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ARDMS Abdomen Sonography Examination Sample Questions (Q106-Q111):

NEW QUESTION # 106
Which finding is most likely demonstrated in these images of a hypertensive patient with a history of hematuria?

A. Pheochromocytoma
B. Renal cell carcinoma
C. Nephroblastoma
D. Adenoma

Answer: B

Explanation:
The ultrasound images show a heterogeneous, solid-appearing mass within the right kidney. The patient has a history of hypertension and hematuria-classic clinical features that raise suspicion for renal cell carcinoma (RCC), especially in an adult.
Renal cell carcinoma is the most common primary malignant tumor of the kidney in adults. Common presenting symptoms include:
* Hematuria (most frequent symptom)
* Flank pain
* Palpable abdominal mass
* Hypertension (due to increased renin secretion)
* Sometimes paraneoplastic syndromes (e.g., polycythemia due to erythropoietin production) Ultrasound Features of RCC:
* Solid renal mass, often with heterogeneous echotexture
* May contain cystic components, calcifications, or necrotic areas
* May distort the renal contour
* Doppler may show internal vascularity
Differentiation from other options:
* B. Adenoma: Rare and typically small, benign cortical lesions. They do not typically present with hematuria or hypertension and cannot be reliably distinguished from RCC on ultrasound.
* C. Nephroblastoma (Wilms tumor): Pediatric renal tumor seen almost exclusively in children under age
5.
* D. Pheochromocytoma: Arises from the adrenal gland (not the kidney); associated with hypertension but not hematuria.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Urinary Tract, pp. 210-222.
American College of Radiology (ACR) Appropriateness Criteria - Hematuria, 2022.
Radiopaedia.org. Renal cell carcinoma: https://radiopaedia.org/articles/renal-cell-carcinoma

NEW QUESTION # 107
Which condition is most consistent with thinning of the renal cortex, reduction in renal length, and prominence of the renal sinus fat in a patient presenting four months after renal transplant with slightly reduced renal function?

A. Arterial stricture
B. Chronic rejection
C. Acute rejection
D. Normal findings

Answer: B

Explanation:
Chronic rejection presents sonographically as cortical thinning, decreased renal size, and increased echogenicity of the renal sinus fat. Acute rejection typically causes an enlarged, edematous kidney with increased parenchymal echogenicity but preserved size early on.
According to Zwiebel's Introduction to Vascular Ultrasound:
"In chronic rejection, the allograft becomes smaller with cortical thinning, increased echogenicity, and prominence of the central sinus fat." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Transplant Ultrasound, 2020.
-

NEW QUESTION # 108
Which vascular condition is most consistent with patent cutaneous para-umbilical channels and portal hypertension?

A. Caput medusae
B. Esophageal varices
C. Splenic vein varices
D. Coronary vein varices

Answer: A

Explanation:
Caput medusae refers to dilated paraumbilical veins due to portal hypertension. When portal venous pressure rises, collateral channels may open along the ligamentum teres and recanalized paraumbilical vein, resulting in visible dilated veins radiating from the umbilicus.
* Esophageal varices (B) are gastroesophageal collaterals.
* Coronary vein varices (C) involve gastric veins.
* Splenic vein varices (D) are typically localized to the splenic hilum.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
* Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed. Saunders, 2015.
-

NEW QUESTION # 109
Which finding is an indication for renal biopsy to assess for renal failure?

A. Proteinuria
B. Hematuria
C. Hypercalcemia
D. Leukocytosis

Answer: A

Explanation:
Significant proteinuria, especially if persistent or in the nephrotic range, may indicate glomerular disease and is a common indication for renal biopsy. Leukocytosis and hypercalcemia are not specific for renal biopsy.
Hematuria may warrant biopsy if accompanied by proteinuria.
According to KDIGO Clinical Practice Guidelines:
"Persistent proteinuria is one of the strongest indications for renal biopsy to evaluate underlying glomerular pathology." Reference:
Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis,
2021.
American Society of Nephrology (ASN) Nephrology Board Review, 2021.

NEW QUESTION # 110
Which structure is indicated by the arrow on this image?

A. Middle hepatic vein
B. Left portal vein
C. Proper hepatic artery
D. Inferior vena cava

Answer: A

Explanation:
The structure indicated by the arrow is the middle hepatic vein. This is confirmed by both its anatomical location within the liver and its Doppler waveform characteristics.
Key ultrasound and Doppler features:
* The middle hepatic vein runs between the right and left hepatic lobes and drains into the inferior vena cava (IVC). On grayscale imaging, it appears as a tubular anechoic structure extending toward the IVC.
* On spectral Doppler, hepatic veins (including the middle hepatic vein) demonstrate a characteristic triphasic waveform due to pressure changes in the right atrium. This triphasic pattern is clearly visible in the Doppler tracing below the image.
* This differs significantly from the monophasic low-resistance flow of the hepatic artery or the continuous hepatopetal flow of the portal vein.
Differentiation from other options:
* A. Left portal vein: Would show continuous, hepatopetal flow (toward the liver) and lies more anterior and medial within the liver.
* C. Proper hepatic artery: Small-caliber vessel with low-resistance pulsatile waveform (not triphasic).
* D. Inferior vena cava: Lies posterior to the liver and demonstrates phasic flow with respiration, but this vessel is more centrally located and not shown in this field of view.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Hepatic Vasculature, pp. 90-95.
AIUM Practice Parameter for the Performance of Hepatic Doppler Ultrasound Examinations, 2020.
Radiopaedia.org. Hepatic vein Doppler waveform: https://radiopaedia.org/articles/hepatic-vein-doppler- waveform

NEW QUESTION # 111
......

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ARDMS Abdomen Sonography Examination Sample Questions (Q106-Q111):

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