Pass the ARDMS RDMS AB-Abdomen Questions and answers with ExamsMirror

Retroperitoneal fibrosis can encase and compress the ureters, leading to obstructive uropathy and hydronephrosis. It may also involve other retroperitoneal structures but hydronephrosis is the most common significant complication.

According to Rumack’s Diagnostic Ultrasound:

“Retroperitoneal fibrosis frequently results in ureteral obstruction, leading to hydronephrosis.”

In hepatic steatosis (fatty liver), increased echogenicity can obscure visualization of deeper structures like the common bile duct. Lowering the transducer frequency increases sound wave penetration, allowing better visualization of deep structures despite increased liver echogenicity. Decreasing gain or increasing dynamic range primarily adjusts image brightness and contrast but does not improve penetration.

According to Rumack’s Diagnostic Ultrasound:

“Lower frequency transducers are used to improve penetration and visualization of deeper structures in patients with fatty liver.”

The image provided is a right upper quadrant (RUQ) ultrasound—typically performed during a FAST (Focused Assessment with Sonography in Trauma) exam or for abdominal assessment. The arrow points to an anechoic (black) fluid collection seen above the diaphragm and posterior to the liver.

This fluid collection lies within the thoracic cavity, confirming the diagnosis of a pleural effusion. Pleural effusions are seen sonographically as an anechoic or hypoechoic area superior to the diaphragm in the thoracic cavity and often appear triangular or crescent-shaped. The diaphragm is visualized as a curvilinear echogenic structure separating the liver (or spleen) below from the lung space above.

Comparison of answer choices:

A. Retroperitoneal hemorrhage would be seen in the posterior abdomen, not above the diaphragm.

B. Pleural effusion is correct—anechoic fluid above the diaphragm is classic for this condition.

C. Mirror image artifact occurs when liver echoes are mirrored across the diaphragm and lung—this is not a mirror artifact.

D. Ascites collects inferior to the diaphragm and around the abdominal organs, not in the thoracic cavity.

The image shows a color Doppler ultrasound of the main portal vein (MPV), which appears irregular and replaced by multiple small, serpiginous vascular channels — a hallmark of cavernous transformation. Cavernous transformation of the portal vein is a late complication of chronic portal vein thrombosis, in which collateral vessels develop around the thrombosed portal vein to bypass the obstruction.

Key Doppler ultrasound features of cavernous transformation:

Absence of a normal portal vein

Multiple tortuous vessels in the porta hepatis

Color Doppler shows hepatopetal flow in these channels

Low velocity, continuous waveform flow in collateral vessels

Differentiation from other options:

B. Portal vein thrombosis: Would show an absence of color flow within the portal vein lumen and possibly echogenic material within the vessel. There would be no serpiginous collateral vessels yet if it's an acute process.

C. Portal hypertension: Often diagnosed with other sonographic findings (e.g., splenomegaly, reversed portal flow, varices) but not characterized by the replacement of the portal vein by collateral vessels.

D. Tumor extension: Typically appears as echogenic intraluminal material within the portal vein with arterial waveforms on Doppler due to neovascularity. Tumor thrombus can be seen in hepatocellular carcinoma or pancreatic cancer, not multiple small collateral vessels.

The ultrasound image shows the liver in a transverse view with the arrow pointing to the middle hepatic vein (MHV). The MHV is a key sonographic landmark that anatomically divides the right and left lobes of the liver.

According to Couinaud's segmental anatomy, which is the basis for surgical and radiological liver segmentation:

The middle hepatic vein runs within the main lobar fissure.

It separates the right lobe (segments V–VIII) from the left lobe (segments II–IV).

This division is crucial in liver surgery and interventional procedures.

Comparison of answer choices:

A. Right anterior and posterior segments are divided by the right hepatic vein, not the middle hepatic vein.

B. Right and left lobes — Correct. The middle hepatic vein, shown by the arrow, defines this boundary.

C. Left medial and lateral segments are divided by the left hepatic vein or falciform ligament.

D. Left superior and inferior is not a standard anatomic division in liver segmentation.

The tunica albuginea is the dense fibrous capsule that directly surrounds the testicular parenchyma. The tunica vaginalis is a serous covering surrounding the testis externally, and the dartos fascia and pampiniform plexus are part of the scrotal wall and spermatic cord, respectively.

According to Rumack’s Diagnostic Ultrasound:

“The tunica albuginea is the fibrous capsule surrounding the testis and forming septa within the gland.”

Courvoisier sign describes the clinical finding of painless jaundice combined with a palpable, distended gallbladder. This typically results from obstruction at the distal common bile duct, often due to pancreatic head carcinoma or cholangiocarcinoma, leading to bile accumulation and gallbladder distention. In contrast, Mirizzi syndrome involves compression of the common hepatic duct by an impacted stone in the cystic duct.

According to Rumack's Diagnostic Ultrasound and standard clinical references:

“Courvoisier sign refers to a palpable, enlarged gallbladder due to obstruction of the distal bile duct, often from malignancy.”

Graded compression technique is the gold standard for ultrasound evaluation of the appendix. It displaces gas and compresses overlying bowel loops to visualize the noncompressible, blind-ending tubular appendix directly at the point of maximal tenderness.

According to Rumack’s Diagnostic Ultrasound:

“Graded compression using steady, increasing pressure displaces gas and bowel to optimize visualization of the appendix.”

On ultrasound, tendons appear as cord-like hyperechoic structures with linear fibrillar echotexture when imaged in long axis. The fibrils are highly reflective, creating the typical hyperechoic appearance. Posterior shadowing is not typical unless there is calcification.

According to Rumack’s Diagnostic Ultrasound:

“Tendons have a highly organized hyperechoic linear fibrillar pattern when examined along their long axis.”