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ARDMS Abdomen Sonography Examination Sample Questions (Q137-Q142):

NEW QUESTION # 137
Which of the following is the most common symptom of cholelithiasis?

A. Hemoptysis
B. Jaundice
C. Biliary colic
D. Flank pain

Answer: C

Explanation:
The most common symptom of cholelithiasis (gallstones) is biliary colic, characterized by intermittent right upper quadrant or epigastric pain often triggered by fatty meals. Jaundice occurs in complications such as choledocholithiasis.
According to Rumack's Diagnostic Ultrasound:
"Gallstones may cause biliary colic - episodic upper abdominal pain often related to food intake." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
American College of Gastroenterology (ACG) Guidelines for Gallstone Disease, 2013.
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NEW QUESTION # 138
Which change of the inferior vena cava spectral Doppler waveform is expected superior to a nonocclusive thrombus?

A. Absence of flow
B. Becomes multiphasic
C. Dampening
D. Increased velocity

Answer: C

Explanation:
In the presence of a nonocclusive thrombus, Doppler waveform above the thrombus typically shows dampened flow with loss of normal respiratory phasicity due to partial venous outflow obstruction. Complete absence of flow is typically seen with occlusive thrombus.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Partial obstruction produces dampened and continuous flow patterns superior to a nonocclusive thrombus." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Venous Ultrasound, 2020.
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NEW QUESTION # 139
Which foreign body is better visualized with sonography than computed tomography (CT)?

A. Stone
B. Glass
C. Wood
D. Metal

Answer: C

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 # 140
Which finding is most likely demonstrated in this abdominal wall image of a patient with a history of atrial fibrillation?

A. Hernia
B. Lipoma
C. Abscess
D. Hematoma

Answer: D

Explanation:
The ultrasound image demonstrates a complex, heterogeneous hypoechoic collection within the abdominal wall, with mixed echogenicity and ill-defined margins. The lesion appears to contain internal debris but lacks definitive signs of vascularity or air (which would be seen in an abscess). There is no peristalsis, herniated bowel, or fat to suggest hernia.
Given the history of atrial fibrillation - a condition commonly treated with anticoagulation therapy (e.g., warfarin, apixaban) - this clinical background raises high suspicion for a rectus sheath or abdominal wall hematoma.
Key ultrasound features of hematomas:
* Early (acute): hyperechoic or heterogeneous
* Chronic/resolving: complex or cystic with fluid-debris levels
* No internal vascularity on Doppler
* May be confined to muscle or fascial planes
This is consistent with a hematoma, particularly in patients on anticoagulation therapy.
Comparison of answer choices:
* A. Hernia - typically shows bowel or fat with movement/peristalsis passing through a fascial defect.
* B. Lipoma - usually homogeneous and echogenic, not complex or fluid-filled.
* C. Abscess - often presents as a complex fluid collection with peripheral hyperemia and possibly air, plus systemic signs of infection.
* D. Hematoma - Correct. The image and clinical history (anticoagulation due to atrial fibrillation) strongly support this diagnosis.
References:
Berman L, et al. Sonographic appearance and evolution of rectus sheath hematomas. AJR Am J Roentgenol.
1996.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Diagnostic Ultrasound Examinations of the Abdomen and Retroperitoneum (2020).

NEW QUESTION # 141
A patient presents with ampulla of Vater obstruction, distention of the gallbladder, and painless jaundice.
Which condition is most likely associated with these findings?

A. Mirizzi syndrome
B. Choledochal cyst
C. Porcelain gallbladder
D. Courvoisier sign

Answer: D

Explanation:
Courvoisier sign describes the clinical finding of painless jaundice combined with a palpable, distended gallbladder. This typically results from obstruction at the distal common bile duct, often due to pancreatic head carcinoma or cholangiocarcinoma, leading to bile accumulation and gallbladder distention. In contrast, Mirizzi syndrome involves compression of the common hepatic duct by an impacted stone in the cystic duct.
According to Rumack's Diagnostic Ultrasound and standard clinical references:
"Courvoisier sign refers to a palpable, enlarged gallbladder due to obstruction of the distal bile duct, often from malignancy." 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 # 142
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