2026 ARDMS Abdomen Exam Prep: AB
Specialty Practice Questions, Answer
Rationales, Abdominal Ultrasound Anatomy,
Pathology, Imaging Techniques &
Sonography Study Guide
Domain 1: Anatomy, Perfusion, and Function (Questions 1–35)
Question 1. Which of the following best describes the normal sonographic
appearance of the liver parenchyma?
A) Homogeneous, hypoechoic compared to the kidney
B) Homogeneous, mid-level echogenicity, slightly hyperechoic to the renal
cortex
C) Heterogeneous with multiple echogenic foci
D) Anechoic with posterior acoustic enhancement
Rationale: Normal liver parenchyma is homogeneous with mid-level echogenicity.
It is typically slightly hyperechoic (brighter) compared to the normal renal cortex,
which serves as a useful internal reference. Marked heterogeneity or focal lesions
warrant further evaluation .
Question 2. Which vessel serves as the primary landmark for dividing the liver
into right and left lobes?
A) Right hepatic vein
B) Middle hepatic vein
C) Left portal vein
D) Main portal vein
Rationale: The middle hepatic vein is the primary landmark that divides the liver
into right and left lobes. 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.
,Question 3. Which of the following is NOT a branch of the portal vein?
A) Right portal vein
B) Left portal vein
C) Middle hepatic vein
D) Main portal vein
Rationale: The portal vein divides into the right and left portal veins. The middle
hepatic vein is a hepatic vein, not a portal vein branch. The portal venous system
delivers blood to the liver, while the hepatic veins drain blood from the liver into
the IVC.
Question 4. The normal diameter of the main portal vein in adults is
approximately:
A) 3–6 mm
B) 10–13 mm
C) 15–20 mm
D) 20–25 mm
Rationale: The normal main portal vein diameter is approximately 10–13 mm in
adults. Portal vein dilation (>13 mm) may suggest portal hypertension. The portal
vein should demonstrate hepatopetal (toward the liver) flow on Doppler.
Question 5. Which of the following is a normal variant of the gallbladder?
A) Phrygian cap
B) Gallstone
C) Adenomyomatosis
D) Porcelain gallbladder
Rationale: A Phrygian cap is a normal anatomic variant of the gallbladder in
which the fundus folds back on itself. It is a benign finding and should not be
confused with pathology. Gallstones, adenomyomatosis, and porcelain gallbladder
are pathologic conditions .
,Question 6. The normal thickness of the gallbladder wall is:
A) <3 mm
B) 3–5 mm
C) 5–7 mm
D) >7 mm
Rationale: The normal gallbladder wall thickness is less than 3 mm. Wall
thickening (>3 mm) may indicate acute cholecystitis, chronic cholecystitis, or other
pathology .
Question 7. Which of the following is the normal sonographic appearance of the
pancreas?
A) Mid-level echogenicity, similar to or slightly hyperechoic to the liver
B) Markedly hypoechoic compared to the liver
C) Anechoic
D) Markedly hyperechoic with posterior shadowing
Rationale: The normal pancreas is mid-level echogenicity, similar to or slightly
hyperechoic to the liver. The pancreas may be difficult to visualize in some
patients due to overlying bowel gas .
Question 8. Which portion of the pancreas is most commonly visualized on
ultrasound?
A) Tail
B) Body and head
C) Head, body, and tail (when visible)
D) Uncinate process only
Rationale: The head, body, and tail of the pancreas can be visualized on
ultrasound when bowel gas does not obscure the view. The head is anterior to the
IVC, the body crosses the midline over the splenic vein and SMA, and the tail
extends toward the splenic hilum.
Question 9. Which vessel serves as a landmark for identifying the pancreas?
, A) Splenic vein
B) Right renal artery
C) Left hepatic vein
D) Common bile duct
Rationale: The splenic vein serves as a key landmark for identifying the pancreas.
It runs along the posterior aspect of the pancreas and is often the most reliable
landmark for locating the pancreatic body and tail.
Question 10. The normal length of the adult kidney is approximately:
A) 5–7 cm
B) 9–12 cm
C) 13–15 cm
D) 15–18 cm
Rationale: The normal adult kidney length is approximately 9–12 cm. Renal
length is typically measured in the sagittal plane. Kidneys smaller than 9 cm may
suggest chronic renal disease, while kidneys larger than 12 cm may suggest acute
processes or compensatory hypertrophy.
Question 11. Which of the following is the normal sonographic appearance of the
renal cortex?
A) Hypoechoic relative to the liver and spleen
B) Hyperechoic relative to the liver and spleen
C) Anechoic
D) Isoechoic to the renal sinus
Rationale: The normal renal cortex is hypoechoic (darker) relative to the liver and
spleen. The renal medulla (pyramids) is even more hypoechoic than the cortex.
The renal sinus is hyperechoic due to fat and collecting system structures.
Question 12. Which of the following is a normal anatomic variant of the kidney?
A) Junctional parenchymal defect
B) Renal cell carcinoma
Specialty Practice Questions, Answer
Rationales, Abdominal Ultrasound Anatomy,
Pathology, Imaging Techniques &
Sonography Study Guide
Domain 1: Anatomy, Perfusion, and Function (Questions 1–35)
Question 1. Which of the following best describes the normal sonographic
appearance of the liver parenchyma?
A) Homogeneous, hypoechoic compared to the kidney
B) Homogeneous, mid-level echogenicity, slightly hyperechoic to the renal
cortex
C) Heterogeneous with multiple echogenic foci
D) Anechoic with posterior acoustic enhancement
Rationale: Normal liver parenchyma is homogeneous with mid-level echogenicity.
It is typically slightly hyperechoic (brighter) compared to the normal renal cortex,
which serves as a useful internal reference. Marked heterogeneity or focal lesions
warrant further evaluation .
Question 2. Which vessel serves as the primary landmark for dividing the liver
into right and left lobes?
A) Right hepatic vein
B) Middle hepatic vein
C) Left portal vein
D) Main portal vein
Rationale: The middle hepatic vein is the primary landmark that divides the liver
into right and left lobes. 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.
,Question 3. Which of the following is NOT a branch of the portal vein?
A) Right portal vein
B) Left portal vein
C) Middle hepatic vein
D) Main portal vein
Rationale: The portal vein divides into the right and left portal veins. The middle
hepatic vein is a hepatic vein, not a portal vein branch. The portal venous system
delivers blood to the liver, while the hepatic veins drain blood from the liver into
the IVC.
Question 4. The normal diameter of the main portal vein in adults is
approximately:
A) 3–6 mm
B) 10–13 mm
C) 15–20 mm
D) 20–25 mm
Rationale: The normal main portal vein diameter is approximately 10–13 mm in
adults. Portal vein dilation (>13 mm) may suggest portal hypertension. The portal
vein should demonstrate hepatopetal (toward the liver) flow on Doppler.
Question 5. Which of the following is a normal variant of the gallbladder?
A) Phrygian cap
B) Gallstone
C) Adenomyomatosis
D) Porcelain gallbladder
Rationale: A Phrygian cap is a normal anatomic variant of the gallbladder in
which the fundus folds back on itself. It is a benign finding and should not be
confused with pathology. Gallstones, adenomyomatosis, and porcelain gallbladder
are pathologic conditions .
,Question 6. The normal thickness of the gallbladder wall is:
A) <3 mm
B) 3–5 mm
C) 5–7 mm
D) >7 mm
Rationale: The normal gallbladder wall thickness is less than 3 mm. Wall
thickening (>3 mm) may indicate acute cholecystitis, chronic cholecystitis, or other
pathology .
Question 7. Which of the following is the normal sonographic appearance of the
pancreas?
A) Mid-level echogenicity, similar to or slightly hyperechoic to the liver
B) Markedly hypoechoic compared to the liver
C) Anechoic
D) Markedly hyperechoic with posterior shadowing
Rationale: The normal pancreas is mid-level echogenicity, similar to or slightly
hyperechoic to the liver. The pancreas may be difficult to visualize in some
patients due to overlying bowel gas .
Question 8. Which portion of the pancreas is most commonly visualized on
ultrasound?
A) Tail
B) Body and head
C) Head, body, and tail (when visible)
D) Uncinate process only
Rationale: The head, body, and tail of the pancreas can be visualized on
ultrasound when bowel gas does not obscure the view. The head is anterior to the
IVC, the body crosses the midline over the splenic vein and SMA, and the tail
extends toward the splenic hilum.
Question 9. Which vessel serves as a landmark for identifying the pancreas?
, A) Splenic vein
B) Right renal artery
C) Left hepatic vein
D) Common bile duct
Rationale: The splenic vein serves as a key landmark for identifying the pancreas.
It runs along the posterior aspect of the pancreas and is often the most reliable
landmark for locating the pancreatic body and tail.
Question 10. The normal length of the adult kidney is approximately:
A) 5–7 cm
B) 9–12 cm
C) 13–15 cm
D) 15–18 cm
Rationale: The normal adult kidney length is approximately 9–12 cm. Renal
length is typically measured in the sagittal plane. Kidneys smaller than 9 cm may
suggest chronic renal disease, while kidneys larger than 12 cm may suggest acute
processes or compensatory hypertrophy.
Question 11. Which of the following is the normal sonographic appearance of the
renal cortex?
A) Hypoechoic relative to the liver and spleen
B) Hyperechoic relative to the liver and spleen
C) Anechoic
D) Isoechoic to the renal sinus
Rationale: The normal renal cortex is hypoechoic (darker) relative to the liver and
spleen. The renal medulla (pyramids) is even more hypoechoic than the cortex.
The renal sinus is hyperechoic due to fat and collecting system structures.
Question 12. Which of the following is a normal anatomic variant of the kidney?
A) Junctional parenchymal defect
B) Renal cell carcinoma
