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Free PDF Quiz 2026 AB-Abdomen: Reliable Valid Abdomen Sonography Examination Test Objectives
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ARDMS Abdomen Sonography Examination Sample Questions (Q127-Q132):
NEW QUESTION # 127
Which diagnosis is most consistent with this image from a patient with acute scrotal pain?
- A. Testicular torsion
- B. Scrotal abscess
- C. Epididymitis
- D. Testicular rupture
Answer: A
Explanation:
The grayscale ultrasound image demonstrates a uniformly enlarged, hypoechoic (dark), and heterogeneous testis without signs of surrounding scrotal wall thickening or a discrete fluid collection. This pattern is highly suggestive of testicular torsion in the setting of acute scrotal pain.
Sonographic features of testicular torsion on grayscale imaging:
* Enlarged testis
* Diffusely hypoechoic parenchyma
* Loss of normal homogeneity
* Absence of internal vascular flow on Doppler imaging (not shown here but critical in confirming diagnosis) Testicular torsion occurs due to twisting of the spermatic cord, leading to vascular compromise and eventual infarction if not promptly corrected. It is a surgical emergency and typically presents in adolescent males with sudden-onset, severe unilateral testicular pain.
Comparison of answer choices:
* A. Scrotal abscess appears as a complex fluid collection with irregular margins and posterior enhancement.
* B. Testicular rupture would show discontinuity of the tunica albuginea, heterogeneous texture, and often a hematocele.
* C. Testicular torsion - Correct. The enlarged, hypoechoic, heterogeneous testis is characteristic, particularly in the acute phase.
* D. Epididymitis typically shows an enlarged, hypervascular epididymis and may extend to the testis (epididymo-orchitis), but vascularity is usually increased rather than absent.
References:
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Scrotal Ultrasound Examination (2021).
NEW QUESTION # 128
What is the adrenal disorder that produces excessive secretion of aldosterone?
- A. Cushing disease
- B. Conn syndrome
- C. Addison disease
- D. Waterhouse-Friderichsen syndrome
Answer: B
Explanation:
Conn syndrome (primary hyperaldosteronism) results from excessive aldosterone secretion, often due to an adrenal adenoma, leading to hypertension, hypokalemia, and metabolic alkalosis. Cushing disease involves cortisol, Addison disease involves adrenal insufficiency, and Waterhouse-Friderichsen is associated with adrenal hemorrhage.
According to Rumack's Diagnostic Ultrasound:
"Conn syndrome is due to excessive secretion of aldosterone, often secondary to adrenal cortical adenoma." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Adrenal Ultrasound, 2020.
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NEW QUESTION # 129
The absence of which sonographic finding indicates the acute process depicted in these images?
- A. Ductal dilatation
- B. Hepatic vein thrombosis
- C. Free fluid
- D. Cavernous transformation
Answer: D
Explanation:
The sonographic images depict an acute thrombotic process involving the portal venous system. The absence of cavernous transformation in the setting of portal vein thrombus indicates that the process is acute. In chronic portal vein thrombosis, collateral vessels form in the porta hepatis to bypass the obstruction, a process known as cavernous transformation.
Sonographic features suggesting acute portal vein thrombosis:
* Echogenic thrombus within the portal vein lumen
* Absence of flow on color Doppler
* Enlarged portal vein diameter early in the process
* No evidence of cavernous transformation (i.e., no serpiginous collateral vessels at porta hepatis) Cavernous transformation is a hallmark of chronic portal vein thrombosis and takes weeks to months to develop. Therefore, its absence on ultrasound supports an acute diagnosis.
Differentiation from other options:
* A. Free fluid: Non-specific and may or may not be present in hepatic vascular thrombosis.
* B. Ductal dilatation: Related to biliary obstruction, not portal or hepatic venous thrombosis.
* C. Hepatic vein thrombosis: Seen in Budd-Chiari syndrome, which affects hepatic outflow, not portal inflow.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Portal Venous System, pp. 105-108.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of Hepatic Doppler Ultrasound Examinations, 2020.
Radiopaedia.org. Cavernous transformation of the portal vein: https://radiopaedia.org/articles/cavernous- transformation-of-the-portal-vein
NEW QUESTION # 130
Which finding is most likely demonstrated in these images of a hypertensive patient with a history of hematuria?
- A. Pheochromocytoma
- B. Renal cell carcinoma
- C. Nephroblastoma
- D. Adenoma
Answer: B
Explanation:
The ultrasound images show a heterogeneous, solid-appearing mass within the right kidney. The patient has a history of hypertension and hematuria-classic clinical features that raise suspicion for renal cell carcinoma (RCC), especially in an adult.
Renal cell carcinoma is the most common primary malignant tumor of the kidney in adults. Common presenting symptoms include:
* Hematuria (most frequent symptom)
* Flank pain
* Palpable abdominal mass
* Hypertension (due to increased renin secretion)
* Sometimes paraneoplastic syndromes (e.g., polycythemia due to erythropoietin production) Ultrasound Features of RCC:
* Solid renal mass, often with heterogeneous echotexture
* May contain cystic components, calcifications, or necrotic areas
* May distort the renal contour
* Doppler may show internal vascularity
Differentiation from other options:
* B. Adenoma: Rare and typically small, benign cortical lesions. They do not typically present with hematuria or hypertension and cannot be reliably distinguished from RCC on ultrasound.
* C. Nephroblastoma (Wilms tumor): Pediatric renal tumor seen almost exclusively in children under age
5.
* D. Pheochromocytoma: Arises from the adrenal gland (not the kidney); associated with hypertension but not hematuria.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Urinary Tract, pp. 210-222.
American College of Radiology (ACR) Appropriateness Criteria - Hematuria, 2022.
Radiopaedia.org. Renal cell carcinoma: https://radiopaedia.org/articles/renal-cell-carcinoma
NEW QUESTION # 131
Which malignancy most commonly metastasizes to the testes?
- A. Prostate cancer
- B. Hodgkin lymphoma
- C. Non-Hodgkin lymphoma
- D. Bladder cancer
Answer: A
Explanation:
Testicular metastases are rare and usually identified in older patients. The most frequent primary site of malignancies metastasizing to the testes is theprostate. 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 viaimmunohistochemical markers like prostate-specific antigen (PSA), supporting its prostatic origin.
References:
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.
NEW QUESTION # 132
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