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ARDMS Abdomen Sonography Examination Sample Questions (Q142-Q147):

NEW QUESTION # 142
What is the location of the left lobe of the thyroid gland?

A. Posterior to the longus colli muscle
B. Anterolateral to the esophagus
C. Anterior to the trachea
D. Anterior to the left jugular vein

Answer: B

Explanation:
The left lobe of the thyroid is located anterolateral to the esophagus. On transverse ultrasound imaging, the esophagus can often be seen posterior to the left thyroid lobe as a circular structure with echogenic mucosa and hypoechoic muscular layer. The longus colli muscle lies posterior to the thyroid. The thyroid is anterior to the trachea but this refers more to the isthmus or midline portion.
According to Rumack's Diagnostic Ultrasound:
"The esophagus is seen as a target-shaped structure posterior to the left thyroid lobe; thus, the thyroid lobe is anterolateral to the esophagus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Thyroid Ultrasound, 2020.
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NEW QUESTION # 143
Which congenital anomaly is characterized by the failure of the dorsal and ventral pancreatic buds to fuse?

A. Pancreatic agenesis
B. Annular pancreas
C. Pancreas divisum
D. Ectopic pancreas

Answer: C

Explanation:
Pancreas divisum occurs when the dorsal and ventral pancreatic ducts fail to fuse during embryologic development. This results in most pancreatic secretions draining through the minor papilla via the dorsal duct (duct of Santorini).
According to Rumack's Diagnostic Ultrasound:
"In pancreas divisum, the dorsal and ventral pancreatic ducts fail to fuse, resulting in separate drainage systems." 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 # 144
Which of the following would optimize visualization of a bladder mass?

A. Utilize a high-frequency linear transducer
B. Have patient empty bladder
C. Have patient fill bladder
D. Compression technique to move bowel gas

Answer: C

Explanation:
A full bladder provides an acoustic window that displaces bowel gas and distends the bladder walls, allowing optimal visualization of any bladder masses or lesions. An empty bladder may collapse, obscuring masses.
According to Rumack's Diagnostic Ultrasound:
"Bladder evaluation should be performed with the bladder optimally distended to visualize its walls and any intraluminal masses." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
-

NEW QUESTION # 145
Which structure is most likely shown in this image of the right lower quadrant?

A. Ureter
B. Jejunum
C. Appendix
D. Fallopian tube

Answer: C

Explanation:
The ultrasound image shows a blind-ending, non-compressible, tubular structure in the right lower quadrant with a target or bullseye appearance in transverse section - highly suggestive of the appendix.
Sonographic features of the appendix (especially in suspected appendicitis):
* Blind-ending tubular structure arising from the cecum
* Non-compressible on graded compression
* Diameter >6 mm is suggestive of appendicitis
* May demonstrate a "target sign" in transverse view (concentric ring-like appearance)
* Increased echogenicity of surrounding fat in cases of inflammation
* May contain an appendicolith or show hyperemia on color Doppler if inflamed The location (right lower quadrant) and appearance in this case are classic for the normal or potentially inflamed appendix.
Differentiation from other options:
* A. Fallopian tube: Located more in the adnexal regions and usually not visible unless distended (e.g., hydrosalpinx).
* B. Ureter: Usually not visualized on ultrasound unless dilated due to obstruction.
* D. Jejunum: Has valvulae conniventes ("keyboard sign") and peristalsis; does not present with a blind- ending tubular appearance from the cecum.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gastrointestinal Tract, pp. 460-468.
American College of Radiology (ACR). ACR Appropriateness Criteria - Right Lower Quadrant Pain - Suspected Appendicitis.
AIUM Practice Parameter for the Performance of a Pediatric Abdominal and/or Retroperitoneal Ultrasound Examination, 2020.

NEW QUESTION # 146
Which technique is best for demonstrating the characteristic of the small hepatic lesion identified by the arrow on this image?

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

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 # 147
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