Get ARDMS AB-Abdomen Exam Practice Questions - Real and Updated

Answer : B

The structure indicated by the arrow is the middle hepatic vein. This is confirmed by both its anatomical location within the liver and its Doppler waveform characteristics.

Key ultrasound and Doppler features:

The middle hepatic vein runs between the right and left hepatic lobes and drains into the inferior vena cava (IVC). On grayscale imaging, it appears as a tubular anechoic structure extending toward the IVC.

On spectral Doppler, hepatic veins (including the middle hepatic vein) demonstrate a characteristic triphasic waveform due to pressure changes in the right atrium. This triphasic pattern is clearly visible in the Doppler tracing below the image.

This differs significantly from the monophasic low-resistance flow of the hepatic artery or the continuous hepatopetal flow of the portal vein.

Differentiation from other options:

A . Left portal vein: Would show continuous, hepatopetal flow (toward the liver) and lies more anterior and medial within the liver.

C . Proper hepatic artery: Small-caliber vessel with low-resistance pulsatile waveform (not triphasic).

D . Inferior vena cava: Lies posterior to the liver and demonstrates phasic flow with respiration, but this vessel is more centrally located and not shown in this field of view.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018. Chapter: Hepatic Vasculature, pp. 90--95.

AIUM Practice Parameter for the Performance of Hepatic Doppler Ultrasound Examinations, 2020.

Radiopaedia.org. Hepatic vein Doppler waveform: https://radiopaedia.org/articles/hepatic-vein-doppler-waveform

Answer : A

Testicular metastases are rare and usually identified in older patients. The most frequent primary site of malignancies metastasizing to the testes is the prostate. Studies (Ulbright and Young, 2008; Mosharafa et al., 2003) indicate that prostatic adenocarcinoma accounts for the highest number of testicular metastases, with lung and gastrointestinal tract malignancies also contributing less frequently. These metastases can be unilateral or bilateral and are often discovered incidentally during surgical intervention for prostate cancer.

The metastatic route involves retrograde venous extension, arterial embolism, or lymphatic dissemination. Histologically, prostatic adenocarcinoma in the testis can be confirmed via immunohistochemical markers like prostate-specific antigen (PSA), supporting its prostatic origin.

Ulbright TM, Young RH. Tumors of the Testis, Adnexa, Spermatic Cord, and Scrotum. AFIP Atlas of Tumor Pathology, 4th Series, Fascicle 18. Armed Forces Institute of Pathology, 2008.

Mosharafa AA, Foster RS, Bihrle R, et al. Clinical and pathologic features of testicular metastases from solid tumors: a 40-year review. Urology. 2003;61(5): 1064--1068.

Answer : B

The most serious long-term complication of undescended testis (cryptorchidism) is an increased risk of testicular malignancy, especially seminoma. Although torsion and hernia may also occur, seminoma is the most concerning complication due to its life-threatening potential.

According to Rumack's Diagnostic Ultrasound:

''Cryptorchidism is associated with a significantly increased risk of seminoma, the most common malignancy in undescended testes.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

American Urological Association (AUA) Guidelines, 2019.

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Answer : D

The image demonstrates a gallbladder with a possible echogenic focus (likely a gallstone) and posterior acoustic shadowing. This is suggestive of cholelithiasis. To differentiate uncomplicated gallstones from acute cholecystitis, the most effective technique is to assess for a positive sonographic Murphy sign.

A positive sonographic Murphy sign refers to the presence of focal tenderness over the gallbladder when it is directly palpated with the ultrasound transducer. It is a strong indicator of acute cholecystitis when combined with other features such as gallbladder wall thickening, pericholecystic fluid, and gallstones.

Sonographic Murphy sign --- key points:

Assessed during real-time scanning

Localized tenderness when pressure is applied over the gallbladder

Highly sensitive for acute cholecystitis (especially in the presence of stones)

Differentiation from other options:

A . Use compound imaging: Improves image quality by reducing artifacts but does not verify tenderness or confirm acute inflammation.

B . Change the patient's position: Helpful to confirm mobility of gallstones, but not diagnostic of inflammation.

C . Ask patient to perform Valsalva: Used primarily in vascular studies (e.g., assessing for varicocele or venous reflux), not relevant here.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018. Chapter: Gallbladder and Biliary System, pp. 148--152.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.

Radiopaedia.org. Sonographic Murphy sign: https://radiopaedia.org/articles/sonographic-murphy-sign

Answer : A

Pancreatic pseudocysts most commonly develop in the lesser sac, which lies between the posterior wall of the stomach and the anterior surface of the pancreas. This space allows for the accumulation of pancreatic fluid collections following pancreatitis or pancreatic ductal disruption.

The left anterior pararenal space (B) is a secondary location.

The right subdiaphragmatic space (C) and left pericolic gutter (D) are less common sites.

Reference Extracts:

Mortele KJ, Wiesner W, et al. 'Pancreatic pseudocysts: imaging features and diagnostic difficulties.' Radiographics. 2004;24(4):1005-1020.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

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