ULTRASOUND REGISTRY EXAM PREP:
ARDMS ABDOMEN BOARD-STYLE
QUESTIONS
Section 1: Hepatic Pathology & Vascular Relationships
Q1. A 34-year-old female presents with acute right upper
quadrant pain, ascites, and hepatomegaly. Duplex Doppler
ultrasound reveals a lack of flow within the hepatic veins and
an enlarged caudate lobe. Which of the following conditions
is most consistent with these findings?
A) Gilbert's syndrome
B) Budd-Chiari syndrome
C) Portal hypertension secondary to schistosomiasis
D) Cavernous hemangioma
• Correct Answer: B
• Rationale: Budd-Chiari syndrome is characterized by the
occlusion of hepatic venous outflow, which characteristically
leads to hepatomegaly, ascites, and compensatory
hypertrophy of the caudate lobe due to its independent
venous drainage directly into the inferior vena cava (IVC).
Q2. During a routine abdominal sonogram, a highly
echogenic, linear structure is visualized running from the
umbilicus to the left portal vein within the left lobe of the
liver. This structure represents the obliterated remnant of
which fetal vessel?
,A) Ductus venosus
B) Umbilical artery
C) Umbilical vein
D) Vitelline duct
• Correct Answer: C
• Rationale: The ligamentum teres (round ligament of the
liver) serves as the anatomical remnant of the fetal umbilical
vein. In cases of severe portal hypertension, this vestigial
pathway can recanalize to shunt blood away from the liver
toward the systemic venous system.
Q3. An ultrasound demonstrates a patient with long-standing
history of hepatitis C presenting with a shrunken, nodular
liver. Sonographically, the hepatic parenchyma exhibits a
diffuse decrease in echogenicity, appearing noticeably
darker (hypoechoic) than the adjacent normal renal
parenchyma. What does this relative echogenicity indicate?
A) Early acute hepatitis
B) Normal fatty infiltration
C) Advanced, end-stage cirrhosis
D) Diffuse hepatic steatosis
• Correct Answer: C
• Rationale: While early or standard cirrhosis typically
presents with increased echogenicity, advanced, burnt-out
end-stage cirrhosis can result in architectural distortion
where the liver parenchymal echogenicity paradoxically
, drops below that of the renal cortex, or appears atypical due
to extensive nodularity and fibrosis.
Q4. While evaluating the abdominal aorta in a sagittal plane,
you visualize a vascular structure coursing horizontally in
the transverse plane directly anterior to the aorta and
posterior to the superior mesenteric artery (SMA). Which
vessel is this?
A) Right renal artery
B) Left renal vein
C) Splenic vein
D) Inferior mesenteric vein
• Correct Answer: B
• Rationale: The left renal vein follows a predictable
anatomical course, traveling from the left kidney hilum
anterior to the abdominal aorta and posterior to the SMA
("nutcracker" space) to drain directly into the inferior vena
cava.
Q5. A sonographer is performing a renal vascular
assessment. In a longitudinal view of the inferior vena cava
(IVC), a round, anechoic structure is noted directly posterior
to the IVC, running horizontally toward the right
retroperitoneum. This structure represents the:
A) Right renal artery
B) Left renal vein
C) Right adrenal vein
D) Gonadal artery
ARDMS ABDOMEN BOARD-STYLE
QUESTIONS
Section 1: Hepatic Pathology & Vascular Relationships
Q1. A 34-year-old female presents with acute right upper
quadrant pain, ascites, and hepatomegaly. Duplex Doppler
ultrasound reveals a lack of flow within the hepatic veins and
an enlarged caudate lobe. Which of the following conditions
is most consistent with these findings?
A) Gilbert's syndrome
B) Budd-Chiari syndrome
C) Portal hypertension secondary to schistosomiasis
D) Cavernous hemangioma
• Correct Answer: B
• Rationale: Budd-Chiari syndrome is characterized by the
occlusion of hepatic venous outflow, which characteristically
leads to hepatomegaly, ascites, and compensatory
hypertrophy of the caudate lobe due to its independent
venous drainage directly into the inferior vena cava (IVC).
Q2. During a routine abdominal sonogram, a highly
echogenic, linear structure is visualized running from the
umbilicus to the left portal vein within the left lobe of the
liver. This structure represents the obliterated remnant of
which fetal vessel?
,A) Ductus venosus
B) Umbilical artery
C) Umbilical vein
D) Vitelline duct
• Correct Answer: C
• Rationale: The ligamentum teres (round ligament of the
liver) serves as the anatomical remnant of the fetal umbilical
vein. In cases of severe portal hypertension, this vestigial
pathway can recanalize to shunt blood away from the liver
toward the systemic venous system.
Q3. An ultrasound demonstrates a patient with long-standing
history of hepatitis C presenting with a shrunken, nodular
liver. Sonographically, the hepatic parenchyma exhibits a
diffuse decrease in echogenicity, appearing noticeably
darker (hypoechoic) than the adjacent normal renal
parenchyma. What does this relative echogenicity indicate?
A) Early acute hepatitis
B) Normal fatty infiltration
C) Advanced, end-stage cirrhosis
D) Diffuse hepatic steatosis
• Correct Answer: C
• Rationale: While early or standard cirrhosis typically
presents with increased echogenicity, advanced, burnt-out
end-stage cirrhosis can result in architectural distortion
where the liver parenchymal echogenicity paradoxically
, drops below that of the renal cortex, or appears atypical due
to extensive nodularity and fibrosis.
Q4. While evaluating the abdominal aorta in a sagittal plane,
you visualize a vascular structure coursing horizontally in
the transverse plane directly anterior to the aorta and
posterior to the superior mesenteric artery (SMA). Which
vessel is this?
A) Right renal artery
B) Left renal vein
C) Splenic vein
D) Inferior mesenteric vein
• Correct Answer: B
• Rationale: The left renal vein follows a predictable
anatomical course, traveling from the left kidney hilum
anterior to the abdominal aorta and posterior to the SMA
("nutcracker" space) to drain directly into the inferior vena
cava.
Q5. A sonographer is performing a renal vascular
assessment. In a longitudinal view of the inferior vena cava
(IVC), a round, anechoic structure is noted directly posterior
to the IVC, running horizontally toward the right
retroperitoneum. This structure represents the:
A) Right renal artery
B) Left renal vein
C) Right adrenal vein
D) Gonadal artery
