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ARDMS Abdomen Sonography Examination Sample Questions (Q12-Q17):

NEW QUESTION # 12
Which condition presents sonographically as an anechoic mass between the umbilicus and the bladder?

• A. Mesenteric cyst
• B. Urinoma
• C. Bladder abscess
• D. Urachal cyst

Answer: D

Explanation:
A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.
According to Rumack's Diagnostic Ultrasound:
"A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pelvis, 2020.
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NEW QUESTION # 13
Which type of hernia is located medial to the inferior epigastric artery?

• A. Femoral
• B. Indirect inguinal
• C. Spigelian
• D. Direct inguinal

Answer: D

Explanation:
Direct inguinal hernias protrude through Hesselbach's triangle, which lies medial to the inferior epigastric artery. In contrast, indirect inguinal hernias pass lateral to the inferior epigastric artery via the deep inguinal ring.
According to Moore's Clinically Oriented Anatomy:
"Direct inguinal hernias occur medial to the inferior epigastric vessels, within Hesselbach's triangle." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 14
Which finding is indicated by the arrow in this image of the right upper quadrant?

• A. Mirror image
• B. Ascites
• C. Pleural effusion
• D. Retroperitoneal hemorrhage

Answer: C

Explanation:
The image provided is a right upper quadrant (RUQ) ultrasound-typically performed during a FAST (Focused Assessment with Sonography in Trauma) exam or for abdominal assessment. The arrow points to an anechoic (black) fluid collection seen above the diaphragm and posterior to the liver.
This fluid collection lies within the thoracic cavity, confirming the diagnosis of a pleural effusion. Pleural effusions are seen sonographically as an anechoic or hypoechoic area superior to the diaphragm in the thoracic cavity and often appear triangular or crescent-shaped. The diaphragm is visualized as a curvilinear echogenic structure separating the liver (or spleen) below from the lung space above.
Comparison of answer choices:
* A. Retroperitoneal hemorrhage would be seen in the posterior abdomen, not above the diaphragm.
* B. Pleural effusion is correct-anechoic fluid above the diaphragm is classic for this condition.
* C. Mirror image artifact occurs when liver echoes are mirrored across the diaphragm and lung-this is not a mirror artifact.
* D. Ascites collects inferior to the diaphragm and around the abdominal organs, not in the thoracic cavity.
References:
Ma OJ, Mateer JR, Blaivas M. Emergency Ultrasound, 3rd ed. McGraw-Hill; 2014.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-757.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

NEW QUESTION # 15
Which condition is characterized by abnormal dilatation of veins of the pampiniform plexus and most commonly affects the left testicle?

• A. Hydrocele
• B. Spermatocele
• C. Hematocele
• D. Varicocele

Answer: D

Explanation:
A varicocele is an abnormal dilatation of the pampiniform plexus veins, usually seen on the left side due to the perpendicular insertion of the left testicular vein into the left renal vein, making it more susceptible to elevated venous pressure. Sonographically, varicoceles appear as multiple serpiginous anechoic tubular structures that show venous flow on color Doppler, often accentuated with Valsalva maneuver.
Hydrocele (A) is a fluid collection surrounding the testis.
Hematocele (C) is blood within the tunica vaginalis.
Spermatocele (D) is a cystic lesion arising from the epididymis.
Reference Extracts:
Dogra VS, Bhatt S. "Sonographic evaluation of testicular varicoceles." Journal of Ultrasound in Medicine.
2004;23(6): 829-838.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 16
Which condition is associated with multiple pancreatic cysts?

• A. Autosomal recessive polycystic kidney disease
• B. Cystic fibrosis
• C. Beckwith Wiedemann syndrome
• D. Von Hippel Lindau syndrome

Answer: D

Explanation:
Von Hippel-Lindau (VHL) syndrome is a genetic disorder associated with multiple pancreatic cysts, pancreatic neuroendocrine tumors, and other systemic neoplasms. While cystic fibrosis can produce thickened pancreatic secretions, it rarely causes true pancreatic cysts.
According to Rumack's Diagnostic Ultrasound:
"Multiple pancreatic cysts are strongly associated with Von Hippel Lindau syndrome." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Digestive System Tumors, 5th ed., IARC, 2019.
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NEW QUESTION # 17
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