PRACTICE AB-ABDOMEN EXAM FEE | EXAMCOLLECTION AB-ABDOMEN QUESTIONS ANSWERS

Practice AB-Abdomen Exam Fee | Examcollection AB-Abdomen Questions Answers

Practice AB-Abdomen Exam Fee | Examcollection AB-Abdomen Questions Answers

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ARDMS Abdomen Sonography Examination Sample Questions (Q127-Q132):

NEW QUESTION # 127
Which condition is demonstrated in this image?

  • A. Portal vein thrombosis
  • B. Tumor extension
  • C. Portal hypertension
  • D. Cavernous transformation

Answer: D

Explanation:
The image shows a color Doppler ultrasound of the main portal vein (MPV), which appears irregular and replaced by multiple small, serpiginous vascular channels - a hallmark of cavernous transformation.
Cavernous transformation of the portal vein is a late complication of chronic portal vein thrombosis, in which collateral vessels develop around the thrombosed portal vein to bypass the obstruction.
Key Doppler ultrasound features of cavernous transformation:
* Absence of a normal portal vein
* Multiple tortuous vessels in the porta hepatis
* Color Doppler shows hepatopetal flow in these channels
* Low velocity, continuous waveform flow in collateral vessels
Differentiation from other options:
* B. Portal vein thrombosis: Would show an absence of color flow within the portal vein lumen and possibly echogenic material within the vessel. There would be no serpiginous collateral vessels yet if it's an acute process.
* C. Portal hypertension: Often diagnosed with other sonographic findings (e.g., splenomegaly, reversed portal flow, varices) but not characterized by the replacement of the portal vein by collateral vessels.
* D. Tumor extension: Typically appears as echogenic intraluminal material within the portal vein with arterial waveforms on Doppler due to neovascularity. Tumor thrombus can be seen in hepatocellular carcinoma or pancreatic cancer, not multiple small collateral vessels.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Portal Venous System, pp. 107-110.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Vascular Ultrasound Examination, 2021.
Radiopaedia.org. Cavernous transformation of the portal vein: https://radiopaedia.org/articles/cavernous- transformation-of-the-portal-vein


NEW QUESTION # 128
Which complication would be associated with retroperitoneal fibrosis?

  • A. Hydronephrosis
  • B. Venous thrombosis
  • C. Portal hypertension
  • D. Aortic stenosis

Answer: A

Explanation:
Retroperitoneal fibrosis can encase and compress the ureters, leading to obstructive uropathy and hydronephrosis. It may also involve other retroperitoneal structures but hydronephrosis is the most common significant complication.
According to Rumack's Diagnostic Ultrasound:
"Retroperitoneal fibrosis frequently results in ureteral obstruction, leading to hydronephrosis." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
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NEW QUESTION # 129
Which diagnosis is most accurate based on the findings in this image from an adult patient?

  • A. Transitional cell carcinoma
  • B. Clear cell carcinoma
  • C. Renal cell carcinoma
  • D. Nephroblastoma

Answer: C

Explanation:
The ultrasound images (sagittal and transverse views of the left kidney) demonstrate a large, well-defined, heterogeneous mass within the renal parenchyma. This is highly characteristic of renal cell carcinoma (RCC), the most common primary renal malignancy in adults.
Renal cell carcinoma accounts for approximately 85% of all malignant renal tumors in adults. RCC often appears as:
* A solid, heterogeneous, hypoechoic to isoechoic mass within the kidney
* May contain areas of necrosis or hemorrhage (seen as mixed echogenicity)
* Distortion of the normal renal contour
* May have internal vascularity on Doppler imaging
Clear cell carcinoma (choice B) is the most common histological subtype of RCC but is not a separate diagnosis from RCC in imaging terms. Therefore, the most accurate answer is choice C: Renal cell carcinoma.
Differentiation from other options:
* A. Nephroblastoma (Wilms tumor): A pediatric renal tumor, typically seen in children under 5 years of age-not applicable in adults.
* B. Clear cell carcinoma: Histological subtype of RCC, not a distinct radiologic diagnosis.
* D. Transitional cell carcinoma: Arises from the renal pelvis or ureter, typically appears as a central or collecting system mass rather than a cortical/parenchymal one.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Kidneys, pp. 215-222.
Radiopaedia.org. Renal cell carcinoma: https://radiopaedia.org/articles/renal-cell-carcinoma American College of Radiology (ACR) Appropriateness Criteria - Hematuria, 2022.


NEW QUESTION # 130
Which structure is indicated by the arrow in this image?

  • A. Kidney
  • B. Diaphragm
  • C. Adrenal gland
  • D. Bowel loop

Answer: C

Explanation:
The structure indicated by the arrow in the ultrasound image is the adrenal gland. On ultrasound, the adrenal gland in neonates and infants is relatively large and has a distinctive "Y" or "V" shape in the transverse view.
It is located superior and slightly medial to the upper pole of the kidney.
In this image, the arrow is pointing to a hypoechoic, curved structure with a thin echogenic central stripe, representing the fetal adrenal gland. This echogenic stripe corresponds to the adrenal medulla, while the surrounding hypoechoic area represents the cortex.
Differential features:
* A. Kidney: While the kidney is visualized posterior to the adrenal gland and shows a reniform shape with a central echogenic sinus and peripheral cortex, it is not the structure being directly pointed to by the arrow.
* B. Bowel loop: Bowel has variable echogenicity with peristalsis and shadowing from air. It does not have the consistent morphology or location seen in the image.
* C. Diaphragm: Appears as a thin, hyperechoic linear structure separating the thoracic cavity from the abdomen. It is seen more superiorly than the indicated structure and lacks the "Y" or "V" adrenal configuration.
Key Anatomical Landmarks:
* The adrenal glands are located in the retroperitoneum, superior to the kidneys, and appear prominent on ultrasound in neonates.
* In transverse view, the right adrenal gland is anterior to the crus of the diaphragm and posterior to the inferior vena cava (IVC).
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Adrenal Glands and Retroperitoneum, pp. 291-295.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum. 2020.


NEW QUESTION # 131
Which parameter is most likely increased distal to a renal artery stenosis?

  • A. Pulsatility index
  • B. Acceleration time
  • C. Spectral broadening
  • D. Resistive index

Answer: B

Explanation:
Downstream from a significant renal artery stenosis, the acceleration time is prolonged due to delayed systolic upstroke ("tardus-parvus waveform"). This is a sensitive Doppler parameter for detecting hemodynamically significant stenosis. Spectral broadening usually occurs at the stenotic site, not distal to it.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Prolonged acceleration time and reduced acceleration index characterize tardus-parvus waveforms distal to renal artery stenosis." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Artery Duplex Doppler Ultrasound, 2020.


NEW QUESTION # 132
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