Abdomen Mock Exam 2025–2026 ARDMS and
other abdominal imaging certification
Accurate Exam Questions
1. A 52-year-old male with a history of alcohol abuse presents for a liver ultrasound. The
echotexture of the liver is markedly increased, and the liver appears brighter than the right
kidney. What is the most likely diagnosis?
A. Acute viral hepatitis
B. Hepatic steatosis
C. Cirrhosis
D. Budd-Chiari syndrome
Correct Answer: B
Rationale: Increased echogenicity of the liver parenchyma such that it is brighter than the
adjacent renal cortex is the classic sonographic hallmark of fatty infiltration (hepatic steatosis).
This finding occurs because fat vacuoles within hepatocytes increase acoustic reflectivity. Acute
hepatitis typically produces decreased echogenicity with prominent portal triads, while cirrhosis
shows a coarse, nodular echotexture with surface irregularity.
2. Which of the following is a sonographic finding associated with cirrhosis?
A. Smooth, well-defined liver surface
B. Enlarged, tortuous hepatic veins
C. Coarse echotexture with nodular surface
D. Increased hepatic vein flow velocity
Correct Answer: C
Rationale: Cirrhosis results from chronic progressive injury leading to parenchymal necrosis,
fibrosis, and nodular regeneration. The sonographic appearance includes a coarse echotexture,
irregular or nodular liver surface, and reduced liver size in later stages. Hepatic veins may
become narrowed or attenuated rather than enlarged.
3. SATA: Which of the following are sonographic features of portal hypertension? (Select all
that apply)
,A. Portal vein diameter greater than 13 mm
B. Reversed or biphasic portal vein flow
C. Enlarged hepatic veins
D. Splenomegaly
Correct Answers: A, B, D
Rationale: Portal hypertension manifests with portal vein dilation (>13 mm), altered flow
dynamics including hepatofugal (reversed) or biphasic flow, and splenomegaly due to passive
congestion. Hepatic veins are not typically enlarged in portal hypertension; they may become
compressed or attenuated.
4. A patient with right upper quadrant pain undergoes ultrasound. A well-defined, anechoic
lesion with thin walls and posterior acoustic enhancement is identified in the liver. No internal
flow is seen on Doppler. What is the most likely diagnosis?
A. Hepatocellular carcinoma
B. Simple hepatic cyst
C. Liver abscess
D. Hemangioma
Correct Answer: B
Rationale: Simple hepatic cysts are anechoic with sharply defined thin walls, may have
lobulated contours, and demonstrate posterior acoustic enhancement (increased through-
transmission). Doppler confirms absence of internal vascularity. Abscesses typically show thick,
poorly marginated walls with internal debris, while hemangiomas are echogenic and HCC is
usually a solid mass.
5. The most common benign liver tumor is:
A. Focal nodular hyperplasia
B. Hepatocellular adenoma
C. Hemangioma
D. Lipoma
Correct Answer: C
Rationale: Cavernous hemangioma is the most common benign liver tumor, found in up to
7% of the population. Sonographically, it typically appears as a well-circumscribed,
homogeneously hyperechoic mass.
,6. A patient with known colon carcinoma presents with multiple hypoechoic liver lesions.
What is the most likely diagnosis?
A. Simple cysts
B. Hepatic metastases
C. Hemangiomas
D. Focal fatty sparing
Correct Answer: B
Rationale: The liver is a common site for metastatic disease, particularly from colorectal,
pancreatic, breast, and lung primaries. Metastases typically appear as multiple hypoechoic or
mixed echogenicity masses. They may demonstrate a "target" or "bull's eye" appearance.
7. Which vascular structure separates the right and left lobes of the liver?
A. Portal vein
B. Middle hepatic vein
C. Falciform ligament
D. Ligamentum venosum
Correct Answer: C
Rationale: The falciform ligament separates the right and left lobes of the liver anatomically.
The middle hepatic vein separates the right and left lobes functionally (surgically). The
ligamentum venosum separates the left lobe from the caudate lobe.
8. SATA: Which of the following are causes of increased liver echogenicity? (Select all that
apply)
A. Fatty infiltration
B. Acute hepatitis
C. Cirrhosis
D. Glycogen storage disease
Correct Answers: A, C, D
Rationale: Fatty infiltration, cirrhosis, and glycogen storage disease all cause increased liver
echogenicity. Acute hepatitis typically causes decreased echogenicity due to parenchymal
edema, making portal triads appear more prominent.
, 9. A patient with Budd-Chiari syndrome would most likely demonstrate which sonographic
finding?
A. Patent hepatic veins with normal flow
B. Enlarged, thrombosed hepatic veins with absent or reversed flow
C. Dilated portal vein with hepatofugal flow
D. Normal hepatic vein waveform
Correct Answer: B
Rationale: Budd-Chiari syndrome results from hepatic venous outflow obstruction.
Sonographically, hepatic veins appear enlarged, may contain thrombus, and demonstrate
absent, reversed, or turbulent flow. The caudate lobe may be hypertrophied due to separate
venous drainage.
10. The caudate lobe of the liver is separated from the left lobe by which structure?
A. Falciform ligament
B. Ligamentum teres
C. Ligamentum venosum
D. Main lobar fissure
Correct Answer: C
Rationale: The ligamentum venosum separates the caudate lobe from the left lobe of the
liver. The falciform ligament and ligamentum teres separate the right and left lobes. The main
lobar fissure separates the right and left lobes and contains the middle hepatic vein.
11. A 45-year-old female with a history of oral contraceptive use presents with a liver mass.
Sonography reveals a well-circumscribed, hypoechoic mass with internal vascularity. What is
the most likely diagnosis?
A. Hemangioma
B. Focal nodular hyperplasia
C. Hepatocellular adenoma
D. Simple cyst
Correct Answer: C
Rationale: Hepatocellular adenoma is associated with oral contraceptive use.
other abdominal imaging certification
Accurate Exam Questions
1. A 52-year-old male with a history of alcohol abuse presents for a liver ultrasound. The
echotexture of the liver is markedly increased, and the liver appears brighter than the right
kidney. What is the most likely diagnosis?
A. Acute viral hepatitis
B. Hepatic steatosis
C. Cirrhosis
D. Budd-Chiari syndrome
Correct Answer: B
Rationale: Increased echogenicity of the liver parenchyma such that it is brighter than the
adjacent renal cortex is the classic sonographic hallmark of fatty infiltration (hepatic steatosis).
This finding occurs because fat vacuoles within hepatocytes increase acoustic reflectivity. Acute
hepatitis typically produces decreased echogenicity with prominent portal triads, while cirrhosis
shows a coarse, nodular echotexture with surface irregularity.
2. Which of the following is a sonographic finding associated with cirrhosis?
A. Smooth, well-defined liver surface
B. Enlarged, tortuous hepatic veins
C. Coarse echotexture with nodular surface
D. Increased hepatic vein flow velocity
Correct Answer: C
Rationale: Cirrhosis results from chronic progressive injury leading to parenchymal necrosis,
fibrosis, and nodular regeneration. The sonographic appearance includes a coarse echotexture,
irregular or nodular liver surface, and reduced liver size in later stages. Hepatic veins may
become narrowed or attenuated rather than enlarged.
3. SATA: Which of the following are sonographic features of portal hypertension? (Select all
that apply)
,A. Portal vein diameter greater than 13 mm
B. Reversed or biphasic portal vein flow
C. Enlarged hepatic veins
D. Splenomegaly
Correct Answers: A, B, D
Rationale: Portal hypertension manifests with portal vein dilation (>13 mm), altered flow
dynamics including hepatofugal (reversed) or biphasic flow, and splenomegaly due to passive
congestion. Hepatic veins are not typically enlarged in portal hypertension; they may become
compressed or attenuated.
4. A patient with right upper quadrant pain undergoes ultrasound. A well-defined, anechoic
lesion with thin walls and posterior acoustic enhancement is identified in the liver. No internal
flow is seen on Doppler. What is the most likely diagnosis?
A. Hepatocellular carcinoma
B. Simple hepatic cyst
C. Liver abscess
D. Hemangioma
Correct Answer: B
Rationale: Simple hepatic cysts are anechoic with sharply defined thin walls, may have
lobulated contours, and demonstrate posterior acoustic enhancement (increased through-
transmission). Doppler confirms absence of internal vascularity. Abscesses typically show thick,
poorly marginated walls with internal debris, while hemangiomas are echogenic and HCC is
usually a solid mass.
5. The most common benign liver tumor is:
A. Focal nodular hyperplasia
B. Hepatocellular adenoma
C. Hemangioma
D. Lipoma
Correct Answer: C
Rationale: Cavernous hemangioma is the most common benign liver tumor, found in up to
7% of the population. Sonographically, it typically appears as a well-circumscribed,
homogeneously hyperechoic mass.
,6. A patient with known colon carcinoma presents with multiple hypoechoic liver lesions.
What is the most likely diagnosis?
A. Simple cysts
B. Hepatic metastases
C. Hemangiomas
D. Focal fatty sparing
Correct Answer: B
Rationale: The liver is a common site for metastatic disease, particularly from colorectal,
pancreatic, breast, and lung primaries. Metastases typically appear as multiple hypoechoic or
mixed echogenicity masses. They may demonstrate a "target" or "bull's eye" appearance.
7. Which vascular structure separates the right and left lobes of the liver?
A. Portal vein
B. Middle hepatic vein
C. Falciform ligament
D. Ligamentum venosum
Correct Answer: C
Rationale: The falciform ligament separates the right and left lobes of the liver anatomically.
The middle hepatic vein separates the right and left lobes functionally (surgically). The
ligamentum venosum separates the left lobe from the caudate lobe.
8. SATA: Which of the following are causes of increased liver echogenicity? (Select all that
apply)
A. Fatty infiltration
B. Acute hepatitis
C. Cirrhosis
D. Glycogen storage disease
Correct Answers: A, C, D
Rationale: Fatty infiltration, cirrhosis, and glycogen storage disease all cause increased liver
echogenicity. Acute hepatitis typically causes decreased echogenicity due to parenchymal
edema, making portal triads appear more prominent.
, 9. A patient with Budd-Chiari syndrome would most likely demonstrate which sonographic
finding?
A. Patent hepatic veins with normal flow
B. Enlarged, thrombosed hepatic veins with absent or reversed flow
C. Dilated portal vein with hepatofugal flow
D. Normal hepatic vein waveform
Correct Answer: B
Rationale: Budd-Chiari syndrome results from hepatic venous outflow obstruction.
Sonographically, hepatic veins appear enlarged, may contain thrombus, and demonstrate
absent, reversed, or turbulent flow. The caudate lobe may be hypertrophied due to separate
venous drainage.
10. The caudate lobe of the liver is separated from the left lobe by which structure?
A. Falciform ligament
B. Ligamentum teres
C. Ligamentum venosum
D. Main lobar fissure
Correct Answer: C
Rationale: The ligamentum venosum separates the caudate lobe from the left lobe of the
liver. The falciform ligament and ligamentum teres separate the right and left lobes. The main
lobar fissure separates the right and left lobes and contains the middle hepatic vein.
11. A 45-year-old female with a history of oral contraceptive use presents with a liver mass.
Sonography reveals a well-circumscribed, hypoechoic mass with internal vascularity. What is
the most likely diagnosis?
A. Hemangioma
B. Focal nodular hyperplasia
C. Hepatocellular adenoma
D. Simple cyst
Correct Answer: C
Rationale: Hepatocellular adenoma is associated with oral contraceptive use.
