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ARDMS ABDOMEN ACTUAL EXAM, PRACTICE
EXAM AND STUDY GUIDE NEWEST 2024
COMPLETE 400 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
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ARDMS ABDOMEN EXAM
You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial segment from the right anterior segment of the liver? - CORRECT ANSWER>>Middle Hepatic Vein You suspect enlargement of the caudate lobe in a patient with liver disease. What structure located at the anterior border of the caudate lobe will help you identify this lobe of the liver? - CORRECT ANSWER>>Fissure for the ligamentum venosum You are asked to rule out the presence of a recanalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure? - CORRECT ANSWER>>Ligamentum Teres *The left portal vein is in contact with the ligamentum teres. A paraumbilical vein begins at the left portal vein and exits the liver at the ligamentum teres. Which vessel courses within the main lobar fissure? - CORRECT ANSWER>>Middle Hepatic Vein Oxygenated blood is supplied to the liver via the: - CORRECT ANSWER>>Portal Vein and Hepatic Artery You are performing a sonogram on a slender female and notice a long, thin extension of the inferior aspect of the right lobe of the liver. This most likely represents: - CORRECT ANSWER>>Reidel's lobe Which of the following forms the caudal border of the left portal vein?
A. Ligamentum venosum B. Hepatoduodenal ligament C. Main Lobar Fissure D. Coronary Ligament E. Ligamentum teres - CORRECT ANSWER>>Ligamentum teres What ligament divides the left lobe of the liver into medial and lateral segments? - CORRECT ANSWER>>Ligamentum teres You are asked to perform a Doppler study on the hepatic veins in the liver. What differentiates the hepatic veins from the portal veins? - CORRECT ANSWER>>The portal veins are accompanied by branches of the biliary tree and hepatic artery You have detected a mass anterior and to the left of the ligamentum venosum. This mass is located in what lobe of the liver? - CORRECT ANSWER>>Left Lobe of the Liver The thin capsule surrounding the liver is known as: - CORRECT ANSWER>>Glisson's capsule Which of the following course interlobar and intersegmental within the liver? A. Bile ducts B. Portal veins C. Hepatic arteries D. Lymphatics E. Hepatic veins - CORRECT ANSWER>>E. Hepatic Veins You are performing an ultrasound exam of the liver on a small patient with a 5 MHz curved linear array. Although you have increased the overall gain to its maximum setting, the posterior border of the liver and diaphragm are not visualized. What should you do? - CORRECT ANSWER>>Rescan the liver with a lower frequency transducer *Lower frequency transducers provide greater penetration than higher frequency transducers. Another way to increase the penetration is to increase the transmit power. Decreasing the transmit power will decrease penetration. Moving the focal zone into the near field will not improve penetration.
A. Elevation of both GGT and ALP suggests the source of elevated ALP is due to metastatic bone cancer B. Elevation of both GGT and ALP is a sensitive indicator of pancreatitis C. If both GGT and ALP are elevated, the lab work is invalid and must be repeated D. Concomitant elevation of both GGT and ALP indicates the source of the elevated ALP in the liver - CORRECT ANSWER>>D. Concomitant elevation of both GGT and ALP indicates the source of the elevated ALP in the liver *ALP may be elevated with multiple conditions including skeletal disease, hyperparathyroidism, and acute hepatocellular disease. GGT is used with ALP to suggest the source of elevated ALP levels. If both ALP and GGT levels are elevated, the source of the ALP is probably of the liver, indicating hepatocellular dysfunction. Which of the following lab tests is NOT used in evaluation of liver function? A. Gamma-glutamyl transpeptidase (GGT) B. Aspartate aminotransferase (AST) C. Direct bilirubin D. Indirect bilirubin E. Lipase - CORRECT ANSWER>>E. Lipase *Lipase is used to evaluate acute pancreatitis. *Elevation of direct bilirubin usually indicates biliary obstruction, which may be intrahepatic (due to hepatitis or cirrhosis) or extrahepatic (due to gallstones, gallbladder or pancreatic cancer) *Indirect bilirubin may be evaluated with hepatocellular dysfunction such as hepatitis. *AST is used in evaluation of acute hepatic disease, it may also be elevated with recent myocardial infarction. *GGT us used with ALP to suggest the source of elevated ALP levels A patient is referred with RUQ tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color Doppler reveals hypervascularity of the mass. What is most likely the diagnosis? - CORRECT ANSWER>>Hepatic Adenoma A liver ultrasound on a 49 year old obese male patient demonstrates diffuse increased echogenicity with a focal hypoechoic area anterior to the portal vein.
This most likely represents: - CORRECT ANSWER>>Fatty metamorphosis of the liver with focal sparing *Focal fatty sparing is commonly seen as a hypoechoic mass anterior to the portal vein A 52 year old male with known liver cirrhosis presents for an abdominal ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of which TRUE statement below? A. Patients with liver cirrhosis are at an increased risk for hepatocellular carcinoma B. Patients with liver cirrhosis tend to develop multiple cysts in their liver and pancreas C. Metastatic disease occurs commonly with cirrhosis D. The presence of regenerative nodules rules out cirrhosis E. All of the above are correct - CORRECT ANSWER>>A. Patients with liver cirrhosis are at an increased risk for hepatocellular carcinoma You are scanning a patient with a suspected liver cirrhosis. All of the above are sonographic features of cirrhosis EXCEPT: A. Surface nodularity B. Shrunken caudate lobe C. Altered echo texture D. Ascites E. Regenerative nodules - CORRECT ANSWER>>B. Shrunken caudate lobe *In liver cirrhosis the caudate lobe is most commonly enlarged compared to the right lobe due to sparing An ultrasound evaluation of liver cirrhosis should include a search for which associated complication? - CORRECT ANSWER>>Portal Hypertension Ultrasound findings of an abdominal study on a 51 year old female include enlargement of the hepatic veins and IVC in an otherwise normal appearing liver. These findings are most consistent with? - CORRECT ANSWER>>Right-sided heart failure
E. Increased through transmission - CORRECT ANSWER>>D. Increased Attenuation *Attenuation through a cyst is decreased rather than increased A single, well-defined mass with smooth walls and homogeneous low-level echoes is seen within the anterior right lobe of the liver in a 48 year old female. No Doppler signals could be obtained within the mass. Which of the following conditions is the most likely etiology of this mass? A. Kaposi's sarcoma B. Focal nodular hyperplasia C. Hemorrhagic cyst D. Portal vein aneurysm E. Hepatocellular carcinoma - CORRECT ANSWER>>C. Hemorrhagic cyst You are scanning a patient with history of fever, abnormal liver function tests, and right upper quadrant tenderness. The liver is enlarged with decreased echogenicity, the gallbladder wall is thickened and thick echogenic bands are noted surrounding the portal veins. What condition is this? - CORRECT ANSWER>>Hepatitis *With hepatitis, the liver parenchyma may appear normal or have a decreased echogenicity of the portal veins. Bright bands seen surrounding the portal veins are known as "periportal cuffing." Hepatomegaly may be present as well as thickening of the gallbladder wall. You are evaluating a suspicious lesion to look for gas bubbles to confirm the presence of a liver abscess in a patient with fever and increased white blood cell count. What is the sonographic appearance of the gas bubbles? - CORRECT ANSWER>>Brightly echogenic foci associated with echogenic ringdown artifact Which of the following is associated with infestation by a parasite and is most prevalent in sheep and cattle-raising countries? - CORRECT ANSWER>>Hydatid disease You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with which of the following abnormalities? A. Cirrhosis
B. Acute Hepatitis C. Fatty liver D. Polycystic liver disease E. Hepatomegaly - CORRECT ANSWER>>A. Cirrhosis Which of the following is NOT true regarding fatty liver? A.It is an irreversible disorder B.Fatty liver may be caused by obesity C. It may be diffuse or focal D. It may show a rapid change in appearance with time E. It commonly causes increased attenuation of the sound beam through liver - CORRECT ANSWER>>A. It is an irreversible disorder. *It is a reversible disorder You are scanning through the liver and notice a luminal narrowing of the hepatic veins. Color and spectral Doppler reveal high velocities through the strictures. These findings are most commonly associated with which of the following? A. Diffuse fatty liver B. Acute hepatitis C. Cirrhosis D. Focal fatty infiltration E. Glycogen storage disease - CORRECT ANSWER>>C. Cirrhosis *Since the walls of the hepatic veins are thin, they may be compressed as cirrhosis progresses. Gray-scale imaging may reveal tapering of the veins with color and spectral Doppler confirming increased velocities through the narrowed lumens. The most common benign tumor in the liver is: - CORRECT ANSWER>>Cavernous hemangioma Which of the following is most commonly associated with invasion of the portal vein? A. Hepatocellular carcinoma B. Cavernous hemangioma C. Liver metastases
E. Liver metastasis from lung cancer - CORRECT ANSWER>>E. Liver metastasis from lung cancer *The appearance of a bull's eye lesion within the liver is nonspecific, but is frequently seen with metastases from lung cancer. You are performing an ultrasound exam on a young female and notice a well- defined solitary mass with a central scar measuring 4 cm in diameter. Color Doppler reveals prominent blood vessels coursing within the scar. This most likely represents: - CORRECT ANSWER>>Focal nodular hyperplasia *FNH is the second most common benign liver mass (hemangioma is the most common liver mass). It is much more common in women than men and typically is seen in women of childbearing age. Most patients are asymptomatic. FNH typically presents as a well-demarcated single mass measuring less than 5 cm (although multiple or larger lesions may occasionally be seen). A central scar is commonly seen. Color Doppler shows prominent peripheral and central vascularity. You are performing a liver sonogram on a young female with RUQ pain, sudden onset of ascites and hepatomegaly. You have obtained TRV and SAG images of the liver, CBD, and gallbladder according to your protocol. What else should you do? A. Nothing, the study is complete B.Expand the study to include the kidneys to rule out associated hydronephrosis C. Use color and spectral Doppler to determine patency of the portal and hepatic venous system D. Give the patient a fatty meal and then measure the portal vein diameter at 1, 2, 5, and 10 minutes E. Call the referring physician to get an order to perform a pelvic study to see if the patients' pain is referred from an ovarian mass - CORRECT ANSWER>>C. Use color and spectral Doppler to determine patency of the portal and hepatic venous system *A patient with a history of RUQ pain and increased liver function tests and findings of ascites and hepatomegaly should be evaluated with color and/or spectral Doppler to determine patency and flow direction of the portal and hepatic venous systems. Budd-Chiari syndrome may be present. The IVC should also be evaluated. Budd-Chiari syndrome is characterized by the occlusion of the hepatic veins and/or IVC. The portal vein may be occluded or may show hepatofugal flow.
Cavernous hemangioma: - CORRECT ANSWER>>*Small, well-defined, hyperechoic masses *Consist of a vascular network *More common in women than men *Usually asymptomatic *The flow in cavernous hemangioma is very slow and may not be detected by color Doppler imaging A patient is referred for ultrasound with a history of liver transplantation. You identify an extrahepatic fluid collection. What is the likely etiology of this finding? A. Biloma B. Hematoma C. Loculated ascites D. Abscess E. All of the above - CORRECT ANSWER>>E. All of the above *There are may considerations for the etiology of an extrahepatic fluid collection following liver transplantation. Additional considerations include tumor, pseudoaneurysm, adrenal hematoma, pancreatic pseudocyst, or Roux loop What significant complication following liver transplantation is NOT detectable with ultrasound? A. Rejection B. Malignant disease C. Hepatic artery thrombosis D. Portal vein thrombosis E. Pseudoaneurysm - CORRECT ANSWER>>A. Rejection Graft rejection is extremely common following liver transplantation. Unfortunately, there have been no imaging findings that have sufficient sensitivity or specificity to rule out rejection. Complications of biopsy, including pseudoaneurysm and hematoma, may be detected sonographically. You are scanning a patient with a history of liver transplantation. What should you search for following complications of this surgery? - CORRECT ANSWER>>Biliary sludge
A. Normalcy B. Hepatic artery thrombosis C. Portal hypertension D. Acute cholecystitis E. Hepatocellular carcinoma - CORRECT ANSWER>>C. Portal Hypertension *The normal flow direction of the portal vein is cranially directed toward the liver and is termed hepatopetal. Hepatofugal flow is retrograde portal vein flow directed away from the liver. It is a sign of severe portal hypertension. A patient is referred for abdominal ultrasound with a high fever and RUQ pain. You document the presence of a large, rounded, homogeneous mass with low-level internal echoes and poorly defined borders. The mass is located in the right lobe of the liver, adjacent to the capsule and shows increased through transmission. This most likely represents: A. Hemorrhagic cyst B. Abscess C. Hematoma D. Choledochal cyst E. Loculated ascites - CORRECT ANSWER>>B. Abscess *These characteristics describe an amebic abscess within the liver. A hemorrhagic cyst could have a similar appearance, but the wall would be clearly defined rather than poorly distinguished. You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial segment separate from the right anterior segment of the liver? - CORRECT ANSWER>>Middle Hepatic Vein Which organ is the largest visceral organ in the body? - CORRECT ANSWER>>Liver Where is the major portion of the liver, the right lobe located? - CORRECT ANSWER>>in the right upper quadrant of the abdomen What organ is covered in large part by the peritoneum , except for a small area posterior to the dome known as the bare area? - CORRECT ANSWER>>the Liver
Which organ is covered in a layer of fibrous tissue, glisson's capsule? - CORRECT ANSWER>>the Liver You suspect enlargement of the caudate lobe in a patient with liver disease. What structure located at the anterior border of the caudate lobe will help you to identify this lobe of the liver? - CORRECT ANSWER>>Fissure for the ligamentum venosum You are asked to rule out the presence of a recannalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure? - CORRECT ANSWER>>Ligamentum teres What is the left portal vein in contact with? - CORRECT ANSWER>>Ligamentum teres Where does the paraumbilical vein begins? - CORRECT ANSWER>>begins at the left portal vein and exits the liver at the ligamentum teres Which vessel course within the main lobar fissure? - CORRECT ANSWER>>middle hepatic vein Oxygenated blood is supplied to the liver via the: - CORRECT ANSWER>>Portal vein and hepatic artery You are performing a sonogram on a slender female and notice a long, thin extension of the inferior aspect of the right lobe of the liver. The most likely represents: - CORRECT ANSWER>>Reidel's lobe What forms the caudal border of the left portal vein? - CORRECT ANSWER>>Ligamentum teres What ligament divides the left lobe of the liver into medial and lateral segments? - CORRECT ANSWER>>Ligamentum teres You are asked to perform a Doppler study on the hepatic veins in the liver. What differentiates the hepatic veins from the portal veins? - CORRECT ANSWER>>the portal veins are accompanied by branches of the biliary tree and hepatic artery
the liver? - CORRECT ANSWER>>Perform a subcostal scan with the probe angled superior and the patient in deep inspiration A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for? - CORRECT ANSWER>>Hepatocellular carcinoma If a non pregnant person with elevated levels of serum alpha-fetoprotein AFP , what is associated with this? - CORRECT ANSWER>>Hepatocellular carcinoma, germ cell tumor of gonadal, retroperitoneal, or mediastinal origin. Sometimes with cancer of pancreas, stomach, or biliary system. What may produce modest serum AFP elevations? - CORRECT ANSWER>>Hepatitis and cirrhosis You are reviewing lab work prior to performing an abnormal ultrasound exam. Elevated lab values include Gamma- glutamyl transpeptidase - GGT and alkaline phosphatase. What would it be? - CORRECT ANSWER>>Concomitant elevation of both GGT and alkaline phosphate indicates the source of the elevated alkaline phosphatase is the liver. what other reasons would alkaline phosphatase be elevated? - CORRECT ANSWER>>skeletal disease, hyperparathyroidism, and acute hepatocellular disease What is NOT a lab test use in evaluation of liver function out of the following GGT, AST, direct bilirubin, indirect bilirubin, or lipase? - CORRECT ANSWER>>Lipase - is used to evaluate acute pancreatitis What does it mean when direct bilirubin is elevated? - CORRECT ANSWER>>usually indicates biliary obstruction, which may be intrahepatic due to hepatitis, cirrhosis, or extrahepatic due to gallstones, gallbladder or pancreatic cancer. Why would indirect bilirubin be elevated? - CORRECT ANSWER>>with hepatocellular dysfunction such as hepatitis
What is Aspartate aminotransferase - AST used in evaluating? - CORRECT ANSWER>>used in evaluation of acute hepatic disease. May also be elevated with recent myocardial infarction. What is Gamma- glutamyl transpeptidase - GGT is used with what to suggest the source of elevated alkaline phosphatase levels? - CORRECT ANSWER>>used with alkaline phosphatase A patient is referred with right upper quadrant tenderness and a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color Doppler reveals hypervascularity of the mass. What is the scenario likely to be? - CORRECT ANSWER>>Hepatic Adenoma - the incidence of hepatic adenomas has increased in the united states since the 1970s. And are associated with use of oral contraceptives. A liver ultrasound on a 49-year-old obese male demonstrates diffuse increased echogenicity with a focal hypoechoic area anterior to the portal vein. This most likely represents: - CORRECT ANSWER>>Fatty metamorphosis of the liver with focal sparing What is commonly seen as a hypoechoic mass anterior to the portal vein? - CORRECT ANSWER>>Focal fatty sparring A 52-year-old male with known liver cirrhosis presents for an abdominal ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of what? - CORRECT ANSWER>>Patients with liver cirrhosis are at increased risk for hepatocellular carcinoma You are scanning a patient with suspected liver cirrhosis. All of the following, 1. Surface nodularity, 2. Shrunken caudate lobe, 3. Altered echo texture, 4. Ascites, 5. Regenerative nodules are sonographic feature of cirrhosis Except: - CORRECT ANSWER>>Shrunken caudate lobe The caudate lobe is most commonly enlarged compared to the right lobe due to sparing in what disease? - CORRECT ANSWER>>Liver cirrhosis An ultrasound evaluation of liver cirrhosis should include a search for which associated complication? - CORRECT ANSWER>>Portal hypertension
Which of the following is NOT a feature of hepatic cysts? a. Thin wall b. Posterior acoustic enhancement c. Anechoic d. increased attenuation e. increased through transmission - CORRECT ANSWER>>Increase attenuation - Attenuation through a cyst is decreased rather than increased. A single large, well-defined mass with smooth walls and homogeneous low-level echoes is seen within the anterior right lobe of the liver in a 48-year-old female. No Doppler signals could be obtained within the mass. What condition is the most likely etiology of this mass? - CORRECT ANSWER>>Hemorrhagic cyst You are scanning a patient with a history of fever, abnormal liver function tests, and right upper quadrant tenderness. The liver is enlarged with decreased echogenicity, the gallbladder wall is thickened and thick echogenic bands are noted surrounding the portal veins. What condition is it most likely? - CORRECT ANSWER>>Hepatitis What is the appearance under ultrasound of hepatitis? - CORRECT ANSWER>>the liver parenchyma may appear normal or have a decreased echogenicity with increased echogenicity of the portal veins. bright bands seen surrounding the portal veins known as "periportal cuffing". Hepatomegaly may be present or gallbladder wall. You are evaluating a suspicious lesion to look for gas bubbles to confirm the presence of liver abscess in a patient with fever and increased white blood cell count. What is the sonographic appearance of the gas bubbles? - CORRECT ANSWER>>Brightly echogenic foci associated with echogenic ringdown artifact Which of the following is associated with infestation by a parasite and is most prevalent in sheep and cattle-raising countries? - CORRECT ANSWER>>Hydatid disease You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with what abnormality? - CORRECT ANSWER>>Cirrhosis Is a fatty liver a reversible disorder? - CORRECT ANSWER>>Yes
What is true about fatty livers? - CORRECT ANSWER>>Fatty liver may be caused by obesity. It may be diffuse or focal. It may show a rapid change in appearance with time. It commonly causes increased attenuation of the sound beam through liver. You are scanning through the liver and notice luminal narrowing of the hepatic veins. Color and spectral Doppler reveal high velocities through the strictures. These findings are most commonly associated with which of the following? - CORRECT ANSWER>>Cirrhosis The most common benign tumor in the liver is: - CORRECT ANSWER>>Cavernous Hemangioma What is most commonly associated with invasion of the portal vein? - CORRECT ANSWER>>Hepatocellular carcinoma
- CORRECT ANSWER>> You have been asked to perform a liver sonogram on a patient with AIDS. Which of the following tumors, hepatocellular carcinoma, Kaposi's sarcoma, budd-chiari syndrome, hemangiosarcoma, or hepatic adenoma, is most commonly associated with this history? - CORRECT ANSWER>>Kaposi's sarcoma You are scanning a 53-year-old female with a history of recent weight loss and vague abdominal pain. The liver is markedly heterogeneous and contains numerous calcified lesions. This most likely represents metastatic disease from which primary? - CORRECT ANSWER>>Adenocarcinoma of the colon What is most commonly associated with mucinous adenocarcinoma of the colon? - CORRECT ANSWER>>Calcified metastases During ultrasound evaluation of the liver, a bull's eye or target lesion is identified in the anterior right lobe. The most likely etiology of this mass is: - CORRECT ANSWER>>Liver metastasis from lung cancer The appearance of a bull's eye lesion within the liver is nonspecific , but when is it frequently seen? - CORRECT ANSWER>>with metastases from the lung cancer
