Abdomen Mock Exam 2025–2026 ARDMS and other
abdominal imaging certification Accurate Exam Questi
SECTION 1: LIVER (Questions 1–20)
1. Which of the following describes the normal sonographic appearance of the
liver parenchyma?
A. Homogeneous, medium-level echoes with fine texture
B. Heterogeneous with coarse echotexture
C. Hypoechoic with prominent portal walls
D. Hyperechoic with acoustic shadowing
Correct Answer: A
Rationale: Normal liver parenchyma appears homogeneous with medium-
level echoes and a fine, uniform texture. It should be slightly more echogenic than
the renal cortex but less echogenic than the pancreas. Coarse echotexture (B)
suggests cirrhosis or diffuse liver disease. Hyperechoic liver with shadowing (D)
would suggest fatty infiltration or hemangioma.
2. The normal liver measures approximately how long in the midclavicular line?
A. 5–8 cm
B. 8–10 cm
C. 13–15 cm
D. 18–20 cm
Correct Answer: C
Rationale: The normal liver spans approximately 13–15 cm in the
midclavicular line (craniocaudal dimension). Measurements less than 13 cm may
suggest atrophy, while greater than 15–16 cm suggests hepatomegaly. The liver is
the largest solid organ in the body.
,3. Which vessel serves as the key landmark dividing the liver into right and left
lobes?
A. Portal vein
B. Middle hepatic vein
C. Left hepatic vein
D. Inferior vena cava
Correct Answer: B
Rationale: The middle hepatic vein divides the liver into right and left lobes
(along Cantlie's line). The right hepatic vein divides the right lobe into anterior and
posterior segments, and the left hepatic vein divides the left lobe into medial and
lateral segments. The portal vein divides the liver into superior and inferior
segments.
4. SATA: Which of the following are sonographic features of cirrhosis? (Select all
that apply)
A. Coarse, heterogeneous echotexture
B. Nodular liver surface
C. Enlarged caudate lobe
D. Increased right lobe size
E. Attenuation of hepatic veins
F. Recanalization of the umbilical vein
Correct Answer: A, B, C, E, F
Rationale: Cirrhosis presents with coarse heterogeneous echotexture (A),
nodular surface (B), caudate lobe hypertrophy (C), attenuated hepatic veins (E),
and recanalization of the umbilical vein (F). The right lobe typically atrophies in
cirrhosis, not enlarges (D is incorrect).
,5. A patient presents with right upper quadrant pain and fever. Sonography
reveals a hypoechoic lesion with irregular walls and internal debris in the liver.
What is the most likely diagnosis?
A. Simple hepatic cyst
B. Hepatic hemangioma
C. Pyogenic liver abscess
D. Focal nodular hyperplasia
Correct Answer: C
Rationale: Pyogenic liver abscess typically presents as a hypoechoic or
complex lesion with irregular, thick walls, internal debris, and often posterior
acoustic enhancement. Clinical presentation of fever and RUQ pain supports
infection. Simple cysts (A) have thin walls and anechoic interiors. Hemangiomas
(B) are hyperechoic. FNH (D) is typically isoechoic or slightly hypoechoic with a
central scar.
6. Which of the following is the most common benign liver tumor?
A. Hepatic adenoma
B. Hemangioma
C. Focal nodular hyperplasia
D. Lipoma
Correct Answer: B
Rationale: Cavernous hemangioma is the most common benign liver tumor,
found in up to 7% of the population. Sonographically, it appears as a well-defined,
homogeneous, hyperechoic mass, most commonly in the right lobe. Adenomas
(A) are rare and associated with oral contraceptive use. FNH (C) is the second
most common benign tumor.
, 7. SATA: Which of the following are risk factors for hepatocellular carcinoma
(HCC)? (Select all that apply)
A. Chronic hepatitis B infection
B. Chronic hepatitis C infection
C. Alcohol-induced cirrhosis
D. Oral contraceptive use
E. Hemochromatosis
F. Obesity-related steatohepatitis
Correct Answer: A, B, C, E, F
Rationale: HCC risk factors include chronic HBV (A), chronic HCV (B), alcoholic
cirrhosis (C), hemochromatosis (E), and NASH/obesity-related steatohepatitis (F).
Oral contraceptive use (D) is associated with hepatic adenomas, not HCC.
8. The sonographic "starry sky" appearance of the liver is most commonly
associated with:
A. Cirrhosis
B. Acute hepatitis
C. Fatty infiltration
D. Hepatic fibrosis
Correct Answer: B
Rationale: The "starry sky" appearance occurs in acute hepatitis due to
decreased parenchymal echogenicity, making the portal vein walls appear
abnormally prominent and bright. This creates a contrast between the dark
parenchyma and bright portal triads. Cirrhosis (A) shows coarse echotexture. Fatty
infiltration (C) shows increased echogenicity with vascular blurring.
9. Which hepatic vein separates the right lobe into anterior and posterior
segments?
abdominal imaging certification Accurate Exam Questi
SECTION 1: LIVER (Questions 1–20)
1. Which of the following describes the normal sonographic appearance of the
liver parenchyma?
A. Homogeneous, medium-level echoes with fine texture
B. Heterogeneous with coarse echotexture
C. Hypoechoic with prominent portal walls
D. Hyperechoic with acoustic shadowing
Correct Answer: A
Rationale: Normal liver parenchyma appears homogeneous with medium-
level echoes and a fine, uniform texture. It should be slightly more echogenic than
the renal cortex but less echogenic than the pancreas. Coarse echotexture (B)
suggests cirrhosis or diffuse liver disease. Hyperechoic liver with shadowing (D)
would suggest fatty infiltration or hemangioma.
2. The normal liver measures approximately how long in the midclavicular line?
A. 5–8 cm
B. 8–10 cm
C. 13–15 cm
D. 18–20 cm
Correct Answer: C
Rationale: The normal liver spans approximately 13–15 cm in the
midclavicular line (craniocaudal dimension). Measurements less than 13 cm may
suggest atrophy, while greater than 15–16 cm suggests hepatomegaly. The liver is
the largest solid organ in the body.
,3. Which vessel serves as the key landmark dividing the liver into right and left
lobes?
A. Portal vein
B. Middle hepatic vein
C. Left hepatic vein
D. Inferior vena cava
Correct Answer: B
Rationale: The middle hepatic vein divides the liver into right and left lobes
(along Cantlie's line). The right hepatic vein divides the right lobe into anterior and
posterior segments, and the left hepatic vein divides the left lobe into medial and
lateral segments. The portal vein divides the liver into superior and inferior
segments.
4. SATA: Which of the following are sonographic features of cirrhosis? (Select all
that apply)
A. Coarse, heterogeneous echotexture
B. Nodular liver surface
C. Enlarged caudate lobe
D. Increased right lobe size
E. Attenuation of hepatic veins
F. Recanalization of the umbilical vein
Correct Answer: A, B, C, E, F
Rationale: Cirrhosis presents with coarse heterogeneous echotexture (A),
nodular surface (B), caudate lobe hypertrophy (C), attenuated hepatic veins (E),
and recanalization of the umbilical vein (F). The right lobe typically atrophies in
cirrhosis, not enlarges (D is incorrect).
,5. A patient presents with right upper quadrant pain and fever. Sonography
reveals a hypoechoic lesion with irregular walls and internal debris in the liver.
What is the most likely diagnosis?
A. Simple hepatic cyst
B. Hepatic hemangioma
C. Pyogenic liver abscess
D. Focal nodular hyperplasia
Correct Answer: C
Rationale: Pyogenic liver abscess typically presents as a hypoechoic or
complex lesion with irregular, thick walls, internal debris, and often posterior
acoustic enhancement. Clinical presentation of fever and RUQ pain supports
infection. Simple cysts (A) have thin walls and anechoic interiors. Hemangiomas
(B) are hyperechoic. FNH (D) is typically isoechoic or slightly hypoechoic with a
central scar.
6. Which of the following is the most common benign liver tumor?
A. Hepatic adenoma
B. Hemangioma
C. Focal nodular hyperplasia
D. Lipoma
Correct Answer: B
Rationale: Cavernous hemangioma is the most common benign liver tumor,
found in up to 7% of the population. Sonographically, it appears as a well-defined,
homogeneous, hyperechoic mass, most commonly in the right lobe. Adenomas
(A) are rare and associated with oral contraceptive use. FNH (C) is the second
most common benign tumor.
, 7. SATA: Which of the following are risk factors for hepatocellular carcinoma
(HCC)? (Select all that apply)
A. Chronic hepatitis B infection
B. Chronic hepatitis C infection
C. Alcohol-induced cirrhosis
D. Oral contraceptive use
E. Hemochromatosis
F. Obesity-related steatohepatitis
Correct Answer: A, B, C, E, F
Rationale: HCC risk factors include chronic HBV (A), chronic HCV (B), alcoholic
cirrhosis (C), hemochromatosis (E), and NASH/obesity-related steatohepatitis (F).
Oral contraceptive use (D) is associated with hepatic adenomas, not HCC.
8. The sonographic "starry sky" appearance of the liver is most commonly
associated with:
A. Cirrhosis
B. Acute hepatitis
C. Fatty infiltration
D. Hepatic fibrosis
Correct Answer: B
Rationale: The "starry sky" appearance occurs in acute hepatitis due to
decreased parenchymal echogenicity, making the portal vein walls appear
abnormally prominent and bright. This creates a contrast between the dark
parenchyma and bright portal triads. Cirrhosis (A) shows coarse echotexture. Fatty
infiltration (C) shows increased echogenicity with vascular blurring.
9. Which hepatic vein separates the right lobe into anterior and posterior
segments?
