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ARDMS Abdomen Sonography Examination Sample Questions (Q120-Q125):

NEW QUESTION # 120
Which anatomical area of the male reproductive system is demonstrated in this endorectal image?

• A. Ejaculatory ducts
• B. Urethra
• C. Seminal vesicles
• D. Prostate base

Answer: C

Explanation:
The ultrasound image shown is a transverse endorectal (transrectal) ultrasound, commonly used to evaluate the prostate and adjacent structures. The two hypoechoic (dark) oval-shaped structures seen superior and posterior to the prostate are characteristic of the seminal vesicles.
The seminal vesicles are paired, elongated glands located superior and posterior to the base of the prostate and are best visualized in transverse planes on endorectal imaging. They appear as hypoechoic or anechoic structures with internal septations, depending on the degree of fluid content.
In contrast:
* The urethra appears as a central echogenic linear structure within the prostate.
* The prostate base is more inferior in the scan and is visualized just above the urethra.
* The ejaculatory ducts are usually not as prominently visualized and are located medial to the seminal vesicles, entering the prostate near the verumontanum.
This image most clearly demonstrates the bilateral seminal vesicles.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
ACR-AIUM-SRU Practice Parameter for the Performance of an Ultrasound Examination of the Prostate (2021).
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

 

NEW QUESTION # 121
Which description best characterizes a normal systolic spectral waveform of the renal artery?

• A. Early reversal
• B. Blunt peak
• C. Rapid acceleration
• D. Slow acceleration

Answer: C

Explanation:
A normal renal artery waveform demonstrates rapid systolic upstroke (acceleration) with continuous forward flow in diastole due to the kidney's low-resistance vascular bed. Slow acceleration or blunted peaks may indicate significant renal artery stenosis.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Normal renal artery waveforms demonstrate a rapid systolic acceleration with a sharp systolic peak." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
ACR Practice Parameter for the Performance of a Duplex Doppler Examination, 2021.
-

 

NEW QUESTION # 122
Which thyroid condition is most likely caused by a viral infection?

• A. Hashimoto
• B. De Quervain
• C. Graves
• D. Abscess

Answer: B

Explanation:
De Quervain thyroiditis (subacute granulomatous thyroiditis) is often triggered by a viral infection. Patients may present with painful thyroid enlargement, elevated inflammatory markers, and transient hyperthyroidism.
Hashimoto's and Graves' diseases are autoimmune in nature.
According to Braverman's The Thyroid:
"Subacute (De Quervain) thyroiditis typically follows a viral upper respiratory tract infection and is characterized by thyroid pain and transient thyrotoxicosis." Reference:
Braverman LE, Cooper DS. The Thyroid: A Fundamental and Clinical Text. 11th ed. Wolters Kluwer, 2021.
American Thyroid Association Guidelines, 2016.

 

NEW QUESTION # 123
Which technique is best for demonstrating the characteristic of the small hepatic lesion identified by the arrow on this image?

• A. Decrease depth
• B. Scan in upright position
• C. Use a standoff pad
• D. Move the transducer focus

Answer: C

Explanation:
The image shows a small hepatic lesion located very close to the anterior liver capsule, as indicated by the arrow. When imaging very superficial or near-field structures like subcapsular hepatic lesions, using a standoff pad is the most effective technique for optimizing visualization.
A standoff pad (also known as an acoustic stand-off or gel pad) helps increase the distance between the transducer and the superficial target. This improves the focus and beam shape for near-field imaging and minimizes reverberation and ring-down artifacts. It allows better evaluation of superficial lesions by positioning them within the focal zone of the transducer, which is usually set a few millimeters below the probe surface.
Differentiation from other options:
* A. Decrease depth: While reducing depth can help center deeper lesions in the field of view, it does not address issues with near-field resolution.
* B. Scan in upright position: This may help in gallbladder or fluid positioning but is not optimal for improving visualization of superficial liver lesions.
* C. Move the transducer focus: Adjusting focus deeper into the image won't enhance resolution of very superficial structures unless a standoff is used to bring the lesion into the focal zone.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Liver, pp. 80-84.
Kremkau FW. Sonography: Principles and Instruments. 9th Edition. Elsevier, 2015. Chapter: Image Formation and Optimization, pp. 114-117.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.

 

NEW QUESTION # 124
Which outcome would be present if the sample volume gate is larger than the examined vessel?

• A. Spectral noise
• B. Aliasing
• C. Spike turbulence
• D. Indeterminate flow direction

Answer: A

Explanation:
When the sample volume (gate) is too large, it captures signals from both the vessel and surrounding tissues or adjacent flows. This leads to a broadening of the spectral waveform and produces "spectral noise" or
"spectral broadening," reducing the accuracy of velocity measurements and waveform analysis. Aliasing results from high velocity relative to the Nyquist limit, not from gate size.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Increasing the sample volume beyond the vessel size causes spectral broadening, resulting in spectral noise and inaccurate Doppler measurements." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Spectral Doppler Ultrasound, 2021.
-

 

NEW QUESTION # 125
......

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