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ARDMS Abdomen Sonography Examination Sample Questions (Q103-Q108):
NEW QUESTION # 103
Which condition is demonstrated in this image of a febrile patient with breast redness and tenderness?
Answer: A
Explanation:
The ultrasound image demonstrates an irregular, complex fluid collection in the subareolar region of the breast with internal echoes, septations, and poorly defined margins. These sonographic findings are classic for a breast abscess, particularly in a patient presenting with clinical signs of infection-fever, redness, and localized tenderness.
A breast abscess is typically seen as:
* A hypoechoic or anechoic area with thick walls
* Presence of internal debris, septations, or floating echoes
* Posterior acoustic enhancement
* Increased peripheral vascularity on Doppler (surrounding inflammation)
* Surrounding hyperechoic fat due to cellulitis
This clinical and imaging profile strongly supports the diagnosis of a breast abscess, most commonly seen in lactating women (puerperal mastitis) or in non-lactating women with chronic infection.
Comparison of answer choices:
* A. Ductal ectasia usually presents with dilated ducts and minimal inflammatory changes, often asymptomatic or causing nipple discharge.
* B. Abscess - Correct. The irregular fluid collection with complex echoes and clinical signs of infection supports this.
* C. Sebaceous cysts are typically superficial, round, and well-defined with a punctum.
* D. Galactocele appears as a well-circumscribed, fat-fluid level-containing lesion in lactating women but lacks surrounding inflammation.
References:
Mendelson EB, Bohm-Velez M, Berg WA.ACR BI-RADS Atlas: Ultrasound. American College of Radiology; 2013.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Diagnostic and Screening Ultrasound of the Breast (2021).
NEW QUESTION # 104
Which arterial branches lie at the base of the renal pyramids?
Answer: D
Explanation:
The arcuate arteries are located at the corticomedullary junction, arching over the base of the renal pyramids.
They form as the interlobar arteries reach the boundary between the cortex and medulla. The arcuate arteries give rise to the interlobular arteries, which supply the renal cortex.
* Segmental arteries (A) branch directly from the renal artery.
* Interlobar arteries (B) course between the renal pyramids.
* Interlobular arteries (D) extend into the cortex from the arcuate arteries.
Reference Extracts:
* Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. 7th ed. Lippincott Williams & Wilkins, 2013.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 105
Which renal condition is commonly associated with pyuria and leukocytosis?
Answer: B
Explanation:
Acute pyelonephritis is a bacterial infection of the renal parenchyma and collecting system. Classic clinical findings include fever, flank pain, leukocytosis (elevated white blood cells), and pyuria (white blood cells in urine). Ultrasound may demonstrate renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation.
* Nephrocalcinosis (A) involves calcium deposition without infection.
* Staghorn calculus (B) may lead to infection but is primarily characterized by obstructive uropathy.
* Renal cell carcinoma (C) presents with hematuria and mass formation rather than infection symptoms.
Reference Extracts:
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Chapter: Kidneys.
* Middleton WD, Kurtz AB, Hertzberg BS.Ultrasound: The Requisites. 3rd ed. Elsevier, 2015.
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NEW QUESTION # 106
Which clinical finding is most likely associated with the pathology in this image?
Answer: D
Explanation:
The ultrasound image shows a classic longitudinal view of a markedly thickened pyloric muscle with an elongated pyloric channel. This finding is consistent with hypertrophic pyloric stenosis (HPS), a condition most commonly seen in male infants between 2 and 8 weeks of age.
The most characteristic clinical finding associated with HPS is an "olive-shaped" palpable mass in the right upper quadrant or epigastric region, which represents the hypertrophied pylorus.
Clinical presentation of HPS includes:
* Non-bilious projectile vomiting (due to gastric outlet obstruction)
* Dehydration and weight loss
* A palpable "olive" mass on physical exam
* Visible peristalsis may be noted on the abdominal wall
Sonographic diagnostic criteria for HPS:
* Pyloric muscle thickness # 3 mm
* Pyloric channel length # 15-17 mm
* "Cervix sign" or "target sign" (transverse view)
* Failure of gastric contents to pass through the pylorus on real-time imaging Differentiation from other options:
* B. Fever of unknown origin: Not characteristic of HPS.
* C. Red currant jelly stools: Classic for intussusception.
* D. Bilious vomiting: Seen in distal duodenal or jejunal obstruction, not in pyloric stenosis (vomiting is non-bilious in HPS).
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Gastrointestinal Tract, pp. 474-479.
American College of Radiology (ACR). Appropriateness Criteria - Vomiting in Infants Up to 3 Months of Age.
Radiopaedia.org. Hypertrophic pyloric stenosis:https://radiopaedia.org/articles/hypertrophic-pyloric-stenosis
NEW QUESTION # 107
Which condition results in the vascular abnormality shown in this image of a renal transplant?
Answer: A
Explanation:
The Doppler ultrasound image shows an elevated peak systolic velocity (PSV) of 637 cm/s, an elevated end- diastolic velocity (EDV) of 312 cm/s, and a low resistive index (RI) of 0.51 at the arterial anastomosis of a renal transplant. These findings are characteristic of significant renal artery stenosis (RAS) at the transplant vascular anastomosis.
Key sonographic features of renal artery stenosis:
* Peak systolic velocity (PSV) > 250-300 cm/s at the stenotic segment (this case: 637 cm/s)
* Post-stenotic turbulence with spectral broadening
* Low resistive index (RI < 0.56 suggests downstream vasodilation)
* Elevated acceleration time (AT > 0.07 sec), and reduced acceleration slope
* Aliasing on color Doppler due to high velocity
In this image, the marked increase in velocity with spectral aliasing and low RI is diagnostic of transplant renal artery stenosis - the most common vascular complication post-transplant, typically occurring at the site of surgical anastomosis.
Differentiation from other options:
* A. Iliac arteritis: A rare condition, not typically presenting with these Doppler changes.
* C. Renal vein thrombosis: Would show reversed or absent diastolic flow, not elevated systolic velocities.
* D. Arteriovenous malformation (AVM): Produces a high-velocity, low-resistance waveform but is associated with color bruit, aliasing, and pulsatile venous waveforms - not evident here.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Transplant Imaging, pp. 1035-1045.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Renal Artery Duplex Sonographic Examination, 2020.
Radiopaedia.org. Renal artery stenosis (transplant): https://radiopaedia.org/articles/renal-artery-stenosis- transplant
NEW QUESTION # 108
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