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ARDMS Abdomen Sonography Examination Sample Questions (Q152-Q157):
NEW QUESTION # 152
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 # 153
Which exam type would be most beneficial for evaluating an elderly male patient who is complaining of dysuria and nocturia?
Answer: B
Explanation:
In elderly men, dysuria and nocturia often suggest lower urinary tract symptoms such as benign prostatic hyperplasia (BPH). A pelvis limited ultrasound is most appropriate to evaluate the bladder and prostate for enlargement, residual urine volume, or other causes of obstructive symptoms.
According to AIUM Practice Guidelines:
"Pelvic ultrasound can evaluate bladder volume, post-void residual, and prostate size in men with lower urinary tract symptoms." Reference:
AIUM Practice Parameter for the Performance of Ultrasound of the Prostate, 2020.
Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
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NEW QUESTION # 154
Which technique is used to demonstrate the finding in this video?
Answer: C
Explanation:
The technique shown in the video is compression. In ultrasound imaging-especially of soft tissue masses, the bowel, or venous structures-compression is used to evaluate the compressibility of structures. The image demonstrates a classic grayscale ultrasound view of a lesion or structure being compressed with the probe.
Compression sonography is particularly important in:
* Evaluating venous patency (e.g., for deep vein thrombosis)
* Differentiating cystic from solid structures
* Evaluating bowel wall abnormalities or intussusception
* Assessing lymph nodes and soft tissue masses (as shown here)
When a structure compresses easily under probe pressure, it suggests that the lesion is fluid-filled or soft. In contrast, incompressibility may indicate a solid mass or thrombus.
Differentiation from other options:
* B. Valsalva: Involves forced expiration against a closed airway, used primarily to assess venous reflux or inguinal hernias-not what is demonstrated here.
* C. Exhalation: A respiratory maneuver that passively alters thoracoabdominal pressure, not actively performed by the operator or causing focal structural change.
* D. Deep inspiration: Used to improve visualization of the liver, diaphragm, or gallbladder-not to evaluate the compressibility of soft tissue.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Ultrasound Technique and Physics, pp. 35-39.
AIUM Practice Parameter for the Performance of a Diagnostic Ultrasound Examination, 2020.
NEW QUESTION # 155
Which foreign body is better visualized with sonography than computed tomography (CT)?
Answer: A
Explanation:
Wooden foreign bodies are often difficult to detect on CT because of their low radiodensity, but they are highly echogenic with posterior shadowing or reverberation on ultrasound, making ultrasound superior for detecting retained wooden objects. Glass, metal, and stones are better visualized with CT due to their high radiodensity.
According to AIUM and musculoskeletal ultrasound literature:
"Wood is poorly visualized on CT but demonstrates high reflectivity and acoustic shadowing on ultrasound." Reference:
Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal System. Springer, 2007.
AIUM Practice Parameter for Musculoskeletal Ultrasound, 2020.
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NEW QUESTION # 156
Which congenital disorder is most consistent with the finding identified by the arrow on this image?
Answer: A
Explanation:
The image demonstrates a characteristic "central dot sign" - a hallmark finding of Caroli disease. This is best appreciated on ultrasound as a cystic dilation of the intrahepatic bile ducts with a central echogenic dot or linear structure (which corresponds to the portal vein and fibrous tissue within the dilated duct). The arrow in the image points to one such dilated duct.
Caroli disease is a rare congenital disorder characterized by segmental, saccular dilation of intrahepatic bile ducts. It is often associated with congenital hepatic fibrosis and may predispose to cholangitis, stone formation, and even cholangiocarcinoma.
Key ultrasound features of Caroli disease:
* Cystic or saccular dilations of the intrahepatic bile ducts
* The "central dot sign" - echogenic focus in the center of the dilated ducts (representing portal vein radicle or fibrous tissue)
* May show associated hepatosplenomegaly or signs of portal hypertension Differentiation from other options:
* A. Sclerosing cholangitis: Typically causes diffuse or segmental biliary ductal wall thickening and stricturing; does not present with cystic dilations.
* B. Alagille syndrome: A multisystem disorder often characterized by a paucity of intrahepatic bile ducts, not dilation.
* D. Biliary atresia: Presents in infancy with obliteration of extrahepatic bile ducts, echogenic "triangular cord" sign, and absence of a visible gallbladder. It does not cause ductal dilation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Biliary System, pp. 152-155.
Radiopaedia.org. Caroli disease. https://radiopaedia.org/articles/caroli-disease American College of Radiology (ACR). ACR-SPR Practice Parameter for the Performance of Pediatric Abdominal Ultrasound, 2022.
NEW QUESTION # 157
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