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ARDMS Abdomen Sonography Examination Sample Questions (Q34-Q39):

NEW QUESTION # 34
Where in the neck are most thyroid cancer recurrences found?

A. Subauricular
B. Bilateral
C. Contralateral
D. Ipsilateral

Answer: D

Explanation:
Most thyroid cancer recurrences are found in the ipsilateral neck-particularly in the central (level VI) or lateral (levels II-V) compartments on the same side as the original malignancy.
According to AIUM Practice Parameters:
"Post-thyroidectomy recurrence most frequently occurs ipsilateral to the original tumor, commonly involving regional lymph nodes." Reference:
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
American Thyroid Association (ATA) Guidelines for Thyroid Cancer Management, 2015.

NEW QUESTION # 35
Which area of the spleen is not covered by visceral peritoneum?

A. Gastric surface
B. Capsule
C. Hilum
D. Inferior border

Answer: C

Explanation:
The spleen is almost entirely covered by visceral peritoneum, except at the hilum where vessels, nerves, and lymphatics enter and exit. This area lacks peritoneal covering to allow vascular connection to the splenic artery and vein.
According to Moore's Clinically Oriented Anatomy:
"The spleen is entirely covered by visceral peritoneum except at its hilum where the vascular structures enter." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 36
Which of the following would optimize visualization of a bladder mass?

A. Have patient empty bladder
B. Have patient fill bladder
C. Utilize a high-frequency linear transducer
D. Compression technique to move bowel gas

Answer: B

Explanation:
A full bladder provides an acoustic window that displaces bowel gas and distends the bladder walls, allowing optimal visualization of any bladder masses or lesions. An empty bladder may collapse, obscuring masses.
According to Rumack's Diagnostic Ultrasound:
"Bladder evaluation should be performed with the bladder optimally distended to visualize its walls and any intraluminal masses." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
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NEW QUESTION # 37
Based on this image, which congenital anomaly should be suspected?

A. Annular pancreas
B. Supernumerary kidney
C. Pancreas divisum
D. Horseshoe kidney

Answer: A

Explanation:
The ultrasound image demonstrates a dilated duodenum with a hypoechoic soft tissue structure encircling it.
This is a classic sonographic appearance suggestive of an annular pancreas. In annular pancreas, pancreatic tissue completely or partially encircles the second portion of the duodenum, which can lead to duodenal narrowing or obstruction.
Annular pancreas is a congenital anomaly that results from failure of the ventral pancreatic bud to rotate properly during embryologic development. As a result, pancreatic tissue encircles the duodenum. It may present in neonates with symptoms of duodenal obstruction or in adults with abdominal pain, pancreatitis, or vomiting.
Ultrasound Findings:
* Hypoechoic pancreatic tissue encircling the duodenum
* Evidence of duodenal dilatation proximal to the obstruction
* "Double bubble" sign may be seen in neonates
Differentiation from other options:
* A. Supernumerary kidney: Refers to an accessory kidney. It would be seen in the retroperitoneum and is unrelated to the duodenum or pancreas.
* B. Pancreas divisum: A ductal anomaly best diagnosed on MRCP or ERCP. It is not typically visible on conventional ultrasound.
* D. Horseshoe kidney: A renal fusion anomaly where the lower poles of the kidneys are fused. It is seen in the pelvis or lower abdomen and does not involve the duodenum or pancreas.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Pancreas, pp. 269-272.
Radiopaedia.org. Annular pancreas: https://radiopaedia.org/articles/annular-pancreas AIUM Practice Parameter for the Performance of Abdominal and Retroperitoneal Ultrasound Examinations,
2020.

NEW QUESTION # 38
Which normal anatomical structure is also known as the accessory pancreatic duct?

A. Duct of Santorini
B. Duct of Wirsung
C. Common pancreatic duct
D. Duct of Vater

Answer: A

Explanation:
The Duct of Santorini is the accessory pancreatic duct that drains the superior portion of the pancreatic head into the minor duodenal papilla. The main pancreatic duct (Duct of Wirsung) drains into the major papilla, often joining the common bile duct at the Ampulla of Vater.
According to Moore's Clinically Oriented Anatomy:
"The accessory pancreatic duct (Duct of Santorini) may be present and drains into the minor duodenal papilla." Reference:
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
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NEW QUESTION # 39
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