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Abdomen Sonography
Examination
Version: Demo
[ Total Questions: 10]
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ARDMS
AB-Abdomen
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Category Breakdown
Category
Number of Questions
Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy
6
Anatomy, Perfusion, and Function
2
Clinical Care, Practice, and Quality Assurance
2
TOTAL
10
Question #:1 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
Which congenital anomaly is characterized by the failure of the dorsal and ventral pancreatic buds to fuse?
Ectopic pancreas
Annular pancreas
Pancreatic agenesis
Pancreas divisum
Answer: D
Explanation
Pancreas divisum occurs when the dorsal and ventral pancreatic ducts fail to fuse during embryologic
development. This results in most pancreatic secretions draining through the minor papilla via the dorsal duct
(duct of Santorini).
According to Rumack’s Diagnostic Ultrasound:
“In pancreas divisum, the dorsal and ventral pancreatic ducts fail to fuse, resulting in separate drainage
systems.”
Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
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Question #:2 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
Which sonographic finding is commonly associated with transitional cell cancer of urinary bladder?
Polypoidal non-mobile focal mass
Ulcerated solid infiltrative lesion
Diffuse wall thickening
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D.
A.
B.
C.
D.
Flat sessile lesion
Answer: A
Explanation
Transitional cell carcinoma (TCC) typically presents as a non-mobile, polypoidal, focal intraluminal mass
projecting from the bladder wall. Mobility of the lesion helps differentiate TCC from blood clots or debris.
According to Rumack’s Diagnostic Ultrasound:
“Bladder TCC most often appears as a non-mobile, polypoid mass attached to the bladder wall.”
Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
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Question #:3 - [Anatomy, Perfusion, and Function]
What is the normal Doppler waveform signature of the hepatic veins?
Low resistant
Monophasic
Triphasic
Turbulent
Answer: C
Explanation
The normal hepatic vein Doppler waveform is triphasic, reflecting cardiac cycle variations in central venous
pressure transmitted from the right atrium through the IVC. Loss of triphasicity may suggest elevated right
atrial pressures or hepatic venous obstruction.
According to Rumack’s Diagnostic Ultrasound:
“The normal hepatic vein waveform is triphasic due to transmitted right atrial pressure variations.”
Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Vascular Ultrasound, 2020.
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Question #:4 - [Clinical Care, Practice, and Quality Assurance]
Which mechanism is used for a fine needle aspiration?
Automated spring loaded device
Cutting needle obtains core tissue
Packing of cells in the needle
Injection of saline and suction
Answer: C
Explanation
Fine needle aspiration (FNA) uses a thin needle to aspirate cells, which are then packed into the lumen of the
needle for cytological evaluation. It is distinct from core biopsy, which uses cutting needles to obtain tissue
cores.
According to AIUM Practice Parameters:
“Fine needle aspiration involves insertion of a thin needle into a lesion to aspirate cells for cytologic analysis.
The cells are collected inside the needle lumen.”
Reference:
AIUM Practice Parameter for the Performance of Ultrasound-Guided Percutaneous Needle Biopsy, 2020.
Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
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Question #:5 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
Which condition is demonstrated in this image?
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B.
C.
D.
Bell clapper deformity
Inguinal hernia
Pyocele
Cryptorchidism
Answer: D
Explanation
The ultrasound image shows an ovoid, homogeneously hypoechoic soft tissue structure located in the inguinal
canal, surrounded by echogenic fat and soft tissue. This is consistent with an undescended testis, also known
as cryptorchidism.
Cryptorchidism refers to the failure of one or both testes to descend into the scrotal sac. On ultrasound, the
undescended testis typically appears:
Ovoid in shape
Homogeneous and hypoechoic compared to scrotal testis
Located in the inguinal canal or, less commonly, within the abdomen
Smaller in size than a normally descended testis
Comparison of answer choices:
A. Bell clapper deformity refers to an anatomic predisposition for testicular torsion where the tunica
vaginalis surrounds the entire testis and epididymis—usually a clinical rather than directly sonographic
diagnosis.
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B. Inguinal hernia appears as bowel or omentum within the inguinal canal or scrotum with peristalsis or
fat—no bowel loops are seen here.
C. Pyocele is a complex fluid collection around the testis (usually with septations and internal echoes)—
not evident in this image.
D. Cryptorchidism — Correct. The findings match those of an undescended testis in the inguinal canal.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Dogra VS, Gottlieb RH, Rubens DJ, Oka M. Sonography of the scrotum. Radiology. 2003;227(1):18–36.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations (2021).
Question #:6 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
Which condition results in the vascular abnormality shown in this image of a renal transplant?
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B.
C.
D.
Iliac arteritis
Renal artery stenosis
Renal vein thrombosis
Arteriovenous malformation
Answer: B
Explanation
The Doppler ultrasound image shows an elevated peak systolic velocity (PSV) of 637 cm/s, an elevated end-
diastolic velocity (EDV) of 312 cm/s, and a low resistive index (RI) of 0.51 at the arterial anastomosis of a
renal transplant. These findings are characteristic of significant renal artery stenosis (RAS) at the transplant
vascular anastomosis.
Key sonographic features of renal artery stenosis:
Peak systolic velocity (PSV) > 250–300 cm/s at the stenotic segment (this case: 637 cm/s)
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Post-stenotic turbulence with spectral broadening
Low resistive index (RI < 0.56 suggests downstream vasodilation)
Elevated acceleration time (AT > 0.07 sec), and reduced acceleration slope
Aliasing on color Doppler due to high velocity
In this image, the marked increase in velocity with spectral aliasing and low RI is diagnostic of transplant
renal artery stenosis — the most common vascular complication post-transplant, typically occurring at the site
of surgical anastomosis.
Differentiation from other options:
A. Iliac arteritis: A rare condition, not typically presenting with these Doppler changes.
C. Renal vein thrombosis: Would show reversed or absent diastolic flow, not elevated systolic
velocities.
D. Arteriovenous malformation (AVM): Produces a high-velocity, low-resistance waveform but is
associated with color bruit, aliasing, and pulsatile venous waveforms — not evident here.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Transplant Imaging, pp. 1035–1045.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Renal
Artery Duplex Sonographic Examination, 2020.
Radiopaedia.org. Renal artery stenosis (transplant): https://radiopaedia.org/articles/renal-artery-stenosis-
transplant
Question #:7 - [Clinical Care, Practice, and Quality Assurance]
In which position should a patient be placed when internal echoes are seen within a fluid-filled bladder?
Erect
Trendelenburg
Lateral decubitus
Fowler
Answer: C
Explanation
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B.
C.
D.
Lateral decubitus positioning allows shifting of internal echoes within the bladder, helping differentiate
mobile debris (such as blood clots or sediment) from adherent masses like tumors. This technique is helpful in
evaluating questionable bladder filling defects.
According to Rumack’s Diagnostic Ultrasound:
“Changing the patient’s position, such as turning to the lateral decubitus, can help distinguish mobile debris
from attached bladder wall lesions.”
Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
Question #:8 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
Which change of the inferior vena cava spectral Doppler waveform is expected superior to a nonocclusive
thrombus?
Increased velocity
Becomes multiphasic
Dampening
Absence of flow
Answer: C
Explanation
In the presence of a nonocclusive thrombus, Doppler waveform above the thrombus typically shows
dampened flow with loss of normal respiratory phasicity due to partial venous outflow obstruction. Complete
absence of flow is typically seen with occlusive thrombus.
According to Zwiebel’s Introduction to Vascular Ultrasound:
“Partial obstruction produces dampened and continuous flow patterns superior to a nonocclusive thrombus.”
Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Venous Ultrasound, 2020.
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Question #:9 - [Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy]
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Which clinical finding is most likely associated with the pathology in this image?
Olive-shaped palpable mass
Fever of unknown origin
Red currant jelly stools
Bilious vomiting
Answer: A
Explanation
The ultrasound image shows a classic longitudinal view of a markedly thickened pyloric muscle with an
elongated pyloric channel. This finding is consistent with hypertrophic pyloric stenosis (HPS), a condition
most commonly seen in male infants between 2 and 8 weeks of age.
The most characteristic clinical finding associated with HPS is an “olive-shaped” palpable mass in the right
upper quadrant or epigastric region, which represents the hypertrophied pylorus.
Clinical presentation of HPS includes:
Non-bilious projectile vomiting (due to gastric outlet obstruction)
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Dehydration and weight loss
A palpable “olive” mass on physical exam
Visible peristalsis may be noted on the abdominal wall
Sonographic diagnostic criteria for HPS:
Pyloric muscle thickness # 3 mm
Pyloric channel length # 15–17 mm
“Cervix sign” or “target sign” (transverse view)
Failure of gastric contents to pass through the pylorus on real-time imaging
Differentiation from other options:
B. Fever of unknown origin: Not characteristic of HPS.
C. Red currant jelly stools: Classic for intussusception.
D. Bilious vomiting: Seen in distal duodenal or jejunal obstruction, not in pyloric stenosis (vomiting is
non-bilious in HPS).
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gastrointestinal Tract, pp. 474–479.
American College of Radiology (ACR). Appropriateness Criteria – Vomiting in Infants Up to 3 Months of
Age.
Radiopaedia.org. Hypertrophic pyloric stenosis:https://radiopaedia.org/articles/hypertrophic-pyloric-stenosis
Question #:10 - [Anatomy, Perfusion, and Function]
Which renal anomaly is demonstrated on this image?
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A.
B.
C.
D.
Duplicated collecting system
Crossed renal ectopia
Horseshoe kidney
Pelvic kidney
Answer: C
Explanation
The ultrasound image labeled “SAG RUQ KIDNEY” demonstrates a midline sagittal view showing a renal
parenchymal structure that extends across the midline anterior to the aorta and vertebral bodies, suggesting the
presence of a horseshoe kidney.
A horseshoe kidney is a congenital renal anomaly in which the lower poles of both kidneys are fused across
the midline by a parenchymal or fibrous isthmus. This isthmus typically lies anterior to the aorta and inferior
vena cava and can be seen as a hypoechoic band of tissue crossing the midline on ultrasound.
Ultrasound findings characteristic of a horseshoe kidney:
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Abnormally low position of the kidneys in the abdomen
Renal tissue (isthmus) bridging the lower poles anterior to the great vessels
Renal axes may be more horizontal than usual
Kidneys may appear closer together or “kissing” the spine anteriorly
Differentiation from other options:
A. Duplicated collecting system: Manifests as two separate collecting systems within one kidney, often
with a central renal sinus split into two — not typically midline bridging.
B. Crossed renal ectopia: Involves one kidney crossing midline and fusing with the other on the
opposite side, but they do not form a midline isthmus.
D. Pelvic kidney: A single kidney located in the pelvis due to failed ascent — it does not appear as
midline fusion of two kidneys.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Urinary Tract, pp. 215–218.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of an
Ultrasound Examination of the Abdomen and/or Retroperitoneum. 2020.
Radiopaedia.org. Horseshoe kidney: https://radiopaedia.org/articles/horseshoe-kidney
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