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ARDMS Abdomen Sonography Examination Sample Questions (Q75-Q80):
NEW QUESTION # 75
Which term best describes the common bile duct measured in this image of a postcholecystectomy patient?
Answer: C
Explanation:
The ultrasound image shows a measured common bile duct (CBD) diameter of 7.9 mm in a postcholecystectomy patient. In patients who have undergone cholecystectomy, mild dilation of the CBD is considered normal and is a well-recognized post-surgical change.
Normal upper limits for CBD diameter:
* In patients with a gallbladder: #6 mm is generally considered normal.
* In postcholecystectomy patients: up to 10 mm is considered within normal limits, as the CBD compensates for the absence of the gallbladder and slightly enlarges over time.
* With aging, the CBD may enlarge by approximately 1 mm per decade after age 60.
Therefore, a CBD diameter of 7.9 mm in a patient without a gallbladder is considered normal.
Differentiation from other options:
* B. Dilated: This would typically refer to a CBD diameter >10 mm in postcholecystectomy patients, or
>6 mm in patients with an intact gallbladder.
* C. Inflamed: Inflammation refers to wall thickening or hyperemia, which is not evaluated simply by measuring diameter.
* D. Atretic: Describes a congenitally absent or severely narrowed duct - not applicable here.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Biliary System, pp. 143-146.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of a Hepatobiliary Ultrasound Examination, 2020.
Radiopaedia.org. Common bile duct: https://radiopaedia.org/articles/common-bile-duct
NEW QUESTION # 76
Which sonographic finding is commonly associated with transitional cell cancer of urinary bladder?
Answer: C
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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NEW QUESTION # 77
Which pancreatic condition is commonly associated with complete or partial atresia of the duodenum?
Answer: C
Explanation:
Annular pancreas is a congenital anomaly in which pancreatic tissue encircles the second part of the duodenum, potentially causing partial or complete duodenal obstruction (atresia). It is due to abnormal migration of the ventral pancreatic bud.
According to Rumack's Diagnostic Ultrasound:
"Annular pancreas results from failure of the ventral pancreatic bud to rotate properly, leading to encirclement of the duodenum." 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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NEW QUESTION # 78
Which vascular condition is most commonly associated with a wandering spleen?
Answer: C
Explanation:
A wandering spleen occurs when the spleen is not adequately anchored by its supporting ligaments, allowing it to move freely within the abdomen. This increases the risk of splenic torsion, which compromises vascular supply and may result in infarction if not corrected.
According to Rumack's Diagnostic Ultrasound:
"The most serious complication of a wandering spleen is torsion, which may result in splenic infarction." 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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NEW QUESTION # 79
Which condition is demonstrated in this image?
Answer: C
Explanation:
The ultrasound image clearly demonstrates a thickened and elongated pyloric muscle with a visible channel, which is characteristic of hypertrophic pyloric stenosis (HPS). This condition is most commonly seen in male infants between 2 and 8 weeks of age who present with non-bilious projectile vomiting, dehydration, and a palpable "olive-like" mass in the right upper quadrant.
Ultrasound is the imaging modality of choice and is highly sensitive and specific for diagnosing pyloric stenosis.
Key sonographic criteria for HPS:
* Muscle thickness >3 mm
* Pyloric channel length >15-17 mm
* "Target sign" or "doughnut sign" on transverse imaging (concentric rings)
* "Cervix" or "railroad track sign" on longitudinal imaging (elongated canal with echogenic center) Differentiation from other options:
* A. Intussusception: Also shows a target sign, but it occurs in the right lower quadrant or periumbilical region, not in the gastric antrum.
* C. Hydronephrosis: Refers to dilation of the renal pelvis and calyces - not gastrointestinal.
* D. Gastritis: May show gastric wall thickening but lacks the distinct elongated, thickened pyloric muscle seen here.
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.
AIUM Practice Parameter for the Performance of a Pediatric Abdominal Ultrasound Examination, 2020.
NEW QUESTION # 80
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