ARDMS PEDIATRIC
SONOGRAPHY (PS) REGISTRY
EXAM STUDY GUIDE (2026) | 300
High-Yield Practice Questions with
Answers & Comprehensive
Rationales
Pass your ARDMS Pediatric Sonography specialty
exam on your first attempt with this premium, 300-
question practice bank engineered for the 2026
registry specifications. This high-yield guide features
comprehensive coverage of neonatal
neurosonography, pediatric abdominal pathologies,
congenital anomalies, and critical hip/spine
protocols. Complete with bold italicized answers and
highly detailed, italicized rationales, this document
provides the exact active recall structure needed to
turn complex pediatric ultrasound physics and
pathology into an effortless pass.
,1.
A 3-week-old male infant presents to the emergency department with a history of
projectile, non-bilious vomiting after feeding and a palpable "olive-shaped" right upper
quadrant mass. During the ultrasound evaluation, which of the following measurement
criteria is diagnostic for hypertrophic pyloric stenosis (HPS)?
A) Pyloric muscle thickness less than 2 mm and channel length less than 10 mm
B) Pyloric muscle thickness greater than or equal to 3 mm and channel length greater
than or equal to 15 mm
C) Pyloric wall diameter of 5 mm with active hyperperistalsis into the duodenum
D) Persistent pyloric fluid volume retention greater than 20 mL within a 5-minute window
Answer: B) Pyloric muscle thickness greater than or equal to 3 mm and channel
length greater than or equal to 15 mm
Rationale: The gold standard sonographic diagnostic criteria for hypertrophic pyloric
stenosis include a pyloric muscle wall thickness of 3 mm or greater and an elongated
pyloric channel length of 15 mm or greater, viewed in longitudinal and transverse
planes.
2. While performing a neonatal cranial ultrasound through the anterior fontanelle on a
premature infant, the sonographer visualizes echogenic material completely filling the
left lateral ventricle, causing noticeable ventricular dilatation. According to the Papile
grading system, how should this intraventricular hemorrhage (IVH) be classified?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
Answer: C) Grade III
Rationale: A Grade III intraventricular hemorrhage is characterized by hemorrhage
extending into the lateral ventricles with associated ventricular dilatation. Grade I is
confined to the germinal matrix, Grade II involves intraventricular blood without
dilatation, and Grade IV involves parenchymal extension.
3. A 14-month-old female child is brought to the clinic due to an asymptomatic, firm,
palpable abdominal mass. The sonographic examination reveals a large,
heterogeneous solid intra-renal tumor that destroys the normal renal parenchyma and
shows no signs of intrinsic calcification. What is the most likely diagnosis?
A) Neuroblastoma
B) Nephroblastoma (Wilms Tumor)
,C) Multicystic Dysplastic Kidney (MCDK)
D) Mesoblastic Nephroma
Answer: B) Nephroblastoma (Wilms Tumor)
Rationale: Nephroblastoma, or Wilms tumor, is the most common malignant pediatric
renal mass, typically presenting as a large, solid, intra-renal mass that distorts the
normal collecting system architecture. Neuroblastoma is an extra-renal, adrenal mass
that frequently displays calcifications and displaces the kidney inferiorly.
4. During a pediatric hip ultrasound evaluated via the Graf method for suspected
developmental dysplasia of the hip (DDH), which anatomical structural landmark must
be perfectly visualized to ensure the validity of the coronal alpha and beta angle
measurements?
A) The ligamentum teres fiber insertion track
B) The lower gluteal muscle border and the sciatic nerve pathway
C) The lower hip adductor muscle belly
D) The lower limb of the os ilium, the acetabular labrum, and the bony roof
Answer: D) The lower limb of the os ilium, the acetabular labrum, and the bony
roof
Rationale: To perform accurate Graf classification metrics for DDH, the standard
coronal plane view requires three essential landmarks: the lower edge of the ilium bone
where it meets the triradiate cartilage, the bony roof of the acetabulum, and the
fibrocartilaginous labrum.
5. A 4-year-old child presents with acute right lower quadrant pain, fever, and
leukocytosis. Sonographic evaluation reveals a non-compressible, blind-ended tubular
structure in the right iliac fossa measuring 8 mm in outer-to-outer diameter with a
prominent "target sign" in the transverse view. What is the correct clinical interpretation?
A) Intussusception
B) Acute Appendicitis
C) Meckel's Diverticulum
D) Mesenteric Lymphadenitis
Answer: B) Acute Appendicitis
Rationale: Pediatric appendicitis is sonographically diagnosed by visualizing a blind-
ended, non-compressible aperistaltic tubular structure in the right lower quadrant with
an outer diameter exceeding 6 mm, often demonstrating a hyperemic wall "target sign"
on transverse imaging.
, 6. A 2-month-old infant presents with worsening jaundice, clay-coloured stools, and
hepatomegaly. Sonography demonstrates a small, irregular gallbladder, an echogenic
anterior wall of the right portal vein measuring greater than 4 mm (the "triangular cord
sign"), and absent flow within the common bile duct. What is the most likely diagnosis?
A) Neonatal Hepatitis
B) Biliary Atresia
C) Choledochal Cyst
D) Caroli Disease
Answer: B) Biliary Atresia
Rationale: Biliary atresia is a progressive obstruction of the extrahepatic biliary tree. The
"triangular cord sign" represents fibrotic tissue at the porta hepatis and is a classic,
highly specific sonographic feature that differentiates it from neonatal hepatitis.
7. While scanning the neonatal brain through the posterior fontanelle, the sonographer
notes that the posterior fontanelle provides the optimal acoustic window for evaluating
which of the following structures?
A) Third ventricle and caudate nucleus
B) Occipital horns of the lateral ventricles and the cerebellum
C) Frontal lobes and anterior cerebral artery
D) Germinal matrix and cavum septum pellucidum
Answer: B) Occipital horns of the lateral ventricles and the cerebellum
Rationale: While the anterior fontanelle is the primary window for neurosonography, the
posterior fontanelle is a valuable alternative window that provides superior visualization
of the occipital horns and the posterior fossa structures, including the cerebellum.
8. A 10-month-old infant presents with a history of intermittent, severe abdominal pain, a
palpable sausage-shaped abdominal mass, and "currant jelly" stools. Ultrasound
reveals an abdominal mass with a "pseudokidney" appearance in the longitudinal plane
and concentric rings of bowel within bowel in the transverse plane. What is this
pathology?
A) Hypertrophic Pyloric Stenosis
B) Midgut Volvulus
C) Duodenal Atresia
D) Intussusception
SONOGRAPHY (PS) REGISTRY
EXAM STUDY GUIDE (2026) | 300
High-Yield Practice Questions with
Answers & Comprehensive
Rationales
Pass your ARDMS Pediatric Sonography specialty
exam on your first attempt with this premium, 300-
question practice bank engineered for the 2026
registry specifications. This high-yield guide features
comprehensive coverage of neonatal
neurosonography, pediatric abdominal pathologies,
congenital anomalies, and critical hip/spine
protocols. Complete with bold italicized answers and
highly detailed, italicized rationales, this document
provides the exact active recall structure needed to
turn complex pediatric ultrasound physics and
pathology into an effortless pass.
,1.
A 3-week-old male infant presents to the emergency department with a history of
projectile, non-bilious vomiting after feeding and a palpable "olive-shaped" right upper
quadrant mass. During the ultrasound evaluation, which of the following measurement
criteria is diagnostic for hypertrophic pyloric stenosis (HPS)?
A) Pyloric muscle thickness less than 2 mm and channel length less than 10 mm
B) Pyloric muscle thickness greater than or equal to 3 mm and channel length greater
than or equal to 15 mm
C) Pyloric wall diameter of 5 mm with active hyperperistalsis into the duodenum
D) Persistent pyloric fluid volume retention greater than 20 mL within a 5-minute window
Answer: B) Pyloric muscle thickness greater than or equal to 3 mm and channel
length greater than or equal to 15 mm
Rationale: The gold standard sonographic diagnostic criteria for hypertrophic pyloric
stenosis include a pyloric muscle wall thickness of 3 mm or greater and an elongated
pyloric channel length of 15 mm or greater, viewed in longitudinal and transverse
planes.
2. While performing a neonatal cranial ultrasound through the anterior fontanelle on a
premature infant, the sonographer visualizes echogenic material completely filling the
left lateral ventricle, causing noticeable ventricular dilatation. According to the Papile
grading system, how should this intraventricular hemorrhage (IVH) be classified?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
Answer: C) Grade III
Rationale: A Grade III intraventricular hemorrhage is characterized by hemorrhage
extending into the lateral ventricles with associated ventricular dilatation. Grade I is
confined to the germinal matrix, Grade II involves intraventricular blood without
dilatation, and Grade IV involves parenchymal extension.
3. A 14-month-old female child is brought to the clinic due to an asymptomatic, firm,
palpable abdominal mass. The sonographic examination reveals a large,
heterogeneous solid intra-renal tumor that destroys the normal renal parenchyma and
shows no signs of intrinsic calcification. What is the most likely diagnosis?
A) Neuroblastoma
B) Nephroblastoma (Wilms Tumor)
,C) Multicystic Dysplastic Kidney (MCDK)
D) Mesoblastic Nephroma
Answer: B) Nephroblastoma (Wilms Tumor)
Rationale: Nephroblastoma, or Wilms tumor, is the most common malignant pediatric
renal mass, typically presenting as a large, solid, intra-renal mass that distorts the
normal collecting system architecture. Neuroblastoma is an extra-renal, adrenal mass
that frequently displays calcifications and displaces the kidney inferiorly.
4. During a pediatric hip ultrasound evaluated via the Graf method for suspected
developmental dysplasia of the hip (DDH), which anatomical structural landmark must
be perfectly visualized to ensure the validity of the coronal alpha and beta angle
measurements?
A) The ligamentum teres fiber insertion track
B) The lower gluteal muscle border and the sciatic nerve pathway
C) The lower hip adductor muscle belly
D) The lower limb of the os ilium, the acetabular labrum, and the bony roof
Answer: D) The lower limb of the os ilium, the acetabular labrum, and the bony
roof
Rationale: To perform accurate Graf classification metrics for DDH, the standard
coronal plane view requires three essential landmarks: the lower edge of the ilium bone
where it meets the triradiate cartilage, the bony roof of the acetabulum, and the
fibrocartilaginous labrum.
5. A 4-year-old child presents with acute right lower quadrant pain, fever, and
leukocytosis. Sonographic evaluation reveals a non-compressible, blind-ended tubular
structure in the right iliac fossa measuring 8 mm in outer-to-outer diameter with a
prominent "target sign" in the transverse view. What is the correct clinical interpretation?
A) Intussusception
B) Acute Appendicitis
C) Meckel's Diverticulum
D) Mesenteric Lymphadenitis
Answer: B) Acute Appendicitis
Rationale: Pediatric appendicitis is sonographically diagnosed by visualizing a blind-
ended, non-compressible aperistaltic tubular structure in the right lower quadrant with
an outer diameter exceeding 6 mm, often demonstrating a hyperemic wall "target sign"
on transverse imaging.
, 6. A 2-month-old infant presents with worsening jaundice, clay-coloured stools, and
hepatomegaly. Sonography demonstrates a small, irregular gallbladder, an echogenic
anterior wall of the right portal vein measuring greater than 4 mm (the "triangular cord
sign"), and absent flow within the common bile duct. What is the most likely diagnosis?
A) Neonatal Hepatitis
B) Biliary Atresia
C) Choledochal Cyst
D) Caroli Disease
Answer: B) Biliary Atresia
Rationale: Biliary atresia is a progressive obstruction of the extrahepatic biliary tree. The
"triangular cord sign" represents fibrotic tissue at the porta hepatis and is a classic,
highly specific sonographic feature that differentiates it from neonatal hepatitis.
7. While scanning the neonatal brain through the posterior fontanelle, the sonographer
notes that the posterior fontanelle provides the optimal acoustic window for evaluating
which of the following structures?
A) Third ventricle and caudate nucleus
B) Occipital horns of the lateral ventricles and the cerebellum
C) Frontal lobes and anterior cerebral artery
D) Germinal matrix and cavum septum pellucidum
Answer: B) Occipital horns of the lateral ventricles and the cerebellum
Rationale: While the anterior fontanelle is the primary window for neurosonography, the
posterior fontanelle is a valuable alternative window that provides superior visualization
of the occipital horns and the posterior fossa structures, including the cerebellum.
8. A 10-month-old infant presents with a history of intermittent, severe abdominal pain, a
palpable sausage-shaped abdominal mass, and "currant jelly" stools. Ultrasound
reveals an abdominal mass with a "pseudokidney" appearance in the longitudinal plane
and concentric rings of bowel within bowel in the transverse plane. What is this
pathology?
A) Hypertrophic Pyloric Stenosis
B) Midgut Volvulus
C) Duodenal Atresia
D) Intussusception
