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ARDMS Abdomen Sonography Examination Sample Questions (Q90-Q95):

NEW QUESTION # 90
A lactating female presents with a tender, swollen breast, erythema, and fever. Which condition is most likely present in this image?

A. Mastitis
B. Ductal carcinoma
C. Abscess
D. Galactocele

Answer: A

Explanation:
The clinical presentation-tender, swollen breast with erythema and fever-in a lactating female strongly suggests acute mastitis. The sonographic findings support this diagnosis. In the image, the breast parenchyma shows diffuse, hypoechoic, and heterogeneous echotexture with increased vascularity, which is consistent with inflammatory changes typical of mastitis.
Mastitis is a common complication during lactation, particularly in the first few weeks postpartum. It results from milk stasis and subsequent bacterial infection, commonly due to Staphylococcus aureus. Ultrasound features of mastitis include:
* Ill-defined, hypoechoic, edematous areas in the breast parenchyma
* Increased Doppler flow due to hyperemia
* Skin thickening
* Ductal dilatation may also be present
If left untreated, mastitis may progress to abscess formation, which would appear as a localized, complex fluid collection with peripheral hyperemia and internal debris. However, the image does not show a well- formed fluid collection consistent with abscess.
Option B (Ductal carcinoma): Inappropriate here due to the acute clinical scenario and patient age. Ductal carcinoma typically presents as a hypoechoic mass with irregular margins and posterior shadowing, not diffuse edema or inflammatory changes.
Option D (Galactocele): This benign milk-filled retention cyst typically appears anechoic or with fluid-fluid levels but lacks signs of inflammation and systemic symptoms such as fever.
Option A (Abscess): This could be a differential, but abscesses usually present with a well-defined anechoic or complex mass. The absence of a discrete collection and the diffuse appearance makes mastitis more likely.
References:
Mendelson EB. Practical Ultrasound: An Illustrated Guide. Springer, 2004. Chapter: Breast Ultrasound.
American College of Radiology (ACR). ACR Practice Parameter for the Performance of a Breast Ultrasound Examination, 2022.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Breast, pp. 1169-1175.

NEW QUESTION # 91
Which condition is most consistent with thinning of the renal cortex, reduction in renal length, and prominence of the renal sinus fat in a patient presenting four months after renal transplant with slightly reduced renal function?

A. Acute rejection
B. Normal findings
C. Chronic rejection
D. Arterial stricture

Answer: C

Explanation:
Chronic rejection presents sonographically as cortical thinning, decreased renal size, and increased echogenicity of the renal sinus fat. Acute rejection typically causes an enlarged, edematous kidney with increased parenchymal echogenicity but preserved size early on.
According to Zwiebel's Introduction to Vascular Ultrasound:
"In chronic rejection, the allograft becomes smaller with cortical thinning, increased echogenicity, and prominence of the central sinus fat." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Transplant Ultrasound, 2020.
-

NEW QUESTION # 92
Which retroperitoneal finding is most likely associated with trauma?

A. Fibrosis
B. Neuroblastoma
C. Urinoma
D. Adenoma

Answer: C

Explanation:
Urinomas are collections of urine in the retroperitoneum that result from trauma, surgery, or obstruction causing urine leakage. Trauma is a frequent cause of urinoma formation due to disruption of the urinary tract.
According to Rumack's Diagnostic Ultrasound:
"Urinomas may develop as a complication of trauma, surgery, or obstructive uropathy with urinary extravasation into the retroperitoneum." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Renal Ultrasound, 2020.
-

NEW QUESTION # 93
What is the most common ultrasound appearance of the pancreas in mild acute pancreatitis?

A. Hypoechoic
B. Normal
C. Enlarged
D. Heterogeneous

Answer: C

Explanation:
In mild acute pancreatitis, the pancreas often appears diffusely enlarged and slightly hypoechoic due to edema and inflammation. However, in very early or mild cases, the pancreas may still appear normal. Heterogeneous echotexture may develop in more severe or necrotizing pancreatitis.
According to Rumack's Diagnostic Ultrasound:
"In mild pancreatitis, the pancreas is commonly enlarged and hypoechoic due to inflammatory edema." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen, 2020.
-

NEW QUESTION # 94
Which condition is most consistent with the findings in this image?

A. Acute pyelonephritis
B. Renal cell carcinoma
C. Medullary sponge kidney
D. Fungal balls

Answer: C

Explanation:
The ultrasound image demonstrates a longitudinal view of the right kidney. Within the renal pyramids, there are multiple echogenic foci, some showing posterior acoustic shadowing-findings characteristic of medullary nephrocalcinosis. This sonographic appearance is strongly associated with medullary sponge kidney (MSK).
Medullary sponge kidney is a congenital disorder of the renal tubules that results in ectatic (dilated) collecting ducts in the renal medulla. The dilated ducts frequently become calcified, leading to the "paintbrush" or
"bouquet of flowers" appearance seen in the renal pyramids on ultrasound. These calcifications are most often bilateral and symmetrical, further aiding the diagnosis.
Comparison of answer choices:
* A. Fungal balls (mycetomas) typically appear as mobile, non-shadowing echogenic masses within the collecting system, often in immunocompromised patients.
* B. Renal cell carcinoma usually presents as a solid mass with irregular borders and variable echogenicity-this image does not show a mass.
* C. Acute pyelonephritis may show renal enlargement, decreased echogenicity, or loss of corticomedullary differentiation-but not calcification of the pyramids.
* D. Medullary sponge kidney is correct due to the punctate echogenic foci within the medullary pyramids, consistent with nephrocalcinosis.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
Babcock DS. Sonographic findings in medullary sponge kidney. AJR Am J Roentgenol. 1981;137(6):1239-
1243.

NEW QUESTION # 95
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