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ARDMS ABDOMEN Mock Exam Questions and Answers
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]ጨ ᖷ%0% ^灄㶩 鑼槓a **bnormalitiesflattenstheportalveins? (Answer)** Biliary obstruction 5%38%38%骆下U䍋V伸W⡰䱐X牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ ]ጨ ᖷ%0% ^灄㶩_ 鑼槓a gallbladdershouldnotexceed(Answer) 3mm 5%38%38%骆下U䍋V伸W⡰䱐X牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ牚ᷨ ]ጨ ᖷ%0% ^灄㶩 `鑼槓a kelydemonstratingwhichofthefollowi ngabnormalities? (Answer) Pseudoaneurysm ThiscolorDopplerimagedemonstratesturbulentswirlingbloodflowwithinafluidcollec tion, classic sonographic findings of a common femoral artery pseudoa-neurysm. Apatientpresentswithsuddenonsetofupperabdominalpain.Ultrasounddemo nstrates prominence in the stomach rugae. These findings are mostsuspiciousfor whichof thefollowingconditions?(Answer) Gastritis Prominence of the stomach rugae in a patient with upper abdominal pain is mostsuspiciousforgastritis.Hypervascular,thickgastricwallsaresonographicfindingsa ssociatedwith gastric ulcers. Whichofthefollowingisacomplicationofacutepancreatitis?(Answer) Duoden alobstruction Complications of acute pancreatitis may include abscess formation, duodenalobstruction,hemorrhage,phlegmon,andpseudocystformation.Cholecystitisi sapossibleetiology of acute pancreatitis. Apatientpresentswithahistoryofhematuria.Thefindingsinthisdupleximagea remostsuspiciousforwhichofthefollowingpathologies?(Answer) Carcino-ma A vascular echogenic mass is identified protruding from the posterior wall of theurinarybladder.Bladdercarcinomacommonlypresentswithahistoryofpainlesshe maturia. Based on the clinical history, the sonographic findings are suspiciousfora malignant mass. A sagittal sonogram medial to the portahepatis is demonstrating whichofthe following abnormalities?(Answer) Dilated common bileduct
Ahypoechoicmassidentifiedbythecalipersisobstructingthecommonbileductresulting
ligament serves asa barrier between thesetwo peritoneal spaces. ThiscolorDopplersonogramismostlikelydemonstratingwhichofthefollowi ngabnormalities?(Answer) Patent umbilicalvein The sonogram is demonstrating a patent paraumbilical vein. Note the liverparenchymaoftheleftlobesuperiortothepatentumbilicalvein.Gastricvaricesareg enerally located to the left of midline. Splenomegalyisaconsistentfindinginwhichofthefollowingpatholo-gies? (Answer) Portal hypertension Splenomegalyisaconsistentfindingincasesofportalhypertension. Adupleximageofthesplenicveinisdemonstrating(Answer) retrogradeflow. That'scorrect!Thesplenicveinnormallyflowstowardthetransducer,displayingawavefo rm above the baseline (antegrade). In this case, the blood is flowing awayfromthetransducer backtowardthe spleen(retrograde). Whichofthefollowingstructuresseparatesthesubphrenicspaceintotwoco mpartments?(Answer) Falciform ligament The falciformligament divides the subphrenic space into right and left compart- ments. The left coronary ligament suspends the left lobe of the liver from thediaphragm. Anasymptomaticpatientpresentswithahistoryofelevatedliverfunctiontests. Basedonthisclinicalhistory,thesonogrammostlikelydemonstrates- (Answer) fattyinfiltration Fatty infiltration is the most likely diagnosis in an asymptomatic patient demon- stratingdiffuselyechogenicliverparenchyma.Inaddition,theportalveinsarestillclearly visible, consistentwith fatty infiltration. Thesubhepaticspacecommunicateswiththelessersacthroughtheforame nof(Answer) Winslow TheforamenofWinslowallowscommunicationbetweenthesubhepaticspaceandlesser sac. Whichvascularstructurecoursesposteriortothesuperiormesentericartery and anterior to the abdominalaorta?(Answer) Left renal vein
Theleftrenalveincoursesposteriortothesuperiormesentericarteryandanteriorto the abdominal aorta. The celiac axis islocated at(Answer) superiorto the bodyof the pancreas Theceliacaxisislocatedsuperiortothebodyofthepancreas,superiormesentericartery, and splenic vein; posterior to the left gastric vein; inferior to the gastroe-sophageal junction. Apostsurgicalpatientpresentswithabdominaltendernessandleukocy-tosis. A sonogram demonstrates a superficial, ill-defined mass beneath thesurgicalincision.Basedontheclinicalhistory,thesonographicfindingsaremos tsuspicious for(Answer) abscess An ill-defined superficial mass beneath a recent surgical incision in a patient withleukocytosismost likelyrepresents apostsurgical abscess. Secretionofthyroid- stimulatinghormoneiscontrolledbythe(Answer) pituitarygland The anterior pituitary gland controlssecretion of thyroid-stimulating hormone. Thecoronaryveinentersthevenoussystemnearthe(Answer) superiorborder ofthe portosplenic confluence Thecoronaryveinentersthesuperiorborderoftheportosplenicconfluenceandmaybeac ollateralsourceincasesofportalhypertension.Theinferiormesentericveinenters the inferior border ofthe portosplenic confluence. Acomplicationgenerallyoccurringwithindaysofarenaltransplantis(Ans wer) renal vein thrombosis Renalveinthrombosisgenerallyoccurswithindaysofarenaltransplant.Renalartery stenosis typicallyoccurs monthsto years aftertransplantation. Thesonogramismostsuspiciousforwhichofthefollowingabnormali-ties? (Answer) Varicocele Multipleanechoictubularstructuresareidentifiedposteriortothelefttesticle,mostsuspi cious for a varicocele. Duplex imaging of these tubular structures should beincludedin this examination. Thesolitaryechogenicfocusmostlikelyrepresentsa(n)(Answer) floatinggallsto
Awellcircumscribedmassthatdoesnotdemonstrateposterioracousticenhance-ment is most consistent with a lipoma. Extendeduseoforalcontraceptivesisapredisposingfactorindevelop- ingwhich ofthe following hepaticneoplasms?(Answer) Adenoma Extendeduseoforalcontraceptivesislinkedtodevelopmentofliveradenomas.Caverno us hemangiomas and cystadenomas have a female prevalence but arenotrelated to theuse of oralcontraceptives. Whichofthefollowingneoplasmsiscommonlylocatedinthetailofthepancrea s? (Answer) Isletcell tumor Isletcelltumorsaremostcommonlylocatedinthebodyandtailofthepancreas.Adenocarc inoma involving the pancreas commonly develops in the head of thepancreas. Whichofthefollowingvascularstructuresisthearrowidentifying?(Answer) I n- ternal jugular vein The anechoic structure is located lateral to the thyroid lobe and anterior to thecommoncarotidartery.Thisis most consistent with the internal jugular vein.Theexternaljugular veinis located inthe lateral neck. Bilepigmentsareproducedbythe(Answer) liver Theliverbreaksdownredbloodcells,producingbilepigments. Whichofthefollowinganatomicvariantsinvolvesthefundusofthegallbla dder? (Answer) Phrygian cap Folding of the gallbladder fundus describes a phrygian cap. Hartmann pouchandjunctionalfoldareanatomicvariantsintheregionofthegallbladderneck.A multiseptatedgallbladderisacongenitalanomalyandfetallobulationinvolvesthekidne y. Renaldialysispatientshaveanincreasedriskofdevelopingarenal(Answer) ca r- cinoma Renaldialysispatientshaveanincreasedriskofdevelopingarenalcarcinoma,cyst, or adenoma. Thissonogramoftherightkidneyismostlikelydemonstrating(Answer) junctio nalparenchymaldefect.
Atriangular,echogeniccorticaldefectpresentintheanteriorwalloftherightkidneymost likely represents a junctional parenchymal defect. An angiomyolipoma is adifferentialconsiderationbutis notaslikelythe diagnosis. Anendocrinefunctionofthe pancreasincludessecretionof(Answer) glucagon Endocrine functions of thepancreas include secretionof glucagon, insulin, andsomatostatin.Exocrinefunctionsincludesecretionofamylase,lipase,andtrypsin. Whichofthefollowingdemonstratesdiffuseenlargementoftheabdom-inal aorta withoutdistal tapering?(Answer) Arteriomegaly Arteriomegaly (aorticectasia)demonstratesasadiffuseenlargementoftheab-dominal aorta without distal taperingon ultrasound. Apatientpresentswithahistoryofsevereupperabdominalpainincreas-ing in intensity over the last 12 hours. Based on this clinical history, thesonogramis most likelydemonstrating(Answer) acute pancreatitis. Anenlargedhypoechoicpancreasinapatientwithsevereupperabdominalpainismost consistent with acute pancreatitis. Laboratory values will likely demonstrateelevationinserum amylaseandlipase levels. Aroundanechoicmassadjacenttotherenalpelvisismostlikelya(n)(Answer)- parapelviccyst Aroundanechoicmass(cyst)adjacenttotherenalpelvisismostlikelyaparapelviccyst.Ane xtrarenalpelvisandrenalveindemonstrateanovalcontourmedialtotherenalpelvis. Asmallhyperechoicpancreasismostsuspiciousforwhichofthefollow-ing abnormalities?(Answer) Chronic pancreatitis Chronicpancreatitisisassociatedwithatrophyofthepancreasanddemonstratesa hyperechoic parenchyma. Fatty infiltration generally does not affect the size ofthepancreas. An 11-year-old presents with a history a palpable thyroid gland, fatigue,anddysphagia.Basedonthisclinicalhistory,thecolorDopplerimageofther ightthyroidlobeis mostlikelydemonstrating(Answer) thyroiditis Theduplexsonogramisdemonstratingahypervascular,hypoechoicenlarged
Generalizedorfocalswellingofthekidneydemonstratingwell-definedrenalpyra- midsisthetypicalsonographicfindingassociatedwithpyelonephritis. Whichbenignliverneoplasmiscomposedoflarge,blood- filledcysticspaces?(Answer) Cavernous hemangioma Thecavernoushemangiomaiscomposedoflarge,blood-filledcysticspacesandis the most common benign hepatic neoplasm. Whichofthefollowingarteriesaretermedthehypogastricarteries?(Answer) I n- ternal iliac arteries Theinternaliliacarteriesarealsoknownasthehypogastricarteries. Atransverseimageoftheurinarybladderisdemonstratingwhichofthefollowi ng? (Answer) Ureteroceles Bilateralhyperechoicseptationswithintheposteriorbladderwallaremostcon- sistent with ureteroceles. Ureteroceles are focal dilatations of the distal ureterexpandingas urineenters thebladder. Normalsonographicfindingsofarenaltransplantinclude(Answer) promin entrenalpyramids. Normalsonographicfindingsinarenaltransplantincludeprominentrenalpyra- mids,hyperechoicrenalsinus,andhypoechoicrenal cortex. Whichofthefollowingstructuresaidsinlocatingthegallbladderfossa?- (Answer) Main lobar fissure Themainlobarfissureisasonographiclandmarkusedinlocatingthegallbladderfossa. The right hepatic vein divides the right lobe of the liver into anterior andposteriorsegments. A 25-year-old female patient presents with a history of mild right upperquadrantpainandnormalliverfunctiontests.Basedonthesonogram,thes onographershouldaskthepatient(Answer) Doyouuseoralcontraceptives? A 25-year-old female demonstrating a hypoechoic liver mass and a peripheralhypoechoichaloissuspiciousforahepaticadenoma.The sonographershouldinquirewhether thepatient istaking oralcontraceptives. The"waterlily"signisassociatedwithwhichofthefollowingabnormal-ities? (Answer) Echinococcal cyst
The "water lily" sign describes a collapsed cyst within a cyst, characteristic of anechinococcal cyst. Thissagittalimageoftheleftkidneyismostlikelydemonstrating(Answer) anormalneonatal kidney. A5.0cmkidney(usingsidebarmeasurements)inferiortothespleendemonstratesan echogenic renal cortex, anechoic medullary pyramids, and a discrete renalsinus.Thisismostconsistentwithanormalneonatalkidney. Whichofthefollowingmostaccuratelydescribesthelocationoftheadrenal glands?(Answer) Medial to the kidneys Theadrenalglandsarelocatedanterior,medial,andsuperiortoeachkidneyandlateralto the crura of the diaphragm. Cryptorchismisapredisposingriskfactorfordevelopingwhichofthefollowi ngabnormalities?(Answer) Malignancy Undescendedtestis(cryptorchism)isariskfactorfordevelopingtesticulartorsion,malig nancy,andinfertility. Thehyperechoicstructureinthissonogramrepresents(Answer) ahepaticstent Thehyperechoicstructureintherightportalveinismostconsistentwithahepaticstent. Patients with cirrhosis may require a hepatic stent or shunt to decreasepressure within the portosplenic venous system.Recanalization demonstrates asanechogenicthickening totheintraluminal hepaticwalls. Whichofthefollowingvascularstructuresnormallydemonstratesthiswavef orm? A. Portalvein B. Hepatic vein C. Splenic vein D. Superiormesentericvein(Answer) Hepaticvein Pulsatilebidirectionalvenousflowischaracteristicofanormalhepaticvein. A 6-week-old female infant presents with a history of left hip clicking.Basedonthisclinicalhistory,thesonogramismostlikelydemonstratin ga(Answer) dysplastic hip.
Splenomegalyisassociatedwithportalhypertension.Multiple anechoictubularstructuresin theepigastric region aremost suspicious forgastric varices. Thesonographicfindingsaremostconsistentwithwhichofthefollowingabnor malities?(Answer) Cholelithiasis Multiplesmallechogenicfocilayerinthedependentportionofthegallbladder.Attenu ationofsoundbythesefociproducesposterioracousticshadowing. WhichofthefollowingabnormalitiesisdemonstratedinthiscolorDoppl erimage?(Answer) Fattyinfiltrationwithfocalfatsparing The liver parenchyma demonstrates a diffuse increase in echogenicity (fatty infil- tration).Hypoechoicareasareidentifiedanteriorandposteriortoahepaticvessel(fatspa ring).Incidentallytherightrenalcortexhasascallopedappearancetypicaloffetal lobulation. Whatisthefirststepinasterileproceduretechnique?(Answer) Washyourhand sthoroughly Thefirststepinasterileproceduretechniqueistowashyourhandsthoroughly,followed byplacingasterilewrappedpackageonacleanandstablesurface. Hemochromatosisisararedisorderthatmayleadto(Answer) cirrhosis Hemochromatosisischaracterizedbyexcessiveirondepositsthroughoutthebodyandm ay cause cirrhosis. Whichofthefollowingabnormalitiesispresentinthissagittalsono-gram? (Answer) Adenomyomatosis Immobilehyperechoicfocidemonstratinga"comet- tail"reverberationartifactarecharacteristicfindings of adenomyomatosis. Thegastroduodenalarteryarisesfromwhichofthefollowingarteries?- (Answer) Hepaticartery The gastroduodenal artery arises from the common hepatic artery.The commonhepatic artery is a branch ofthe celiac axis. Whichofthefollowingliverpathologiesisassociatedwithglycogenstorage disease?(Answer) Adenoma
Glycogenstoragediseaseisanautosomalrecessivedisorderresultinginexces- sivedepositionofglycogenintheliver,kidneys,andgastrointestinaltract.Itis associatedwithdevelopmentofahepaticadenoma,focalnodularhyperplasia,andnephro megaly. Regulationofserumelectrolytesisafunctionofthe(Answer) kidneys Theurinarysystemregulatesserumelectrolytes. Whichofthefollowingabnormalitiesaredemonstratedinthissono-gram? (Answer) Hydrocele and complex epididymalcyst Ananechoicfluidcollectionisidentified inthe rightscrotalsac.Thescrotal wallappears thin. This is most consistent with a hydrocele. A complex cyst is alsoidentifiedin the head of the epididymis. Thearrowisidentifyingwhichofthefollowingstructures?(Answer) Falcifo rmligament Ahyperechoiclinearstructureextendsanteriortotheleftlobeoftheliverconsistentwithth efalciformligament.Thefalciformattachesthelivertotheanteriorabdomi-nal wall and separates the subphrenic space into rightand left compartments. Elevationincreatininelevelsisassociatedwith(Answer) renalfailure,chro nicnephritis, or urinary obstruction Elevationincreatininelevelsisassociatedwithrenalfailure,chronicnephritis,orurinar y obstruction. Prominenceoftheportalveinsisasonographiccharacteristicofwhichofthe following abnormalities?(Answer) Hepatitis The contour of the liver is generally unaffected in cases of acute hepatitis. Acutehepatitismaydemonstrateahypoechoicliverparenchyma,hepatomegaly,asso- ciatedsplenomegaly,andprominenceoftheportalveins(stareffect). ApositivePhalen'ssignisassociatedwithanabnormalityofwhichofthefollowi ngjoints?(Answer) Wrist ApositivePhalen'sand/orTinel'ssignisassociatedwithcarpaltunnelsyndrome(wrist). Thearrowisidentifyingwhichofthefollowingstructures?(Answer) Rightre nalartery
A Klatskin tumor is a malignant neoplasm located at the junction of the right andleft hepatic ducts near the hepatic hilum. Anormallymphnodewilllikelydemonstrate(Answer) ahyperechoicfattycenter Thenormallymphnodedemonstratesasmooth,hypoechoic,ovalshapeandahyperech oicfatty centeron ultrasound. Thissonogramismostlikelydemonstratingwhichofthefollowing?(Answer)- Gallbladderadenoma Animmobile(decubitusposition),nonshadowing,echogenicintraluminalfocusismostc onsistent with a gallbladder adenoma (polyp). Whichofthefollowingpathologiesismorecommonlyassociatedwithsevere abdominal pain?(Answer) Portalvein thrombosis Severeabdominalpainismorecommonlyassociatedwithportalveinthrombosis. ThecolorDopplerimageismostsuspiciousforwhichofthefollowingabnorm alities? A. Epididymitis B. Testiculartorsion C. Testicularabscess D. Testicularcarcinoma(Answer) Testiculartorsion The color Doppler image demonstrates an absence of testicular flow in the righttesticleandthepresenceofbloodflowwithin the lefttesticle.This ismost suspi- ciousfor testicular torsion. Thesonographicappearanceofcandidiasisisdescribedas(Answer) uniformh y- poechoic masses Candidiasis is a fungal infection associated with immune-suppressed patients.Sonographicfindingsincludeuniformhypoechoicmasses,hyperechoicmass esdemonstratingposterior shadowing, or targetlesions. Whichlaboratoryvaluerevealscellinjuryordamage?(Answer) Aspartateami no- transferase Aspartateaminotransferase(AST)isanenzymepresentinmanykindsoftissues
releasingwhencellsareinjuredordamaged.Levelsareproportionaltotheamountof damage and the time between cell injury and testing An ultrasound is requested to rule out Budd-Chiari syndrome. Thesonographershouldthoroughlyevaluatewhichofthefollowingabdominalve ins?(Answer) Hepatic veins Budd-Chiarisyndromeisalife-threateningconditionassociatedwiththrombosisofthe hepatic veins. The sonographer should thoroughly evaluate the liver vascula-ture. Inthiscasewhichofthefollowinglaboratoryvalueswouldbeofbene-fit? (Answer) Hematocrit Afluid- fluidlevelisdemonstratedwithintheliverparenchymamostsuspiciousforahematoma. Hematocritlevels wouldaid indetermining internal bleeding. Apatientpresentswithahistoryofabdominalpain.Asonogramoftheliveris most likelydemonstrating(Answer) polycystic liverdisease Multiplecontiguoushepaticcystsaremostsuspiciousforpolycysticliverdisease. Whichanatomicvariantispresentinthissonogramofthegallbladder? A. Duplication B. Phrygiancap C. Hartmann pouch D. Intrahepaticlocation(Answer) Phrygiancap Afoldinthegallbladderfundusisconsistentwithaphrygiancap.Hartmannpouchorajunc tionalfoldisanatomicvariantslocatednearthegallbladderneck. Whichofthefollowingaccuratelydescribestheportalveins?(Answer) Port alveinsare intralobar in location Portal veins are intralobaror intrasegmental in location. The portal veins supplyapproximately 70 to 75 percent of the liver's total blood volume. The main portalveindividesintotherightandleftportalveins.Thewallsoftheportalveinscontainfi brin. Whichofthefollowingisanabnormalflowcharacteristicofthehepaticveins?( Answer) Hepatopetal Hepaticveinscourseawayfromthelivertowardtheinferiorvenacava.This
Whichofthefollowingligamentsformstheanteriorborderoftheepi- ploicforamen?(Answer) Hepatoduodenal ligament Thehepatoduodenalligamentsurroundstheportaltriadjustproximaltotheportahepati sand forms theanterior border ofthe epiploic foramen. Whichofthefollowingpathologiesismostlikelyidentifiedinthissono-gram of the liver? A. Abscess B. Adenoma C. Hepatoma D. Cavernoushemangioma(Answer) Hepatoma Asolitary,smoothwalled,hypoechoicmassisidentifiedintheleftlobeofthelivermost suspicious for a hepatoma. The mass does not demonstrate a hypoechoichalocharacteristicofahepaticadenomaorirregularwallmarginscharacteris ticofanabscess. Abeadedappearancetotheintrahepaticductsisasonographicfindinginwhic h of thefollowing conditions?(Answer) Carolidisease Carolidiseasedemonstratesasegmental,saccular,orbeadedappearancetotheintrahep atic biliary ducts. Sonographicfindingsincasesofmesentericlymphomatousarede- scribedby the A. olive sign. B. doughnutsign. C. sandwichsign. D. keyboardsign(Answer) sandwichsign Sandwich sign describes an anechoic lesion with a hyperechoic center found inmesenteric lymphomatous. This type of lesion is more frequent in non- Hodgkin'slymphoma cases. The jejunum and ileum demonstrate small folds in the walltermed the keyboard sign.The doughnut sign isasonographic findingassociatedwith intussusception. Whichofthefollowingpathologiesismostconsistentwiththesesono- graphicfindings?(Answer) Portal vein thrombosis Altered blood flow within the portal vein, in conjunction with a hypoechoicintralu- minalmass,ismostsuspiciousforportalveinthrombosis.Severeabdominalpain
andlossofappetitearecommonclinicalsymptomsconnectedwiththrombosisofthe portal venous system. Atransplantedkidneyiscommonlyplacedinthe(Answer) rightiliacfossa Arenal transplantis commonlyplaced inthe anteriorright iliacfossa. Anobesepatientpresentswithahistoryofelevatedliverfunctiontests.Thearr owsareidentifyingwhichofthefollowingstructures?(Answer) Perinephricfat Increaseinperinephricandperitonealfatarecommonsonographicfindingsinobesepati ents.Thearrows areidentifying a thickamount of perinephric fat. Toobtainanoptimalevaluationofthegallbladder,theadultpatientshoul dfast for A. 2to4hours. B. 4to6hours. C. 6to8hours. D. 8to10 hours(Answer) 6to 8hours Toobtainanoptimalevaluationofthegallbladder,theadultpatientshouldfastfor6to 8 hours prior to the examination. Whichofthefollowingconditionsisassociatedwithsecondarysuba- cutethyroiditis? A. Grave'sdisease B. Mirizzisyndrome C. Hashimoto disease D. deQuervainsyndrome(Answer) deQuervainsyndrome deQuervainsyndromeisassociatedwithsubacutethyroiditissecondarytoaviralinfectio n. Hashimoto disease is a progressive autoimmune inflammatory disorderofthe thyroid gland. Portalveinsappearprominentonultrasoundbecausethewallscontain A. lipids. B. fibrin. C. calcium. D. plaque.(Answer) Fibrin Portalwallscontainfibrin,resultinginaprominenthyperechoicappearanceonultrasou nd.
