavernous hemangiomas and cystadenomas have a female prevalence but are not related to the use of oral contraceptives. Which of the following neoplasms is commonly located in the tail of the pancreas? Correct Answer: Islet cell tumor Islet cell tumors are most commonly located in the body and tail of the pancreas. Adenocarcinoma involving the pancreas commonly develops in the head of the pancreas. Which of the following vascular structures is the arrow identifying? Correct Answer: Internal jugular vein The anechoic structure is located lateral to the thyroid lobe and anterior to the common carotid artery. This is most consistent with the internal jugular vein. The external jugular vein is located in the lateral neck. Bile pigments are produced by the Correct Answer: liver The liver breaks down red blood cells, producing bile pigments. Which of the following anatomic variants involves the fundus of the gallbladder? Correct Answer: Phrygian cap Folding of the gallbladder fundus describes a phrygian cap. Hartmann pouch and junctional fold are anatomic variants in the region of the
An enlarged hypoechoic pancreas in a patient with severe upper abdominal pain is most consistent with acute pancreatitis. Laboratory values will likely demonstrate elevation in serum amylase and lipase levels. A round anechoic mass adjacent to the renal pelvis is most likely a(n) Correct Answer: parapelvic cyst A round anechoic mass (cyst) adjacent to the renal pelvis is most likely a parapelvic cyst. An extrarenal pelvis and renal vein demonstrate an oval contour medial to the renal pelvis. A small hyperechoic pancreas is most suspicious for which of the following abnormalities? Correct Answer: Chronic pancreatitis Chronic pancreatitis is associated with atrophy of the pancreas and demonstrates a hyperechoic parenchyma. Fatty infiltration generally does not affect the size of the pancreas. An 11-year-old presents with a history a palpable thyroid gland, fatigue, and dysphagia. Based on this clinical history, the color Doppler image of the right thyroid lobe is most likely demonstrating Correct Answer: thyroiditis The duplex sonogram is demonstrating a hypervascular, hypoechoic enlarged thyroid gland, most suspicious for thyroiditis. Clinical symptoms of thyroiditis may include fatigue, fever, leukocytosis, neck pain, dysphagia, and hyperthyroidism followed by hypothyroidism. A patient presents with a history of a painful lump on her posterior wrist. Based on this clinical history, the sonogram is most likely demonstrating which of the following abnormalities? Correct Answer: Ganglion cyst
An anechoic smooth walled mass is identified in the area of concern. This most likely represents a ganglion cyst. A Baker cyst is located in the posterior medial portion of the knee joint. The anechoic structure is most likely arising from which of the following structures? Correct Answer: Kidney The cyst is most likely arising from the renal parenchyma. Possible differential considerations include hepatic or adrenal cyst. The sonographic findings in this infant kidney are most consistent with which of the following anomalies? Correct Answer: Renal duplication Two individual renal sinuses are present. The lower sinus demonstrates pelviectasis (Grade 1 hydronephrosis). This is most suspicious for renal duplication. Hypertrophied column of Bertin is a common anatomic variants. The arrow is identifying which of the following vascular structures? Correct Answer: Common hepatic artery The arrow identifies a structure branching from the celiac axis and coursing toward the liver. This is most consistent with the common hepatic artery. The common hepatic artery becomes the proper hepatic artery after the origin of the gastroduodenal artery. Cases of gallbladder carcinoma frequently demonstrate coexisting Correct Answer: cholelithiasis In approximately 90 percent of cases, cholelithiasis coexists with gallbladder carcinoma Sonographic findings associated with pyelonephritis include Correct Answer: well-defined renal pyramids.
A 25 - year-old female patient presents with a history of mild right upper quadrant pain and normal liver function tests. Based on the sonogram, the sonographer should ask the patient Correct Answer: Do you use oral contraceptives? A 25-year-old female demonstrating a hypoechoic liver mass and a peripheral hypoechoic halo is suspicious for a hepatic adenoma. The sonographer should inquire whether the patient is taking oral contraceptives. The "water lily" sign is associated with which of the following abnormalities? Correct Answer: Echinococcal cyst The "water lily" sign describes a collapsed cyst within a cyst, characteristic of an echinococcal cyst. This sagittal image of the left kidney is most likely demonstrating Correct Answer: a normal neonatal kidney. A 5.0 cm kidney (using sidebar measurements) inferior to the spleen demonstrates an echogenic renal cortex, anechoic medullary pyramids, and a discrete renal sinus. This is most consistent with a normal neonatal kidney. Which of the following most accurately describes the location of the adrenal glands? Correct Answer: Medial to the kidneys The adrenal glands are located anterior, medial, and superior to each kidney and lateral to the crura of the diaphragm. Cryptorchism is a predisposing risk factor for developing which of the following abnormalities? Correct Answer: Malignancy Undescended testis (cryptorchism) is a risk factor for developing testicular torsion, malignancy, and infertility.
The hyperechoic structure in this sonogram represents Correct Answer: a hepatic stent The hyperechoic structure in the right portal vein is most consistent with a hepatic stent. Patients with cirrhosis may require a hepatic stent or shunt to decrease pressure within the portosplenic venous system. Recanalization demonstrates as an echogenic thickening to the intraluminal hepatic walls. Which of the following vascular structures normally demonstrates this waveform? A. Portal vein B. Hepatic vein C. Splenic vein D. Superior mesenteric vein Correct Answer: Hepatic vein Pulsatile bidirectional venous flow is characteristic of a normal hepatic vein. A 6-week-old female infant presents with a history of left hip clicking. Based on this clinical history, the sonogram is most likely demonstrating a Correct Answer: dysplastic hip. The Graf alpha angle is abnormal. To be considered within normal limits the alpha angle should be 60 degrees or greater. The alpha angle in this case measures 46 degrees. The beta angle is normal measuring under 55 degrees ( 48 degrees). This is consistent with developmental dysplasia of the hip. In addition the femoral head is too lateral but still partially lies within the acetabulum consistent with subluxation. The sonographic findings are most suspicious for a(n) Correct Answer: angiomyolipoma
Splenomegaly is associated with portal hypertension. Multiple anechoic tubular structures in the epigastric region are most suspicious for gastric varices. The sonographic findings are most consistent with which of the following abnormalities? Correct Answer: Cholelithiasis Multiple small echogenic foci layer in the dependent portion of the gallbladder. Attenuation of sound by these foci produces posterior acoustic shadowing. Which of the following abnormalities is demonstrated in this color Doppler image? Correct Answer: Fatty infiltration with focal fat sparing The liver parenchyma demonstrates a diffuse increase in echogenicity (fatty infiltration). Hypoechoic areas are identified anterior and posterior to a hepatic vessel (fat sparing). Incidentally the right renal cortex has a scalloped appearance typical of fetal lobulation. What is the first step in a sterile procedure technique? Correct Answer: Wash your hands thoroughly The first step in a sterile procedure technique is to wash your hands thoroughly, followed by placing a sterile wrapped package on a clean and stable surface. Hemochromatosis is a rare disorder that may lead to Correct Answer: cirrhosis Hemochromatosis is characterized by excessive iron deposits throughout the body and may cause cirrhosis. Which of the following abnormalities is present in this sagittal sonogram? Correct Answer: Adenomyomatosis
Immobile hyperechoic foci demonstrating a "comet-tail" reverberation artifact are characteristic findings of adenomyomatosis. The gastroduodenal artery arises from which of the following arteries? Correct Answer: Hepatic artery The gastroduodenal artery arises from the common hepatic artery. The common hepatic artery is a branch of the celiac axis. Which of the following liver pathologies is associated with glycogen storage disease? Correct Answer: Adenoma Glycogen storage disease is an autosomal recessive disorder resulting in excessive deposition of glycogen in the liver, kidneys, and gastrointestinal tract. It is associated with development of a hepatic adenoma, focal nodular hyperplasia, and nephromegaly. Regulation of serum electrolytes is a function of the Correct Answer: kidneys The urinary system regulates serum electrolytes. Which of the following abnormalities are demonstrated in this sonogram? Correct Answer: Hydrocele and complex epididymal cyst An anechoic fluid collection is identified in the right scrotal sac. The scrotal wall appears thin. This is most consistent with a hydrocele. A complex cyst is also identified in the head of the epididymis. The arrow is identifying which of the following structures? Correct Answer: Falciform ligament A hyperechoic linear structure extends anterior to the left lobe of the liver consistent with the falciform ligament. The falciform attaches the
Dehydration increases the risk for developing Correct Answer: renal vein thrombosis Dehydration increases the risk for developing renal vein thrombosis Spectral analysis of the suprarenal portion of the abdominal aorta should demonstrate a Correct Answer: high resistance waveform with a low diastolic component The abdominal aorta demonstrates a high resistance waveform with a low diastolic component proximal to the renal arteries. A triphasic waveform is found distal to the renal arteries. Which of the following ligaments is present in this image of the liver? Correct Answer: Venosum The sonogram demonstrates the left and caudate lobes of the liver separated by the hyperechoic ligament of venosum. Glisson's capsule surrounds which of the following organs? Correct Answer: Liver Glisson's capsule surrounds the liver and Gerota's fascia surrounds the kidneys. A patient presents with abdominal pain and fever following an appendectomy. Based on this clinical history, the sonographic findings are most suspicious for a(n) Correct Answer: abscess An irregular bordered, complex hepatic mass is present in a febrile post appendectomy patient most likely representing a hepatic abscess. Which of the following gallbladder abnormalities is not always pathological in origin? Correct Answer: Biliary sludge
Biliary sludge may develop in cases of prolonged fasting or biliary disease. A Klatskin tumor is located near which of the following structures? Correct Answer: Hepatic hilum A Klatskin tumor is a malignant neoplasm located at the junction of the right and left hepatic ducts near the hepatic hilum. A normal lymph node will likely demonstrate Correct Answer: a hyperechoic fatty center The normal lymph node demonstrates a smooth, hypoechoic, oval shape and a hyperechoic fatty center on ultrasound. This sonogram is most likely demonstrating which of the following? Correct Answer: Gallbladder adenoma An immobile (decubitus position), nonshadowing, echogenic intraluminal focus is most consistent with a gallbladder adenoma (polyp). Which of the following pathologies is more commonly associated with severe abdominal pain? Correct Answer: Portal vein thrombosis Severe abdominal pain is more commonly associated with portal vein thrombosis. The color Doppler image is most suspicious for which of the following abnormalities? A. Epididymitis B. Testicular torsion C. Testicular abscess D. Testicular carcinoma Correct Answer: Testicular torsion
