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ARDMS Abdomen Sonography Examination Sample Questions (Q163-Q168):

NEW QUESTION # 163
Which liver neoplasm is associated with use of oral contraceptives and is most often seen in women under the age of 40?

A. Hepatoblastoma
B. Hepatoma
C. Cavernous hemangioma
D. Adenoma

Answer: D

Explanation:
Hepatic adenomas are benign liver tumors strongly associated with long-term use of oral contraceptives and are most frequently found in women under 40. Hepatoblastoma is seen in children; hepatoma (HCC) is a malignant tumor typically found in cirrhotic livers. Cavernous hemangioma is unrelated to oral contraceptives.
According to Rumack's Diagnostic Ultrasound:
"Hepatic adenomas occur predominantly in young women with a history of oral contraceptive use." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Tumours of the Digestive System, 5th ed., IARC, 2019.
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NEW QUESTION # 164
Which finding is demonstrated in this image?

A. Medullary sponge kidney
B. Acute medical renal disease
C. Hepatic steatosis
D. Acute hepatitis

Answer: C

Explanation:
The ultrasound image demonstrates diffuse increased echogenicity of the liver parenchyma with posterior beam attenuation (acoustic shadowing), findings that are consistent with hepatic steatosis (fatty liver disease).
The liver appears brighter than normal, and the vascular markings, particularly of the portal veins, are obscured due to the increased parenchymal echogenicity.
Hepatic steatosis refers to the abnormal accumulation of fat within hepatocytes and is commonly associated with obesity, diabetes, alcohol use, and metabolic syndrome.
Classic sonographic features of hepatic steatosis include:
* Diffuse hyperechogenicity ("bright liver")
* Poor visualization of intrahepatic vessels and diaphragm
* Posterior acoustic attenuation
* Increased hepatic echogenicity relative to the renal cortex
Differentiation from other options:
* A. Acute hepatitis: Usually presents with normal or slightly decreased echogenicity, "starry sky" appearance due to prominent portal triads and periportal edema.
* C. Medullary sponge kidney: A renal condition with echogenic medullary pyramids, not hepatic.
* D. Acute medical renal disease: Affects the kidneys, often with bilateral renal enlargement and increased cortical echogenicity-again not related to liver imaging.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Liver, pp. 93-97.
American College of Radiology (ACR) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2021.
Radiopaedia.org. Fatty liver (ultrasound): https://radiopaedia.org/articles/fatty-liver-ultrasound

NEW QUESTION # 165
Which anatomical area of the male reproductive system is demonstrated in this endorectal image?

A. Prostate base
B. Seminal vesicles
C. Ejaculatory ducts
D. Urethra

Answer: B

Explanation:
The ultrasound image shown is a transverse endorectal (transrectal) ultrasound, commonly used to evaluate the prostate and adjacent structures. The two hypoechoic (dark) oval-shaped structures seen superior and posterior to the prostate are characteristic of the seminal vesicles.
The seminal vesicles are paired, elongated glands located superior and posterior to the base of the prostate and are best visualized in transverse planes on endorectal imaging. They appear as hypoechoic or anechoic structures with internal septations, depending on the degree of fluid content.
In contrast:
* The urethra appears as a central echogenic linear structure within the prostate.
* The prostate base is more inferior in the scan and is visualized just above the urethra.
* The ejaculatory ducts are usually not as prominently visualized and are located medial to the seminal vesicles, entering the prostate near the verumontanum.
This image most clearly demonstrates the bilateral seminal vesicles.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
ACR-AIUM-SRU Practice Parameter for the Performance of an Ultrasound Examination of the Prostate (2021).
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

NEW QUESTION # 166
Which malignancy most commonly metastasizes to the testes?

A. Bladder cancer
B. Non-Hodgkin lymphoma
C. Prostate cancer
D. Hodgkin lymphoma

Answer: C

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 # 167
Which probe frequency is most appropriate for imaging of the salivary glands?

A. 2 MHz
B. 12 MHz
C. 4 MHz
D. 8 MHz

Answer: B

Explanation:
Salivary glands are superficial structures, and high-frequency transducers (10-15 MHz) are optimal to obtain high spatial resolution. Lower frequencies are inappropriate as they lack sufficient resolution for superficial structures. A 12 MHz transducer provides excellent detail necessary for detecting small lesions, duct abnormalities, and vascular structures.
According to Rumack et al., Diagnostic Ultrasound:
"High-frequency linear transducers (10-15 MHz) are recommended for evaluating superficial structures such as salivary glands." (Rumack CM et al., Diagnostic Ultrasound, 5th ed.).
Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Head and Neck Ultrasound Examination, 2020.
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NEW QUESTION # 168
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