1|Page
ARDMS Abdominal Sonography Exam | Requirements, Prep &
Certification Guide 2025 COMPLETE 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
How are obstructive nephropathy and non obstructive nephropathy differentiated sonographically? -
ANSWER-Obstructive nephropathy (hydronephrosis) is diagnosed if the RI is greater than .7 (can only
occur in acute obstruction)
Non obstructive nephropathy is diagnosed if the RI is less than .7
Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly. What genitourinary tract
anomaly is commonly associated with a contralateral UPJ obstruction? - ANSWER-Unilateral
multicystic dysplastic kidney
What is the most common cause of obstruction in patients with acute flank pain? - ANSWER-Renal
Calculi
Name the three common locations within the urinary tract for obstruction from a renal calculi. Which
is the most common? - ANSWER-1. Ureterovesical Junction (most common)
2. Ureteropelvic junction
3. Ureteric Obstruction at level of pelvic inlet
What is the formula for resistive index? - ANSWER-Peak systolic - End diastolic / Peak systolic
Describe the waveform characteristics of the arterial side of an arteriovenous fistula: - ANSWER-
Abnormally low resistive arterial flow pattern; waveform has increased and sustained diastolic flow
Describe the waveform characteristics of the venous side of an arteriovenous fistula: - ANSWER-
Waveform with increased velocity, pulsatility, and with spectral broadening due to turbulance
List four sonographic criteria for determining renal artery stenosis: - ANSWER-1. Kidney size less than 9
cm in length
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2. Peak main renal artery velocity > 180cm/sec
3. Renal artery/aorta ratio > 3.5
4. Intrarenal parvus tardus waveform
Describe the sonographic appearance of a ureterocele: - ANSWER-Round, cystic structures that project
into the bladder lumen at the ureterovesical junction
Name the structure that connects the apex of the bladder to the umbilicus.
What is the term that describes cystic dilation of this structure? - ANSWER-Medial umbilical ligament
(urachus)- lies in space of Retzius
Urachal Cyst (in the lower abdomen and extends from the umbilicus to the dome of the bladder)
Name the parts of the Biliary Tree, and what is the name of the tumor that occurs between the right and
left hepatic ducts? - ANSWER-A: Left Hepatic Duct
B: Right Hepatic Duct
C: Common Hepatic Duct
D: Cystic Duct
E: Common Bile Duct
X: Cholangiocarcinoma @ junction of rt and lt hepatic duct AKA Klatskin tumor
What tumor occurs at the junction of the right and left hepatic duct? - ANSWER-Cholangiocarcinoma,
also called a Klatskin tumor
Give examples of prehepatic, intrahepatic and posthepatic portal hypertension - ANSWER-Pre- Portal
vein thrombosis
Intra- Cirrhosis; schistosomiasis
Post- Budd-Chiari Syndrome
What is the most common cause of acute renal failure? - ANSWER-Acute Tubular Necrosis (ATN)
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- Renal enlargement + increased resistive index may be associated
Name four sonographic indications of portal vein thrombosis - ANSWER--Echogenic material within
vessel lumen
-increase in portal vein diameter
-portosystemic collateral circulation
-cavernous transformation
Name causes of prehepatic, intrahepatic, or posthepatic portal hypertension: - ANSWER-Prehepatic
portal hypertension: Portal Vein thrombosis
Intrahepatic portal hypertension: Cirrhosis; Schistosomiasis
Posthepatic portal hypertension: Budd-Chiari Syndrome
Identify causes of renal vein thrombosis: - ANSWER--IVC or renal vein extrinsic compression
-nephrotic syndrome
-renal tumors
-renal allografts
-trauma
What are the four sonographic indications for acute renal vein thrombosis? - ANSWER-1. Dilated
thrombosed renal vein
2. Absence of venous flow within the kidney
3. Enlarged hypoechoic kidney
4. high resistive renal artery waveform
What is the sonographic appearance of chronic renal vein thrombosis? - ANSWER-decreased renal size
increased parenchymal echogenicity
What object is placed in the IVC to prevent the ascension of lower extremity thrombus into the lungs?
What role can ultrasound play in the evaluation of these objects? - ANSWER-IVC filters (Greenfield filter)
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- Ultrasound can determine the location of the filter with respect to the renal veins (should be inferior)
- see thrombosis around the filter or perforation through the IVC wall (which can be associated with a
retroperitoneal hematoma)
Name the structures A-E - ANSWER-A: Renal Cortex
B: Column of Bertin
C: Medullary Pyramid
D: Renal pelvis
E: Calyx
What is the sequence of branching renal arteries from the aorta to the renal capsule? - ANSWER-Main
Renal artery -> segmental arteries -> interlobar arteries -> arcuate arteries -> interlobular arteries
Which arteries of the kidney are positioned between the medullary pyramids? - ANSWER-Interlobar
arteries
Which arteries of the kidney are parallel to the base of the medullary pyramids? - ANSWER-Arcuate
Name 8 sonographic findings associated with AIDS patients: - ANSWER-1. Hepatomegaly
2. Splenomegaly
3. Lymphadenopathy
4. Hyperechoic Liver parenchyma
5. Hyperechoic Renal parenchyma
6. Liver abscess
7. metastatic Kaposi sarcoma
8. Acute cholecystitis (thickened gallbladder)
What is the median umbilical ligament (urachus)? - ANSWER-fibrous cord extended from the umbilicus
to the apex of the bladder
ARDMS Abdominal Sonography Exam | Requirements, Prep &
Certification Guide 2025 COMPLETE 250 QUESTIONS AND CORRECT
DETAILED ANSWERS
How are obstructive nephropathy and non obstructive nephropathy differentiated sonographically? -
ANSWER-Obstructive nephropathy (hydronephrosis) is diagnosed if the RI is greater than .7 (can only
occur in acute obstruction)
Non obstructive nephropathy is diagnosed if the RI is less than .7
Ureteropelvic junction (UPJ) obstruction is a common congenital anomaly. What genitourinary tract
anomaly is commonly associated with a contralateral UPJ obstruction? - ANSWER-Unilateral
multicystic dysplastic kidney
What is the most common cause of obstruction in patients with acute flank pain? - ANSWER-Renal
Calculi
Name the three common locations within the urinary tract for obstruction from a renal calculi. Which
is the most common? - ANSWER-1. Ureterovesical Junction (most common)
2. Ureteropelvic junction
3. Ureteric Obstruction at level of pelvic inlet
What is the formula for resistive index? - ANSWER-Peak systolic - End diastolic / Peak systolic
Describe the waveform characteristics of the arterial side of an arteriovenous fistula: - ANSWER-
Abnormally low resistive arterial flow pattern; waveform has increased and sustained diastolic flow
Describe the waveform characteristics of the venous side of an arteriovenous fistula: - ANSWER-
Waveform with increased velocity, pulsatility, and with spectral broadening due to turbulance
List four sonographic criteria for determining renal artery stenosis: - ANSWER-1. Kidney size less than 9
cm in length
,2|Page
2. Peak main renal artery velocity > 180cm/sec
3. Renal artery/aorta ratio > 3.5
4. Intrarenal parvus tardus waveform
Describe the sonographic appearance of a ureterocele: - ANSWER-Round, cystic structures that project
into the bladder lumen at the ureterovesical junction
Name the structure that connects the apex of the bladder to the umbilicus.
What is the term that describes cystic dilation of this structure? - ANSWER-Medial umbilical ligament
(urachus)- lies in space of Retzius
Urachal Cyst (in the lower abdomen and extends from the umbilicus to the dome of the bladder)
Name the parts of the Biliary Tree, and what is the name of the tumor that occurs between the right and
left hepatic ducts? - ANSWER-A: Left Hepatic Duct
B: Right Hepatic Duct
C: Common Hepatic Duct
D: Cystic Duct
E: Common Bile Duct
X: Cholangiocarcinoma @ junction of rt and lt hepatic duct AKA Klatskin tumor
What tumor occurs at the junction of the right and left hepatic duct? - ANSWER-Cholangiocarcinoma,
also called a Klatskin tumor
Give examples of prehepatic, intrahepatic and posthepatic portal hypertension - ANSWER-Pre- Portal
vein thrombosis
Intra- Cirrhosis; schistosomiasis
Post- Budd-Chiari Syndrome
What is the most common cause of acute renal failure? - ANSWER-Acute Tubular Necrosis (ATN)
,3|Page
- Renal enlargement + increased resistive index may be associated
Name four sonographic indications of portal vein thrombosis - ANSWER--Echogenic material within
vessel lumen
-increase in portal vein diameter
-portosystemic collateral circulation
-cavernous transformation
Name causes of prehepatic, intrahepatic, or posthepatic portal hypertension: - ANSWER-Prehepatic
portal hypertension: Portal Vein thrombosis
Intrahepatic portal hypertension: Cirrhosis; Schistosomiasis
Posthepatic portal hypertension: Budd-Chiari Syndrome
Identify causes of renal vein thrombosis: - ANSWER--IVC or renal vein extrinsic compression
-nephrotic syndrome
-renal tumors
-renal allografts
-trauma
What are the four sonographic indications for acute renal vein thrombosis? - ANSWER-1. Dilated
thrombosed renal vein
2. Absence of venous flow within the kidney
3. Enlarged hypoechoic kidney
4. high resistive renal artery waveform
What is the sonographic appearance of chronic renal vein thrombosis? - ANSWER-decreased renal size
increased parenchymal echogenicity
What object is placed in the IVC to prevent the ascension of lower extremity thrombus into the lungs?
What role can ultrasound play in the evaluation of these objects? - ANSWER-IVC filters (Greenfield filter)
, 4|Page
- Ultrasound can determine the location of the filter with respect to the renal veins (should be inferior)
- see thrombosis around the filter or perforation through the IVC wall (which can be associated with a
retroperitoneal hematoma)
Name the structures A-E - ANSWER-A: Renal Cortex
B: Column of Bertin
C: Medullary Pyramid
D: Renal pelvis
E: Calyx
What is the sequence of branching renal arteries from the aorta to the renal capsule? - ANSWER-Main
Renal artery -> segmental arteries -> interlobar arteries -> arcuate arteries -> interlobular arteries
Which arteries of the kidney are positioned between the medullary pyramids? - ANSWER-Interlobar
arteries
Which arteries of the kidney are parallel to the base of the medullary pyramids? - ANSWER-Arcuate
Name 8 sonographic findings associated with AIDS patients: - ANSWER-1. Hepatomegaly
2. Splenomegaly
3. Lymphadenopathy
4. Hyperechoic Liver parenchyma
5. Hyperechoic Renal parenchyma
6. Liver abscess
7. metastatic Kaposi sarcoma
8. Acute cholecystitis (thickened gallbladder)
What is the median umbilical ligament (urachus)? - ANSWER-fibrous cord extended from the umbilicus
to the apex of the bladder
