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ARDMS Abdomen Sonography Examination Sample Questions (Q129-Q134):
NEW QUESTION # 129
Which vascular condition is most consistent with patent cutaneous para-umbilical channels and portal hypertension?
Answer: D
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.
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NEW QUESTION # 130
Which finding is expected in the contralateral kidney given the pathology depicted in this image?
Answer: D
Explanation:
The ultrasound image shows a sagittal view of the right kidney with multiple anechoic (black), non- communicating cysts of varying sizes distributed throughout the renal parenchyma, consistent with autosomal dominant polycystic kidney disease (ADPKD).
ADPKD is a hereditary disorder characterized by the progressive development of multiple bilateral renal cysts, which leads to renal enlargement and eventual loss of function. This condition typically affects both kidneys, making bilateral polycystic involvement expected. Therefore, the same cystic appearance is anticipated in the contralateral (left) kidney as well.
Comparison of answer choices:
* A. Duplicated collecting system: This is a congenital anomaly but does not result in diffusely cystic kidneys.
* B. Polycystic kidney: Correct. Bilateral renal involvement is the hallmark of ADPKD.
* C. Parapelvic cysts: These are simple cysts located in the renal sinus and do not exhibit the diffuse pattern seen here.
* D. Atrophic kidney: Not typical in the contralateral side in ADPKD; the disease affects both kidneys symmetrically.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet. 2007;369(9569):
1287-1301.
NEW QUESTION # 131
Which condition is most likely the cause of claudication experienced two weeks after this image was obtained?
Answer: D
Explanation:
The ultrasound image demonstrates a fluid-filled structure in the posterior knee region, consistent with a Baker cyst (also called a popliteal cyst). A Baker cyst is a synovial fluid-filled sac arising from the posterior medial aspect of the knee joint, typically extending between the medial head of the gastrocnemius and the semimembranosus tendon.
The history of delayed-onset claudication (pain in the calf when walking) two weeks after this image was obtained is strongly suggestive of a ruptured Baker cyst. When a Baker cyst ruptures, synovial fluid may track inferiorly into the calf, producing pain, swelling, and clinical symptoms that mimic deep vein thrombosis (DVT) or arterial insufficiency (e.g., pseudothrombophlebitis syndrome).
Ultrasound findings consistent with a ruptured Baker cyst:
* Complex fluid collection tracking along muscle fascial planes (hypoechoic to anechoic)
* Posterior calf swelling and tenderness
* Absence of thrombus in the deep venous system
* Crescent-shaped fluid may be seen between muscle compartments
Why the other choices are incorrect:
* A. Neuropathy: Would not show fluid-filled structures on ultrasound and would not present with calf swelling.
* B. Infected hematoma: May appear complex, but would require a history of trauma or anticoagulation and systemic signs (fever, redness).
* C. Thrombophlebitis: Involves a thrombosed superficial vein with wall thickening and surrounding inflammation, which is not seen in this image.
References:
American Institute of Ultrasound in Medicine (AIUM). Practice Guidelines for Musculoskeletal Ultrasound Examination, 2020.
Bianchi S., Martinoli C. Ultrasound of the Musculoskeletal System. Springer, 2007. Chapter: Knee Region - Popliteal Fossa and Baker's Cyst, pp. 433-437.
Radiopaedia.org. Ruptured Baker cyst: https://radiopaedia.org/articles/ruptured-bakers-cyst
NEW QUESTION # 132
Which vessel is typically seen with an echogenic ring of fat when imaging the upper abdominal mesenteric circulation?
Answer: B
Explanation:
The superior mesenteric artery (SMA) is typically visualized surrounded by an echogenic fat pad in the mesentery, producing a characteristic "echogenic ring" appearance on ultrasound. This is a helpful landmark for identifying the SMA in the transverse abdominal aortic plane.
According to Rumack's Diagnostic Ultrasound:
"The superior mesenteric artery is often seen as a round anechoic structure surrounded by echogenic fat at its origin from the anterior aorta." 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.
NEW QUESTION # 133
Which condition is demonstrated in this image?
Answer: A
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.
* 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).
NEW QUESTION # 134
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