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ARDMS Abdomen Sonography Examination Sample Questions (Q60-Q65):

NEW QUESTION # 60
Which condition is most consistent with the findings in this image?

A. Medullary sponge kidney
B. Acute pyelonephritis
C. Renal cell carcinoma
D. Fungal balls

Answer: A

Explanation:
The ultrasound image demonstrates a longitudinal view of the right kidney. Within the renal pyramids, there are multiple echogenic foci, some showing posterior acoustic shadowing-findings characteristic of medullary nephrocalcinosis. This sonographic appearance is strongly associated with medullary sponge kidney (MSK).
Medullary sponge kidney is a congenital disorder of the renal tubules that results in ectatic (dilated) collecting ducts in the renal medulla. The dilated ducts frequently become calcified, leading to the "paintbrush" or
"bouquet of flowers" appearance seen in the renal pyramids on ultrasound. These calcifications are most often bilateral and symmetrical, further aiding the diagnosis.
Comparison of answer choices:
* A. Fungal balls (mycetomas) typically appear as mobile, non-shadowing echogenic masses within the collecting system, often in immunocompromised patients.
* B. Renal cell carcinoma usually presents as a solid mass with irregular borders and variable echogenicity-this image does not show a mass.
* C. Acute pyelonephritis may show renal enlargement, decreased echogenicity, or loss of corticomedullary differentiation-but not calcification of the pyramids.
* D. Medullary sponge kidney is correct due to the punctate echogenic foci within the medullary pyramids, consistent with nephrocalcinosis.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
Babcock DS. Sonographic findings in medullary sponge kidney. AJR Am J Roentgenol. 1981;137(6):1239-
1243.

NEW QUESTION # 61
Which condition presents sonographically as an anechoic mass between the umbilicus and the bladder?

A. Bladder abscess
B. Urinoma
C. Urachal cyst
D. Mesenteric cyst

Answer: C

Explanation:
A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.
According to Rumack's Diagnostic Ultrasound:
"A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pelvis, 2020.
-

NEW QUESTION # 62
Which cause of transudative pleural effusion is most common?

A. Congestive heart failure
B. Lymphoma
C. Pulmonary emboli
D. Empyema

Answer: A

Explanation:
Transudative pleural effusions result from imbalances in hydrostatic and oncotic pressures, most commonly caused by congestive heart failure (CHF). In CHF, elevated hydrostatic pressure in the pulmonary capillaries leads to fluid leakage into the pleural space without significant protein or cellular content (hence, transudate).
Exudative effusions (associated with infections, malignancy, and inflammation) are more often seen with pulmonary emboli, lymphoma, or empyema.
According to Light's criteria (which differentiates transudates from exudates):
"Congestive heart failure remains the leading cause of transudative pleural effusions." (Light RW. Pleural Diseases, 6th ed.).
Reference:
Light RW. Pleural Diseases. 6th ed. Lippincott Williams & Wilkins, 2013.
American Thoracic Society Guidelines for Diagnosis and Management of Pleural Effusion, 2019.
-

NEW QUESTION # 63
Which arterial branches lie at the base of the renal pyramids?

A. Segmental
B. Arcuate
C. Interlobular
D. Interlobar

Answer: B

Explanation:
The arcuate arteries are located at the corticomedullary junction, arching over the base of the renal pyramids.
They form as the interlobar arteries reach the boundary between the cortex and medulla. The arcuate arteries give rise to the interlobular arteries, which supply the renal cortex.
* Segmental arteries (A) branch directly from the renal artery.
* Interlobar arteries (B) course between the renal pyramids.
* Interlobular arteries (D) extend into the cortex from the arcuate arteries.
Reference Extracts:
* Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. 7th ed. Lippincott Williams & Wilkins, 2013.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
-

NEW QUESTION # 64
When measuring the abdominal aorta, where should the calipers be placed?

A. Inner wall to outer wall
B. Outer wall to inner wall
C. Outer wall to outer wall
D. Inner wall to inner wall

Answer: C

Explanation:
When measuring the abdominal aorta (or any vessel diameter for aneurysm evaluation), calipers should be placed from outer wall to outer wall to ensure inclusion of the full vessel diameter, including any mural thrombus. This is the standard method accepted by professional societies.
According to AIUM and SRU Guidelines:
"Vessel diameter measurements should be performed from outer wall to outer wall to avoid underestimation of aneurysm size." Reference:
AIUM Practice Parameter for the Performance of Abdominal Aortic Ultrasound, 2020.
Society of Radiologists in Ultrasound (SRU) Consensus Statement, 2003.
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NEW QUESTION # 65
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