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ARDMS Abdomen Sonography Examination Sample Questions (Q156-Q161):
NEW QUESTION # 156
Which action should a sonographer take if the abdominal aorta measures 5.5 centimeters in the anteroposterior diameter?
Answer: A
Explanation:
An abdominal aortic aneurysm (AAA) measuring #5.5 cm represents a significantly increased risk of rupture and often requires surgical evaluation. The sonographer must report this critical finding immediately to the interpreting physician. The sonographer should never disclose a diagnosis directly to the patient.
According to AIUM and SRU Guidelines:
"An aortic diameter of 5.5 cm or greater should be promptly reported to the interpreting physician due to the high risk of rupture." Reference:
AIUM Practice Parameter for Abdominal Aortic Ultrasound, 2020.
Society of Radiologists in Ultrasound (SRU) Consensus Statement, 2003.
NEW QUESTION # 157
Which vascular condition is most likely associated with the sonographic findings demonstrated in this image?
Answer: A
Explanation:
The ultrasound image demonstrates a tubular, anechoic structure coursing anterior to the left portal vein and heading toward the anterior abdominal wall. This is consistent with a recanalized umbilical vein, which is an important collateral pathway that reopens in cases of portal hypertension.
Normally, the umbilical vein becomes obliterated after birth and forms the ligamentum teres. However, in the setting of significant portal hypertension, the umbilical vein may recanalize and serve as a collateral route to decompress the portal system.
Sonographic features of a recanalized umbilical vein:
* Anechoic, tubular structure in the ligamentum teres fissure
* Seen anterior to the left portal vein
* Color Doppler confirms hepatofugal venous flow
* Associated with signs of portal hypertension (e.g., splenomegaly, varices) Differentiation from other options:
* A. Budd-Chiari syndrome: Involves hepatic vein outflow obstruction; ultrasound shows absent or narrowed hepatic veins and may have caudate lobe hypertrophy.
* B. Splenic artery aneurysm: Typically visualized near the splenic hilum as a pulsatile cystic mass; Doppler shows arterial flow.
* D. Median arcuate ligament syndrome: Involves compression of the celiac axis; best assessed with Doppler showing elevated velocities on expiration.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Portal Hypertension and Collaterals, pp. 101-104.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Vascular Ultrasound Examination, 2020.
Radiopaedia.org. Recanalized umbilical vein: https://radiopaedia.org/articles/recanalised-umbilical-vein
NEW QUESTION # 158
Where is the main pancreatic duct located?
Answer: C
Explanation:
The main pancreatic duct (duct of Wirsung) runs through the central portion of the pancreas, medial and slightly posterior to the superior mesenteric vein (SMV). It converges with the common bile duct near the ampulla of Vater.
According to Moore's Clinically Oriented Anatomy:
"The main pancreatic duct runs centrally within the gland and lies medial to the superior mesenteric vein." 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 # 159
Which clinical finding is most likely associated with the splenic pathology demonstrated in this image?
Answer: A
Explanation:
The ultrasound image demonstrates a heterogeneous and echogenic spleen with evidence of atrophy and multiple areas of calcification-consistent with autosplenectomy. This appearance is classically associated with chronic sickle cell anemia.
In sickle cell disease, repeated vaso-occlusive episodes result in infarctions, fibrosis, and progressive calcification of the spleen. Over time, this leads to functional asplenia or complete autosplenectomy (involution and shrinkage of the spleen). The hallmark sonographic features include:
* A small, echogenic spleen
* Multiple coarse calcifications
* Irregular contour or atrophic appearance
These findings are not typically seen in other conditions:
* A. Trauma may cause subcapsular hematomas or lacerations, but not chronic atrophy with calcifications.
* C. Immunocompromised patients may develop abscesses or infections but not the classic features of autosplenectomy.
* D. Portal hypertension typically causes splenomegaly and varices, not atrophic and calcified spleens.
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.
Kellenberger CJ. Imaging of the spleen in children. Eur Radiol. 2004;14(5):92-102.
NEW QUESTION # 160
Which condition is most consistent with the sonographic appearance in this image of the abdominal wall?
Answer: D
Explanation:
The ultrasound image demonstrates a well-defined, ovoid, hypoechoic to isoechoic mass within the subcutaneous tissue of the abdominal wall. The lesion appears compressible and shows linear striations parallel to the skin surface - a classic appearance of a lipoma.
Lipomas are the most common benign soft tissue tumors and frequently arise in the subcutaneous tissue. They are composed of mature adipose tissue and are typically asymptomatic unless large or compressing adjacent structures.
Sonographic features of a lipoma:
* Isoechoic to mildly hyperechoic or hypoechoic relative to subcutaneous fat
* Oval or elliptical in shape with well-defined margins
* Internal linear striations or "feathered" echotexture
* Compressible and non-vascular on Doppler imaging
* Located in subcutaneous fat plane parallel to the skin surface
Differentiation from other options:
* B. Fibroma: Typically appears as a homogeneous, hypoechoic mass but is far less common in the abdominal wall.
* C. Desmoid: Appears as an ill-defined or infiltrative mass within deeper soft tissues; more heterogeneous and may distort surrounding tissue planes.
* D. Metastasis: Often more irregular, heterogeneous, and may show increased vascularity or invasion into adjacent structures.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Musculoskeletal and Soft Tissue Ultrasound, pp. 1448-1450.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of a Diagnostic Ultrasound Examination of Soft Tissue Structures, 2020.
Radiopaedia.org. Lipoma (ultrasound): https://radiopaedia.org/articles/lipoma-ultrasound
NEW QUESTION # 161
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