ARDMS RDMS Abdomen Sonography Certification Exam 2026:
Comprehensive Professional Practice Test — Abdominal Anatomy,
Hepatobiliary Imaging, Pancreas, Spleen, Renal & Vascular
Sonography — 195 Multiple-Choice Questions with Answers &
Detailed Rationales
SECTION 1: LIVER AND BILIARY SYSTEM (Questions 1-40)
Question 1
A 52-year-old male with a history of hepatitis C presents for a routine abdominal ultrasound.
The liver appears coarse and echogenic with a nodular surface. Which sonographic finding is
most consistent with cirrhosis?
A. Increased through-transmission with a homogeneous echotexture
B. Coarse, heterogeneous echotexture with surface nodularity
C. Decreased echogenicity with prominent portal veins
D. Normal liver architecture with focal fat sparing
Correct Answer: B
Explanation: Cirrhosis produces coarse parenchyma, nodular surface, and heterogeneous
echotexture due to fibrosis and regenerative nodules. This is the hallmark sonographic
appearance in advanced chronic liver disease.
Question 2
,During a gallbladder evaluation, you identify a fixed echogenic structure in the gallbladder
fossa that casts a clean acoustic shadow and shows no flow on Doppler. The patient has no
acute symptoms. What is the most likely diagnosis?
A. Gallbladder polyp
B. Gallstone
C. Gallbladder carcinoma
D. Sludge ball
Correct Answer: B
Explanation: Gallstones appear as echogenic foci with posterior acoustic shadowing, mobile
within the lumen, and lack internal vascularity. This classic presentation differentiates stones
from polyps and tumors.
Question 3
A 45-year-old female presents with right upper quadrant pain and fever. Sonography
demonstrates gallbladder wall thickening of 5 mm, pericholecystic fluid, and a positive
sonographic Murphy sign. What is the most likely diagnosis?
A. Chronic cholecystitis
B. Acute cholecystitis
C. Gallbladder adenomyomatosis
D. Pancreatic pseudocyst
Correct Answer: B
,Explanation: Acute cholecystitis presents with wall thickening >3 mm, pericholecystic fluid,
stones, and sonographic Murphy sign. Fever and pain support acute inflammation rather
than chronic changes.
Question 4
Which sonographic feature best distinguishes focal fatty sparing from a true hepatic mass?
A. Mass effect with vessel displacement
B. Geographic margins with no mass effect
C. Hypoechoic halo surrounding the lesion
D. Internal vascularity on Doppler
Correct Answer: B
Explanation: Focal fatty sparing appears as geographic hypoattenuating areas without mass
effect, vessel displacement, or capsule. True masses typically demonstrate mass effect and
may have peripheral halos.
Question 5
A patient with known cirrhosis undergoes surveillance ultrasound. A 1.5 cm hypoechoic
nodule is identified in segment VII. What is the most appropriate next step?
A. Repeat ultrasound in 12 months
B. CT or MRI with contrast for characterization
C. Immediate biopsy
D. No further workup needed
, Correct Answer: B
Explanation: In cirrhotic patients, any new nodule requires multiphase contrast imaging to
evaluate for hepatocellular carcinoma. Ultrasound alone cannot reliably characterize these
lesions.
Question 6
The sonographic "starry sky" appearance of the liver is most commonly associated with:
A. Hepatic steatosis
B. Acute hepatitis
C. Portal hypertension
D. Hepatic metastases
Correct Answer: B
Explanation: Acute hepatitis causes decreased parenchymal echogenicity, making portal vein
walls appear abnormally prominent, creating the "starry sky" pattern. This reflects diffuse
inflammation and edema.
Question 7
Which of the following is the most reliable sonographic sign of gallbladder
adenomyomatosis?
A. Mobile echogenic focus with shadowing
B. Comet-tail artifacts from Rokitansky-Aschoff sinuses
C. Diffuse wall thinning
Comprehensive Professional Practice Test — Abdominal Anatomy,
Hepatobiliary Imaging, Pancreas, Spleen, Renal & Vascular
Sonography — 195 Multiple-Choice Questions with Answers &
Detailed Rationales
SECTION 1: LIVER AND BILIARY SYSTEM (Questions 1-40)
Question 1
A 52-year-old male with a history of hepatitis C presents for a routine abdominal ultrasound.
The liver appears coarse and echogenic with a nodular surface. Which sonographic finding is
most consistent with cirrhosis?
A. Increased through-transmission with a homogeneous echotexture
B. Coarse, heterogeneous echotexture with surface nodularity
C. Decreased echogenicity with prominent portal veins
D. Normal liver architecture with focal fat sparing
Correct Answer: B
Explanation: Cirrhosis produces coarse parenchyma, nodular surface, and heterogeneous
echotexture due to fibrosis and regenerative nodules. This is the hallmark sonographic
appearance in advanced chronic liver disease.
Question 2
,During a gallbladder evaluation, you identify a fixed echogenic structure in the gallbladder
fossa that casts a clean acoustic shadow and shows no flow on Doppler. The patient has no
acute symptoms. What is the most likely diagnosis?
A. Gallbladder polyp
B. Gallstone
C. Gallbladder carcinoma
D. Sludge ball
Correct Answer: B
Explanation: Gallstones appear as echogenic foci with posterior acoustic shadowing, mobile
within the lumen, and lack internal vascularity. This classic presentation differentiates stones
from polyps and tumors.
Question 3
A 45-year-old female presents with right upper quadrant pain and fever. Sonography
demonstrates gallbladder wall thickening of 5 mm, pericholecystic fluid, and a positive
sonographic Murphy sign. What is the most likely diagnosis?
A. Chronic cholecystitis
B. Acute cholecystitis
C. Gallbladder adenomyomatosis
D. Pancreatic pseudocyst
Correct Answer: B
,Explanation: Acute cholecystitis presents with wall thickening >3 mm, pericholecystic fluid,
stones, and sonographic Murphy sign. Fever and pain support acute inflammation rather
than chronic changes.
Question 4
Which sonographic feature best distinguishes focal fatty sparing from a true hepatic mass?
A. Mass effect with vessel displacement
B. Geographic margins with no mass effect
C. Hypoechoic halo surrounding the lesion
D. Internal vascularity on Doppler
Correct Answer: B
Explanation: Focal fatty sparing appears as geographic hypoattenuating areas without mass
effect, vessel displacement, or capsule. True masses typically demonstrate mass effect and
may have peripheral halos.
Question 5
A patient with known cirrhosis undergoes surveillance ultrasound. A 1.5 cm hypoechoic
nodule is identified in segment VII. What is the most appropriate next step?
A. Repeat ultrasound in 12 months
B. CT or MRI with contrast for characterization
C. Immediate biopsy
D. No further workup needed
, Correct Answer: B
Explanation: In cirrhotic patients, any new nodule requires multiphase contrast imaging to
evaluate for hepatocellular carcinoma. Ultrasound alone cannot reliably characterize these
lesions.
Question 6
The sonographic "starry sky" appearance of the liver is most commonly associated with:
A. Hepatic steatosis
B. Acute hepatitis
C. Portal hypertension
D. Hepatic metastases
Correct Answer: B
Explanation: Acute hepatitis causes decreased parenchymal echogenicity, making portal vein
walls appear abnormally prominent, creating the "starry sky" pattern. This reflects diffuse
inflammation and edema.
Question 7
Which of the following is the most reliable sonographic sign of gallbladder
adenomyomatosis?
A. Mobile echogenic focus with shadowing
B. Comet-tail artifacts from Rokitansky-Aschoff sinuses
C. Diffuse wall thinning
