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ARDMS Abdomen Sonography Examination Sample Questions (Q158-Q163):

NEW QUESTION # 158
Which condition is a cause of intrahepatic dilatation with a normal common bile duct?

• A. Choledocholithiasis
• B. Portal vein thrombus
• C. Tumor at the porta hepatis
• D. Acute pancreatitis

Answer: C

Explanation:
Intrahepatic biliary dilatation with a normal common bile duct (CBD) is typically caused by obstruction located at or above the level of the hepatic duct confluence. A tumor at the porta hepatis, such as cholangiocarcinoma (Klatskin tumor), is a classic cause of this pattern. The porta hepatis is the site where the right and left hepatic ducts join to form the common hepatic duct. A mass at this location can obstruct the intrahepatic ducts while leaving the distal CBD unaffected and of normal caliber.
By contrast:
* Portal vein thrombus (A) affects vascular flow but does not directly obstruct bile ducts.
* Choledocholithiasis (C) obstructs the CBD, typically resulting in both intrahepatic and extrahepatic duct dilatation.
* Acute pancreatitis (D) may cause distal CBD compression if there is associated inflammation or pseudocyst formation, but typically results in extrahepatic duct dilatation rather than isolated intrahepatic dilation.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
Chapter: Biliary Tract: "Klatskin tumors cause proximal (intrahepatic) biliary dilatation while the distal bile duct remains normal in caliber."
* Gore RM, Levine MS. Textbook of Gastrointestinal Radiology, 4th ed. Saunders, 2015.
-

NEW QUESTION # 159
Based on this image, what is the most likely clinical indication for the examination?

• A. Neonatal hyperbilirubinemia
• B. Red currant jelly stools
• C. Projectile vomiting
• D. Abnormal prenatal ultrasound

Answer: C

Explanation:
The ultrasound image demonstrates findings consistent with hypertrophic pyloric stenosis (HPS). This condition typically affects infants between 2 and 8 weeks of age and presents clinically with non-bilious projectile vomiting, weight loss, and dehydration.
In the ultrasound image, the classic "target" or "donut" sign can be seen in the transverse view of the hypertrophied pyloric muscle. Key sonographic criteria for HPS include:
* Pyloric muscle thickness #3 mm
* Pyloric channel length #15-18 mm
This imaging appearance strongly correlates with the clinical presentation of projectile vomiting (Choice D), which is the hallmark symptom of HPS.
Comparison of answer choices:
* A. Abnormal prenatal ultrasound (Choice A) is not typically associated with HPS, which develops postnatally.
* B. Neonatal hyperbilirubinemia (Choice B) is not an indication for a pyloric ultrasound and affects liver
/biliary imaging.
* C. Red currant jelly stools (Choice C) are indicative of intussusception, not HPS.
* D. Projectile vomiting (Choice D) is the most common clinical indication leading to an ultrasound exam that reveals HPS.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pyloric Region in Infants (2014).
Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. 2003;227(2):319-331.

NEW QUESTION # 160
Which type of choledochal cyst is the most common?

• A. Type III: Duodenal choledochocele
• B. Type IV: Multiple cystic dilatations of the hepatic ducts
• C. Type I: Fusiform dilatation of the common bile duct
• D. Type II: Diverticula extending off of the common bile duct

Answer: C

Explanation:
Type I choledochal cyst, characterized by fusiform dilatation of the common bile duct, is the most common form, accounting for 80-90% of cases. Other types are much less frequent.
According to Rumack's Diagnostic Ultrasound:
"Type I fusiform dilatation of the extrahepatic bile duct is the most common type of choledochal cyst." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Hepatobiliary Ultrasound, 2020.
-

NEW QUESTION # 161
Which hernia characteristic is demonstrated in these images?

• A. Incarcerated
• B. Strangulated
• C. Fat only
• D. Reducible

Answer: D

Explanation:
The ultrasound images show two views of the same groin region - one without compression (left image labeled "W/O COMPRESSION") and one with graded probe compression (right image labeled "W/ COMPRESSION").
In the non-compression image, a hypoechoic mass-like structure is visible protruding through the abdominal wall, consistent with a hernia sac. On the compression image, the herniated content is no longer visible, indicating that the contents have been pushed back into the abdominal cavity. This is the hallmark feature of a reducible hernia.
Key characteristics of a reducible hernia on ultrasound:
* Herniated contents are visible without pressure.
* Contents disappear or reduce back into the abdomen with graded probe compression or Valsalva release.
* Typically includes omental fat or bowel, but reduction confirms lack of incarceration or strangulation.
Comparison of answer choices:
* A. Fat only refers to the hernia content type, not the behavior or reducibility shown here.
* B. Reducible - Correct. The change in hernia appearance between images demonstrates successful reduction with compression.
* C. Incarcerated hernia would remain visible and not compressible or reducible.
* D. Strangulated hernia would show signs of ischemia (bowel wall thickening, absent perfusion, hyperechoic mesentery), and would also not reduce with compression.
References:
Radswiki. Ultrasound evaluation of hernia. Radiopaedia.org
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination for Hernia (2021)

NEW QUESTION # 162
Which vessel is most likely to display hepatofugal flow in the presence of portal hypertension?

• A. Splenic vein
• B. Inferior vena cava
• C. Coronary vein
• D. Inferior epigastric vein

Answer: C

Explanation:
The coronary vein (left gastric vein) is a common collateral pathway in portal hypertension. It often becomes dilated and may demonstrate hepatofugal (reversed) flow as blood diverts from the high-pressure portal system into systemic collaterals.
According to Zwiebel's Introduction to Vascular Ultrasound:
"The left gastric (coronary) vein is a frequent site of hepatofugal flow in portal hypertension, reflecting collateral development." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Portal Venous Doppler Ultrasound, 2020.

NEW QUESTION # 163
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