ARDMS ABDOMEN MOCK EXAM QUESTIONS ANDANSWERS (2022/2023), Exams of Nursing

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ARDMS ABDOMEN MOCK EXAM QUESTIONS

AND ANSWERS (2022/2023)

1. Progressionofwhichofthefollowingabnormalitiesflattenstheportalveins? (Answer) Biliary obstruction 2. Thewallthicknessinanormalfastinggallbladdershouldnotexceed(Answer) 3mm 3. ThiscolorDopplersonogramismostlikelydemonstratingwhichofthefollowi ngabnormalities?(Answer) Pseudoaneurysm ThiscolorDopplerimagedemonstratesturbulentswirlingbloodflowwithinafluidcollec tion, classic sonographic findings of a common femoral artery pseudoa-neurysm. 4. 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. 5. Whichofthefollowingisacomplicationofacutepancreatitis? (Answer) Duodenalobstruction Complications of acute pancreatitis may include abscess formation, duodenalobstruction,hemorrhage,phlegmon,andpseudocystformation.Cholecystitisi sapossibleetiology of acute pancreatitis. 6. Apatientpresentswithahistoryofhematuria.Thefindingsinthisdupleximagea remostsuspiciousforwhichofthefollowingpathologies?(Answer) Carcino-ma A vascular echogenic mass is identified protruding from the posterior wall of theurinarybladder.Bladdercarcinomacommonlypresentswithahistoryofpainlesshem aturia. Based on the clinical history, the sonographic findings are suspiciousfora malignant mass. 7. A sagittal sonogram medial to the portahepatis is demonstrating whichofthe following abnormalities?(Answer) Dilated common bileduct

Ahypoechoicmassidentifiedbythecalipersisobstructingthecommonbileductresulting in dilatation. The mass is most likely a malignancy in the head of thepancreas.

8. Thepathology inthis sonogramis mostlikely a/an(Answer) Pseudocyst A complex fluid collection is identified posterior to the tail of the pancreas. Thisis most likely a pancreatic pseudocyst. Phlegmons and islet cell tumors appearashypoechoicmassesonultrasound.Apancreatichemorrhageisadifferentialc onsiderationbutnotthemostlikelypathology. 9. Whichofthefollowingabnormalitiesisdemonstratedinthistransversesonog ram?(Answer) Stones in the duct ofWirsung Multiple stones are located in main pancreatic duct (duct ofWirsung). 10. Whichofthefollowingisaclinicalsymptomofhypothyroidism? (Answer) Musclecramps Musclescrampingisasymptomofhypothyroidism.Othersymptomsmayincludeweightg ain,mentalandphysicallethargy,arthritis,skindryness,feelingcold,slowmetabolic rate, and decreased heart rate. Symptoms commonly associated withhyperthyroidism include weight loss, palpitations, nervousness, exophthalmos,constanthunger,tremors,increasedheartrate,andintolerancetoheat. 11. A 20-year-old patient presents with a palpable left scrotal mass. Thesonographicfindingsaremostsuspiciousforwhichofthefollowingpatholo- gies?(Answer) Malignant neoplasm Amalignantneoplasmisthemostlikelydiagnosisinayoungadultdemonstratinga hypoechoicintratesticular mass. The patient is afebrile excluding a testicularabscessfrom the differentialconsiderations. 12. Apatientpresentswithahistory of a palpableneck mass.Which ofthefollowing terms best describes the sonographic findings? (Answer) Heterogeneousthyroidgland The sonographer's technical report should describe the right thyroid lobe asdemonstratinganirregular andheterogeneousecho texture. 13. Apatientpresentswithahistory ofcirrhosis.The arrowsare identifyingthe(Answer) coronary ligament Ahyperechoiclinearstructureisidentifieddividingtherightsubphrenicspacefromthesu bhepaticspace.Thisisconsistentwiththerightcoronaryligament.Therightcoronary ligament serves asa barrier between thesetwo peritoneal spaces.

14. ThiscolorDopplersonogramismostlikelydemonstratingwhichofthefollowi ngabnormalities?(Answer) Patent umbilicalvein The sonogram is demonstrating a patent paraumbilical vein. Note the liverparenchymaoftheleftlobesuperiortothepatentumbilicalvein.Gastricvaricesarege nerally located to the left of midline. 15. Splenomegalyisaconsistentfindinginwhichofthefollowingpatholo-gies? (Answer) Portal hypertension Splenomegalyisaconsistentfindingincasesofportalhypertension. 16. Adupleximageofthesplenicveinisdemonstrating(Answer) retrogradeflow. That'scorrect! Thesplenicveinnormallyflowstowardthetransducer,displayingawaveform above the baseline (antegrade). In this case, the blood is flowing awayfromthetransducer backtowardthe spleen(retrograde). 17. 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. 18. Anasymptomaticpatientpresentswithahistoryofelevatedliverfunctiontests. Basedonthisclinicalhistory,thesonogrammostlikelydemonstrates- (Answer) fattyinfiltration Fatty infiltration is the most likely diagnosis in an asymptomatic patient demon- stratingdiffuselyechogenicliverparenchyma.Inaddition,theportalveinsarestillclearly visible, consistentwith fatty infiltration. 19. Thesubhepaticspacecommunicateswiththelessersacthroughtheforame nof(Answer) Winslow TheforamenofWinslowallowscommunicationbetweenthesubhepaticspaceandlesser sac. 20. Whichvascularstructurecoursesposteriortothesuperiormesentericartery and anterior to the abdominalaorta?(Answer) Left renal vein

Theleftrenalveincoursesposteriortothesuperiormesentericarteryandanteriorto the abdominal aorta.

21. 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. 22. 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. 23. Secretionofthyroid- stimulatinghormoneiscontrolledbythe(Answer) pituitarygland The anterior pituitary gland controlssecretion of thyroid-stimulating hormone. 24. Thecoronaryveinentersthevenoussystemnearthe(Answer) superiorbordero fthe portosplenic confluence Thecoronaryveinentersthesuperiorborderoftheportosplenicconfluenceandmaybeac ollateralsourceincasesofportalhypertension.Theinferiormesentericveinenters the inferior border ofthe portosplenic confluence. 25. Acomplicationgenerallyoccurringwithindaysofarenaltransplantis(Ans wer) renal vein thrombosis Renalveinthrombosisgenerallyoccurswithindaysofarenaltransplant.Renalartery stenosis typicallyoccurs monthsto years aftertransplantation. 26. Thesonogramismostsuspiciousforwhichofthefollowingabnormali-ties? (Answer) Varicocele Multipleanechoictubularstructuresareidentifiedposteriortothelefttesticle,mostsuspi cious for a varicocele. Duplex imaging of these tubular structures should beincludedin this examination. 27. Thesolitaryechogenicfocusmostlikelyrepresentsa(n) (Answer) floatinggallstone

Multiplesmallstonesarepresentin the dependent portion ofthe gallbladder.Thesolitaryfocus most likelyrepresents a floating gallstone.

28. ClinicalfindingsassociatedwithanileusmayincludeallofthefollowingEXCEPT (Answer) hyperactive bowelsounds Clinicalfindingsincasesofileusorbowelobstructionmayincludeabsentorhypoe- choicbowelsounds,fever,constipation,abdominalpain,nausea,andvomiting. 29. Acakekidneyisgenerallylocatedinwhichofthefollowingregions?(Answer)- Pelvis Acakekidneyisavariantofahorseshoekidney.Theentiremedialaspectsofthekidneysaref used.Acakekidneyis typicallylocatedin thepelvis. 30. Focal dilatation of the anterior wall of the abdominal aorta describesa(Answer) saccular aneurysm Focal outpouching of one arterial wall is characteristic of a saccular aneurysm.Theyare oftena result oftrauma or infection. 31. Whichofthefollowingstructuresismostlikelymistakenforthesplenicartery? (Answer) Pancreatic duct Thepancreaticductandthesplenicarteryaremostlikelytobeconfusedwitheachother.Co lorDopplerimagingisaquickmethodofverifyingavascularstructure. 32. Thistransversesonogramoftherighttesticleismostlikelydemonstrat- ingwhichofthefollowingabnormalities?(Answer) Intratesticularcalcifications Multiplesmallhyperechoicfoci(microcalcifications)aredemonstratedintherighttestis. Intratesticular calcifications may be idiopathic or associated with chronicorchitis. 33. Thepathologyinthissonogramismostconsistentwith(Answer) metastaticle -sions Theliverdemonstratesaheterogenousparenchymamostsuspiciousformetasta- ticlesions. 34. Apalpablebuttockmassidentifiedismostconsistentwithwhichofthefollowin g?(Answer) Lipoma

Awellcircumscribedmassthatdoesnotdemonstrateposterioracousticenhance-ment is most consistent with a lipoma.

35. Extendeduseoforalcontraceptivesisapredisposingfactorindevelop- ingwhich ofthe following hepaticneoplasms?(Answer) Adenoma Extendeduseoforalcontraceptivesislinkedtodevelopmentofliveradenomas.Caverno us hemangiomas and cystadenomas have a female prevalence but arenotrelated to theuse of oralcontraceptives. 36. Whichofthefollowingneoplasmsiscommonlylocatedinthetailofthepancrea s?(Answer) Isletcell tumor Isletcelltumorsaremostcommonlylocatedinthebodyandtailofthepancreas.Adenocarc inoma involving the pancreas commonly develops in the head of thepancreas. 37. Whichofthefollowingvascularstructuresisthearrowidentifying? (Answer) In-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. 38. Bilepigmentsareproducedbythe(Answer) liver Theliverbreaksdownredbloodcells,producingbilepigments. 39. Whichofthefollowinganatomicvariantsinvolvesthefundusofthegallbla dder?(Answer) Phrygian cap Folding of the gallbladder fundus describes a phrygian cap. Hartmann pouchandjunctionalfoldareanatomicvariantsintheregionofthegallbladderneck.A multiseptatedgallbladderisacongenitalanomalyandfetallobulationinvolvesthekidney. 40. Renaldialysispatientshaveanincreasedriskofdevelopingarenal(Answer) car -cinoma Renaldialysispatientshaveanincreasedriskofdevelopingarenalcarcinoma,cyst, or adenoma. 41. Thissonogramoftherightkidneyismostlikelydemonstrating(Answer) junctio nalparenchymaldefect.

Atriangular,echogeniccorticaldefectpresentintheanteriorwalloftherightkidneymost likely represents a junctional parenchymal defect. An angiomyolipoma is adifferentialconsiderationbutis notaslikelythe diagnosis.

42. Anendocrinefunctionofthe pancreasincludessecretionof(Answer) glucagon Endocrine functions of thepancreas include secretionof glucagon, insulin, andsomatostatin.Exocrinefunctionsincludesecretionofamylase,lipase,andtrypsin. 43. Whichofthefollowingdemonstratesdiffuseenlargementoftheabdom-inal aorta withoutdistal tapering?(Answer) Arteriomegaly Arteriomegaly (aorticectasia)demonstratesasadiffuseenlargementoftheab-dominal aorta without distal taperingon ultrasound. 44. 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. 45. Aroundanechoicmassadjacenttotherenalpelvisismostlikelya(n)(Answer)- parapelviccyst Aroundanechoicmass(cyst)adjacenttotherenalpelvisismostlikelyaparapelviccyst.Ane xtrarenalpelvisandrenalveindemonstrateanovalcontourmedialtotherenalpelvis. 46. Asmallhyperechoicpancreasismostsuspiciousforwhichofthefollow-ing abnormalities?(Answer) Chronic pancreatitis Chronicpancreatitisisassociatedwithatrophyofthepancreasanddemonstratesa hyperechoic parenchyma. Fatty infiltration generally does not affect the size ofthepancreas. 47. An 11-year-old presents with a history a palpable thyroid gland, fatigue,anddysphagia.Basedonthisclinicalhistory,thecolorDopplerimageofther ightthyroidlobeis mostlikelydemonstrating(Answer) thyroiditis Theduplexsonogramisdemonstratingahypervascular,hypoechoicenlarged

thyroidgland, most suspicious for thyroiditis.Clinical symptoms ofthyroiditismayinclude fatigue, fever, leukocytosis, neck pain, dysphagia, and hyperthyroidismfollowedbyhypothyroidism.

48. Apatientpresentswithahistoryofapainfullumponherposteriorwrist.Based on this clinical history, the sonogram is most likely demonstratingwhichof thefollowing abnormalities?(Answer) Ganglion cyst Ananechoic smooth walled mass is identified in the area ofconcern.This mostlikelyrepresentsaganglioncyst.ABakercystislocatedintheposteriormedialport ion of the knee joint. 49. Theanechoicstructureismostlikelyarisingfromwhichofthefollowingstructu res?(Answer) Kidney Thecystismostlikelyarisingfromtherenalparenchyma.Possibledifferentialconsiderati onsinclude hepatic or adrenal cyst. 50. Thesonographicfindingsinthisinfantkidneyaremostconsistentwithwhicho f thefollowing anomalies?(Answer) Renalduplication Two individual renal sinuses are present. The lower sinus demonstrates pelviec- tasis(Grade1hydronephrosis).Thisis most suspiciousfor renal duplication. HypertrophiedcolumnofBertinisacommonanatomicvariants. 51. Thearrowisidentifyingwhichofthefollowingvascularstructures?(Answer)- Commonhepaticartery The arrow identifies a structure branching from the celiac axis and coursingtoward the liver. This is most consistent with the common hepatic artery. Thecommonhepaticarterybecomestheproperhepaticarteryaftertheoriginofthegastr oduodenalartery. 52. Casesofgallbladdercarcinomafrequentlydemonstratecoexisting(Answer)- cholelithiasis Inapproximately90percentofcases,cholelithiasiscoexistswithgallbladdercarcin oma 53. Sonographicfindingsassociatedwithpyelonephritisinclude(Answer) well- de-finedrenal pyramids.

Generalizedorfocalswellingofthekidneydemonstratingwell-definedrenalpyra- midsisthetypicalsonographicfindingassociatedwithpyelonephritis.

54. Whichbenignliverneoplasmiscomposedoflarge,blood-filledcysticspaces? (Answer) Cavernous hemangioma Thecavernoushemangiomaiscomposedoflarge,blood-filledcysticspacesandis the most common benign hepatic neoplasm. 55. Whichofthefollowingarteriesaretermedthehypogastricarteries? (Answer) In-ternal iliac arteries Theinternaliliacarteriesarealsoknownasthehypogastricarteries. 56. Atransverseimageoftheurinarybladderisdemonstratingwhichofthefollowi ng?(Answer) Ureteroceles Bilateralhyperechoicseptationswithintheposteriorbladderwallaremostcon-sistent with ureteroceles. Ureteroceles are focal dilatations of the distal ureterexpandingas urineenters thebladder. 57. Normalsonographicfindingsofarenaltransplantinclude(Answer) promin entrenalpyramids. Normalsonographicfindingsinarenaltransplantincludeprominentrenalpyra- mids,hyperechoicrenalsinus,andhypoechoicrenal cortex. 58. Whichofthefollowingstructuresaidsinlocatingthegallbladderfossa?- (Answer) Main lobar fissure Themainlobarfissureisasonographiclandmarkusedinlocatingthegallbladderfossa. The right hepatic vein divides the right lobe of the liver into anterior andposteriorsegments. 59. A 25-year-old female patient presents with a history of mild right upperquadrantpainandnormalliverfunctiontests.Basedonthesonogram,theso nographershouldaskthepatient(Answer) Doyouuseoralcontraceptives? A 25-year-old female demonstrating a hypoechoic liver mass and a peripheralhypoechoichaloissuspiciousforahepaticadenoma.The sonographershouldinquirewhether thepatient istaking oralcontraceptives. 60. The"waterlily"signisassociatedwithwhichofthefollowingabnormal-ities? (Answer) Echinococcal cyst

The "water lily" sign describes a collapsed cyst within a cyst, characteristic of anechinococcal cyst.

61. Thissagittalimageoftheleftkidneyismostlikelydemonstrating(Answer) anormalneonatal kidney. A5.0cmkidney(usingsidebarmeasurements)inferiortothespleendemonstratesan echogenic renal cortex, anechoic medullary pyramids, and a discrete renalsinus.Thisismostconsistentwithanormalneonatalkidney. 62. Whichofthefollowingmostaccuratelydescribesthelocationoftheadrenal glands?(Answer) Medial to the kidneys Theadrenalglandsarelocatedanterior,medial,andsuperiortoeachkidneyandlateralto the crura of the diaphragm. 63. Cryptorchismisapredisposingriskfactorfordevelopingwhichofthefollowi ngabnormalities?(Answer) Malignancy Undescendedtestis(cryptorchism)isariskfactorfordevelopingtesticulartorsion,malig nancy,andinfertility. 64. 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. 65. Whichofthefollowingvascularstructuresnormallydemonstratesthiswavef orm? A. Portalvein B. Hepatic vein C. Splenic vein D. Superiormesentericvein(Answer) Hepaticvein Pulsatilebidirectionalvenousflowischaracteristicofanormalhepaticvein. 66. A 6-week-old female infant presents with a history of left hip clicking.Basedonthisclinicalhistory,thesonogramismostlikelydemonstratin ga(Answer) dysplastic hip.

TheGrafalphaangleisabnormal.Tobeconsideredwithinnormallimitsthealphaanglesho uldbe60degreesorgreater.Thealphaangleinthiscasemeasures46degrees.Thebetaangl eisnormalmeasuringunder55degrees(48degrees).Thisisconsistentwithdevelopment aldysplasiaofthehip.Inadditionthefemoralheadistoolateralbutstillpartiallylieswithint heacetabulumconsistentwithsubluxation.

67. Thesonographicfindingsaremostsuspiciousfora(n)(Answer) angiomyolipoma Awell-definedhyperechoicmassispresentintheanteriorcortex.Angiomyolipo-masare common incidental findings. 68. WhichofthefollowinglaboratoryvaluesincreasesinAddisondisease?- (Answer) Serumpotassium LaboratoryvaluesassociatedwithAddisondiseasedemonstrateanelevationinserum potassium and a decrease in serum sodium and glucose. 69. Whichofthefollowingstructuresdividestheleftlobeintotwoseg-ments? (Answer) LefthepaticveinandligamentumofTeres The left hepatic vein and ligamentum of Teres divide the left lobe of the liver intoleftandrightsegments.Theleftlobeisseparatedfromtherightlobebythemiddlehepa ticvein and the main lobarfissure. 70. Acontractedgallbladderisacommonsonographicfindinginwhichofthefollo wing conditions?(Answer) Chronic cholecystitis A small or contracted gallbladder is a common sonographic finding in cases ofchroniccholecystitis.Cholesterolosis,adenomyomatosis,andmetastaticgallblad- derdisease demonstrate as intraluminal masses 71. Whichofthefollowinglaboratoryvaluesisassociatedwithmalignancyinthe elderly population?(Answer) Alpha-fetoprotein Alpha- fetoproteinisanabnormalfindingassociatedwithanunderlyingmalignancyinnonpregn ant patients. 72. A patient with a history of splenomegaly demonstrates multiple tubularstructures posterior to the left lobeoftheliver.Thesetubularstructuresaremostsuspicious for(Answer) gastric varices.

Splenomegalyisassociatedwithportalhypertension.Multiple anechoictubularstructuresin theepigastric region aremost suspicious forgastric varices.

73. Thesonographicfindingsaremostconsistentwithwhichofthefollowingabnor malities?(Answer) Cholelithiasis Multiplesmallechogenicfocilayerinthedependentportionofthegallbladder.Attenua tionofsoundbythesefociproducesposterioracousticshadowing. 74. WhichofthefollowingabnormalitiesisdemonstratedinthiscolorDoppl erimage?(Answer) Fattyinfiltrationwithfocalfatsparing The liver parenchyma demonstrates a diffuse increase in echogenicity (fatty infil- tration).Hypoechoicareasareidentifiedanteriorandposteriortoahepaticvessel(fatspar ing).Incidentallytherightrenalcortexhasascallopedappearancetypicaloffetal lobulation. 75. Whatisthefirststepinasterileproceduretechnique? (Answer) Washyourhandsthoroughly Thefirststepinasterileproceduretechniqueistowashyourhandsthoroughly,followed byplacingasterilewrappedpackageonacleanandstablesurface. 76. Hemochromatosisisararedisorderthatmayleadto(Answer) cirrhosis Hemochromatosisischaracterizedbyexcessiveirondepositsthroughoutthebodyandma y cause cirrhosis. 77. Whichofthefollowingabnormalitiesispresentinthissagittalsono-gram? (Answer) Adenomyomatosis Immobilehyperechoicfocidemonstratinga"comet- tail"reverberationartifactarecharacteristicfindings of adenomyomatosis. 78. Thegastroduodenalarteryarisesfromwhichofthefollowingarteries?- (Answer) Hepaticartery The gastroduodenal artery arises from the common hepatic artery.The commonhepatic artery is a branch ofthe celiac axis. 79. Whichofthefollowingliverpathologiesisassociatedwithglycogenstorage disease?(Answer) Adenoma Glycogenstoragediseaseisanautosomalrecessivedisorderresultinginexces- sivedepositionofglycogenintheliver,kidneys,andgastrointestinaltract.Itis

associatedwithdevelopmentofahepaticadenoma,focalnodularhyperplasia,andnephro megaly.

80. Regulationofserumelectrolytesisafunctionofthe(Answer) kidneys Theurinarysystemregulatesserumelectrolytes. 81. 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. 82. Thearrowisidentifyingwhichofthefollowingstructures? (Answer) Falciformligament Ahyperechoiclinearstructureextendsanteriortotheleftlobeoftheliverconsistentwithth efalciformligament.Thefalciformattachesthelivertotheanteriorabdomi-nal wall and separates the subphrenic space into rightand left compartments. 83. Elevationincreatininelevelsisassociatedwith(Answer) renalfailure,chro nicnephritis, or urinary obstruction Elevationincreatininelevelsisassociatedwithrenalfailure,chronicnephritis,orurinary obstruction. 84. Prominenceoftheportalveinsisasonographiccharacteristicofwhichofthe following abnormalities?(Answer) Hepatitis The contour of the liver is generally unaffected in cases of acute hepatitis. Acutehepatitismaydemonstrateahypoechoicliverparenchyma,hepatomegaly,asso- ciatedsplenomegaly,andprominenceoftheportalveins(stareffect). 85. ApositivePhalen'ssignisassociatedwithanabnormalityofwhichofthefollowi ngjoints?(Answer) Wrist ApositivePhalen'sand/orTinel'ssignisassociatedwithcarpaltunnelsyndrome(wrist). 86. Thearrowisidentifyingwhichofthefollowingstructures? (Answer) Rightrenalartery

The right renal artery coursing posterior to the inferior vena cava is a commonsonographiclandmark.

87. Themainlobarfissureisasonographiclandmarkusedforlocatingthe(An swer) gallbladder fossa Themainlobarfissureisasonographiclandmarkusedtolocatethegallbladderfossa. 88. Dehydrationincreasestheriskfordeveloping(Answer) renalveinthrombosis Dehydrationincreasestheriskfordevelopingrenalveinthrombosis 89. Spectralanalysisofthesuprarenalportionoftheabdominalaortashoulddemo nstratea(Answer) highresistancewaveformwithalowdiastoliccomponent Theabdominalaortademonstratesahighresistancewaveformwithalowdiastoliccompo nent proximal to the renal arteries. A triphasic waveform is found distal tothe renal arteries. 90. Whichofthefollowingligamentsispresentinthisimageoftheliver?(Answer)- Venosum Thesonogramdemonstratestheleftandcaudatelobesoftheliverseparatedbythehyper echoic ligament ofvenosum. 91. Glisson'scapsulesurroundswhichofthefollowingorgans?(Answer) Liver Glisson'scapsulesurroundstheliverandGerota'sfasciasurroundsthekidneys. 92. A patient presents with abdominal pain and fever following an appen- dectomy.Basedonthisclinicalhistory,thesonographicfindingsaremostsuspicio usfor a(n)(Answer) abscess Anirregularbordered,complexhepaticmassispresentinafebrilepostappendec- tomypatient mostlikely representing ahepatic abscess. 93. Whichofthefollowinggallbladderabnormalitiesisnotalwayspatholog-ical in origin?(Answer) Biliary sludge Biliarysludgemaydevelopincasesofprolongedfastingorbiliarydisease. 94. AKlatskintumorislocatednearwhichofthefollowingstructures? (Answer) He-patic hilum

A Klatskin tumor is a malignant neoplasm located at the junction of the right andleft hepatic ducts near the hepatic hilum.

95. Anormallymphnodewilllikelydemonstrate(Answer) ahyperechoicfattycenter Thenormallymphnodedemonstratesasmooth,hypoechoic,ovalshapeandahyperech oicfatty centeron ultrasound. 96. Thissonogramismostlikelydemonstratingwhichofthefollowing?(Answer)- Gallbladderadenoma Animmobile(decubitusposition),nonshadowing,echogenicintraluminalfocusismostc onsistent with a gallbladder adenoma (polyp). 97. Whichofthefollowingpathologiesismorecommonlyassociatedwithsevere abdominal pain?(Answer) Portalvein thrombosis Severeabdominalpainismorecommonlyassociatedwithportalveinthrombosis. 98. 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. 99. Thesonographicappearanceofcandidiasisisdescribedas(Answer) uniformh y-poechoic masses Candidiasis is a fungal infection associated with immune-suppressed patients.Sonographicfindingsincludeuniformhypoechoicmasses,hyperechoicmass esdemonstratingposterior shadowing, or targetlesions. 100. Whichlaboratoryvaluerevealscellinjuryordamage? (Answer) Aspartateamino-transferase Aspartateaminotransferase(AST)isanenzymepresentinmanykindsoftissues

releasingwhencellsareinjuredordamaged.Levelsareproportionaltotheamountof damage and the time between cell injury and testing

101. An ultrasound is requested to rule out Budd-Chiari syndrome. Thesonographershouldthoroughlyevaluatewhichofthefollowingabdominalvei ns?(Answer) Hepatic veins Budd-Chiarisyndromeisalife-threateningconditionassociatedwiththrombosisofthe hepatic veins. The sonographer should thoroughly evaluate the liver vascula-ture. 102. Inthiscasewhichofthefollowinglaboratoryvalueswouldbeofbene-fit? (Answer) Hematocrit Afluid- fluidlevelisdemonstratedwithintheliverparenchymamostsuspiciousforahematoma.H ematocritlevels wouldaid indetermining internal bleeding. 103. Apatientpresentswithahistoryofabdominalpain.Asonogramoftheliveris most likelydemonstrating(Answer) polycystic liverdisease Multiplecontiguoushepaticcystsaremostsuspiciousforpolycysticliverdisease. 104. Whichanatomicvariantispresentinthissonogramofthegallbladder? A. Duplication B. Phrygiancap C. Hartmann pouch D. Intrahepaticlocation(Answer) Phrygiancap Afoldinthegallbladderfundusisconsistentwithaphrygiancap.Hartmannpouchorajunc tionalfoldisanatomicvariantslocatednearthegallbladderneck. 105. Whichofthefollowingaccuratelydescribestheportalveins? (Answer) Portalveinsare 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.Thewallsoftheportalveinscontainfib rin. 106. Whichofthefollowingisanabnormalflowcharacteristicofthehepaticveins? (Answer) Hepatopetal Hepaticveinscourseawayfromthelivertowardtheinferiorvenacava.This

istermed hepatofugalflow.Hepatic veins demonstratespontaneousmultiphasic(pulsatile)flow.

107. The sonographic finding in this sonogram of the common bile duct ismost consistent with A. ascariasis. B. cholangitis. C. clonorchiasis. D. cholangiocarcinoma(Answer) cholangitis Thecommonductdemonstrateshypoechoicwallthickening.This is mostcon-sistent with cholangitis. Cholangitis is a common complication in patients withautoimmunedeficiency syndrome. 108. Productionofprothrombindependsontheamountofvitamin(Answer)D,A, K,B ?(Answer) Vitamin K Production of prothrombin depends on the amount of vitamin K in the circulatorysystem. 109. Ahepatic abscessis mostlikely todevelop withinthe(Answer) rightlobe Hepaticabscessesformwithintherightlobeinapproximately80percentofcases. 110. Inwhichofthefollowinglaboratorytestsismarkedelevationassociatedwith obstructive jaundice?(Answer) Alkaline phosphatase Markedelevationinalkalinephosphataseisassociatedwithobstructivejaundice.Elevati onof direct or conjugated bilirubin is associated with biliary obstruction. 111. Whichofthefollowingpathologiesismostlikelydemonstratedinthissonogr am?(Answer) Hepatitis Anincreaseinechogenicityinthewallsoftheportalveinsisasonographicfindingassociate d with hepatitis (star effect). Biliary obstruction demonstrates parallelchannelingand flattening of the portal veins. 112. Whenassessingformesentericischemia,whichofthefollowingarteriesshoul dbeevaluated?(Answer) Celiac,superior,andinferior mesentericarteries Dupleximagingoftheceliac,superiormesenteric,andinferiormesentericarteriesshould beevaluated whenassessingfor mesentericischemia.

113. Whichofthefollowingligamentsformstheanteriorborderoftheepi- ploicforamen?(Answer) Hepatoduodenal ligament Thehepatoduodenalligamentsurroundstheportaltriadjustproximaltotheportahepati sand forms theanterior border ofthe epiploic foramen. 114. 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. 115. Abeadedappearancetotheintrahepaticductsisasonographicfindinginwhic h of thefollowing conditions?(Answer) Carolidisease Carolidiseasedemonstratesasegmental,saccular,orbeadedappearancetotheintrahepa tic biliary ducts. 116. 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. 117. 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.

118. Atransplantedkidneyiscommonlyplacedinthe(Answer) rightiliacfossa Arenal transplantis commonlyplaced inthe anteriorright iliacfossa. 119. Anobesepatientpresentswithahistoryofelevatedliverfunctiontests.Thearr owsareidentifyingwhichofthefollowingstructures?(Answer) Perinephricfat Increaseinperinephricandperitonealfatarecommonsonographicfindingsinobesepati ents.Thearrows areidentifying a thickamount of perinephric fat. 120. Toobtainanoptimalevaluationofthegallbladder,theadultpatientshoul dfast for A. 2to4hours. B. 4to6hours. C. 6to8hours. D. 8to10 hours(Answer) 6to 8hours Toobtainanoptimalevaluationofthegallbladder,theadultpatientshouldfastfor6to 8 hours prior to the examination. 121. 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. 122. Portalveinsappearprominentonultrasoundbecausethewallscontain A. lipids. B. fibrin. C. calcium. D. plaque.(Answer) Fibrin Portalwallscontainfibrin,resultinginaprominenthyperechoicappearanceonultrasoun d.

123. Theprotectiveconnectivetissuesurroundingeachkidneyistermed A. renal fascia. B. renalcapsule. C. Gerota'sfascia. D. perinephric fat(Answer) renal capsule The renal capsule is a protective connective tissue surrounding each kidney.Gerota'sorrenalfasciaisthefibrouscoveringoftissuesurroundingeachkidney. 124. The caudate lobe is located A. medial to the lesser sac. B. anteriortotheportahepatis. C. anterior to the ligamentumvenosum. D. medialtotheinferiorvenacava(Answer) medialtotheinferiorvenacava Thecaudatelobeliesanteriorandmedialtotheinferiorvenacava,posteriortotheligamen tumvenosum and portahepatis, andlateral to the lesser sac. 125. Themostcommonsonographicappearanceofthemediastinumtestisis described as a(n) A. complex linear structure. B. anechoictortuousstructure. C. hyperechoiclinearstructure. D. hyperechoictubularstructure.(Answer) hyperechoiclinearstructure A hyperechoic linear structure in the posterior medial aspect of the testis is themostcommonsonographicappearanceof themediastinumtestis. 126. Atransversesonogramoftheliverislikelydemonstratingwhichofthefollowin g? A. Hepatomegalyresultingfrombiliarydilatation B. Hepaticveinthrombosis andbiliarydilatation C. Prominentportalveinsresultingfromhepatitis D. Biliary dilatation secondary to metastatic disease(Answer) Biliary dilatation sec-ondary to metastatic disease The most likely diagnosis of this sonogram is biliary dilatation resulting frommetastaticdisease.Multiplediscretemassesarepresentintheliverparenchyma. 127. Prothrombinisanenzymeproducedbythe A. heart. B. liver.

C. spleen. D. pancreas(Answer) Liver Theliverproducesprothrombin.Elevationisassociatedwithcirrhosis,malignancy,malab sorptionof vitamin K, and clotting failure.

128. Therenalcortex isbound bytherenal capsuleand A. majorcalyces. B. perinephric fat. C. arcuatevessels. D. columnof Bertin(Answer) arcuate vessels Therenalcortexisboundbytherenalcapsuleandthearcuatevessels. 129. Howmanycentimetersbelowthesuperiormesentericarterydothemainrenal arteries arise? A. 0.5 to 1.0 cm B. 1.0 to 1.5 cm C. 1.5 to 2.0 cm D.2.0to2.5cm(Answer) 1.0to1.5cm Themainrenalarteriesarelocated1.0to1.5cminferiortothesuperiormesentericartery. Knowing this is useful when determining whether an abdominal aorticaneurysm includes the renalarteries. 130. Theinferiormesentericarteryisbestvisualizedinwhichofthefollowingbodyp lanes? A. Transverse B. Sagittal C. Coronal D. Sagittaloblique(Answer) Sagittaloblique That's correct! The inferior mesenteric artery is best visualized in the sagittalobliqueplane,totheleftofmidline,approximately1cmsuperiortotheabdominala ortic bifurcation. 131. Apatientpresentswithahistoryofvaguerightupperquadrantpain.Laborat ory values are within normal limits. The sonogram is most likelydemonstrating a(n) A. hepatoma. B. metastatic lesion. C. angiomyolipoma.

D. cavernoushemangioma(Answer) cavernoushemangioma. A well-defined hyperechoic mass is present in a patient with normal laboratoryvalues.Thisismostconsistent witha cavernous hemangioma.

132. Whichofthefollowingenzymeswillmostlikelyaffectbloodpressure? A. Renin B. Trypsin C. Somatostatin D. Aldosterone(Answer) Renin Renin,alsoknownasangiotensinogenase,isanenzymesecretedbythekidneystohelp regulate blood pressure. 133. Enlargedlymphnodesdemonstratingsmoothwallmarginsaremostconsis tentwith an underlying A. infection. B. obstruction. C. malignancy. D. hemorrhage(Answer) infection Lymphadenopathy demonstrating a normal oval shape with smooth wall marginsismostconsistentwithanunderlyinginfection.Irregularwallmarginsordecreas esinthefattyhilumarefindingssuspiciousforanunderlyingmalignancy. 134. Extensionoftherightlobeoftheliverinferiorandanteriortotherightkidneyi s termed a(n) A. accessorylobe. B. Riedel'slobe. C. succenturiatelobe. D. pyramidallobe.(Answer) Riedel'slobe. ExtensionoftherightlobeoftheliveranteriorandinferiortothekidneyistermedaRiedel's lobe.This is a common finding in the female population. 135. A patient presents with a history of right upper quadrant pain sincereturning from an overseas vacation. Based on this clinical history, thesonogramis mostly likelydisplaying a(n) A. hepatic abscess. B. hemorrhagiccyst. C. echinococcalcyst. D. hepatocellularcarcinoma.(Answer) echinococcalcyst

AbdomenARDMS_MOCKexam Study online at https://quizlet.com/_8o152e A cystic structure within a cystic structure (honeycomb appearance) in a patientrecentlyreturningfromanoverseasvacationischaracteristicofanechinococcalc yst.Ahepaticabscessdemonstratesasaheterogeneouscomplexmass.

136. Pelviclymphnodescoursealongthe A. psoasmuscles. B. iliac vessels. C. inguinal canal. D. broadligament(Answer) iliacvessels Thepelviclymphnodescoursealongtheiliacvessels. 137. Which of the following most accurately describes the location of thecommonhepaticduct? (Answer) Anteriortothemainportalveinandlateraltotheproperhepatic artery The common hepatic duct lies anterior to the main portal vein and lateral to theproperhepatic artery. 138. AllofthefollowingstructuresattachtotheliverbyaligamentEXCEPT A. stomach. B. diaphragm. C. gallbladder. D. anteriorabdominalwall.(Answer) gallbladder Ligamentsattachthediaphragm,stomach,retroperitoneum,andanteriorabdom- inalwalltotheliver.Thegallbladderlieswithinahepatic fossa. 139. A transjugular intrahepatic portosystemic shunt (TIPS) generally con- nectswhich of the following? A. Rightportalveinandtheinferiorvenacava B. Right hepaticveinandrightportalvein C. Middle hepatic vein and theleft portal vein D. Lefthepaticveinandleftportalvein(Answer) Righthepaticveinandrightportalvein TIPS generally connects the right hepatic vein and right portal vein. 140. Inferiorly,therighthepaticlobeisseparatedfromtheleftlobebythe A. rightportalvein. B. left hepatic vein. C. mainlobarfissure. D. middlehepaticvein.(Answer) mainlobarfissure