ARDMS Abdomen Exam Prep: Free Study Guide, Plan & Practice Questions
Start your ARDMS abdomen exam prep with 20 original, unofficial practice questions. Your score is feedback on these 20 items only, not a prediction of your exam score.
20 practice questions with explanations
AB-01 · Domain 2 — Pathology, vascular, trauma & postoperative · Gallbladder: polyp vs stone vs sludge (outline 2.A.3; related anatomy 1.A.1)
A 4 mm echogenic focus sits on the nondependent wall of the gallbladder. It casts no acoustic shadow. When the patient rolls from supine to left lateral decubitus, it stays in exactly the same spot. What is it most likely to be?
Answer: C. Two useful observations are shadowing and mobility. A focus that stays fixed to the wall and doesn't shadow behaves like a polyp. Changing the patient's position helps separate it from a typical mobile stone.
Why not the others:
- A — Stones typically shadow and roll to the dependent wall when the patient moves.
- B — Typical sludge is nonshadowing, layers dependently and shifts with position. Adherent or tumefactive sludge can mimic a polyp, so mobility alone is not definitive.
- D — Adenomyomatosis is suggested by wall thickening with intramural cystic spaces and echogenic foci, often with comet-tail artifacts. Those features are not described here.
Takeaway: Name what you see (does it shadow? does it move?) before you name what it is. One caution: a stone impacted in the gallbladder neck may not move, so "doesn't move" alone isn't proof of a polyp.
Source: ESGAR/EAES/EFISDS/ESGE gallbladder-polyp guideline, 2022, definition of a polyp; SRU gallbladder-polyp consensus, 2022, Figure 9 and alternative imaging; ACEP Sonoguide: Gallbladder
How to work each one: name what you actually see, list what else could explain it, then find the detail in the stem that separates them. AB-01 walks through that process. The set leans toward pathology, as the exam does, but it's a teaching sample, not a proportional mini-exam. The real exam also includes hotspot items (see Hotspot questions).
Jump to: Study priorities · 6-week plan · Correction log · High-yield criteria · Exam facts
AB-02 · Domain 2 — Pathology, vascular, trauma & postoperative · Acute calculous cholecystitis (outline 2.A.3)
A 46-year-old has right upper quadrant pain. Ultrasound shows several mobile, shadowing gallstones, an anterior gallbladder wall of 5 mm, a small amount of pericholecystic fluid, and maximal tenderness when the transducer presses directly over the gallbladder. Which diagnosis do these findings best support?
Answer: A. Gallstones plus a positive sonographic Murphy sign is the core combination for acute cholecystitis. A wall thicker than 3 mm and pericholecystic fluid support it.
Why not the others:
- B — The stem does not describe the characteristic intramural cysts or echogenic foci with comet-tail artifacts of adenomyomatosis. The combined inflammatory findings better support acute calculous cholecystitis.
- C — A polyp is a nonshadowing, fixed wall lesion; these are mobile, shadowing stones.
- D — A recently fed gallbladder is contracted and can look thick-walled, but that doesn't explain stones, focal tenderness and pericholecystic fluid.
Takeaway: Wall thickening alone is nonspecific (a recent meal, hepatitis, heart failure, ascites). Look for the combination, and measure the anterior wall.
Source: ACEP Sonoguide: Gallbladder; KSAR gallbladder recommendations, 2025, KQ23
AB-03 · Domain 2 — Pathology, vascular, trauma & postoperative · Adenomyomatosis and comet-tail artifact (outline 2.A.3, 3.B.1)
The gallbladder fundus shows focal wall thickening with tiny intramural cystic spaces and echogenic foci. V-shaped comet-tail artifacts extend from the foci into the lumen. There is no focal tenderness. What is the most likely diagnosis?
Answer: C. Intramural cystic spaces with echogenic foci and comet-tail artifacts strongly favor adenomyomatosis. In adenomyomatosis, cholesterol crystals within Rokitansky-Aschoff sinuses can produce these artifacts. Comet-tail artifact alone is not unique to this diagnosis.
Why not the others:
- A — The characteristic finding here is the intramural cystic pattern with echogenic foci and comet tails. The absence of focal tenderness alone would not exclude acute cholecystitis.
- B — Typical sludge lies within the gallbladder lumen rather than within intramural cystic spaces.
- D — Typical freely mobile gallstones lie in the lumen and produce acoustic shadows; they do not explain this intramural cystic pattern.
Takeaway: Some artifacts are diagnostic clues, not noise. Comet tails arising within a thickened wall containing small intramural cystic spaces strongly favor adenomyomatosis.
Source: KSAR gallbladder recommendations, 2025, KQ23; Oh et al.: Comet-tail artifact in thickened gallbladder walls, 2019
AB-04 · Domain 4 — Clinical care, practice & QA · Patient preparation for biliary imaging (outline 4.B.2, 4.B.4, 1.A.1)
An outpatient sent for a routine gallbladder ultrasound ate a full breakfast one hour ago. The gallbladder is small and contracted, the wall appears thick, no stones are clearly seen, and there's no focal tenderness. What is the best approach?
Answer: D. A recent meal contracts the gallbladder and can make the wall look thick, which limits the study. For an elective examination, AIUM's 2026 parameter states that fasting for at least 4 hours will generally allow adequate distension of a normally functioning gallbladder. Follow the department's preparation and rescheduling protocol.
Why not the others:
- A — Wall thickening alone does not establish acute cholecystitis; postprandial contraction provides another explanation in this case.
- B — Measure the anterior wall using an appropriate perpendicular view. Switching to the posterior wall does not resolve the limitation caused by contraction.
- C — In this nonfasting examination, contraction limits assessment and should be documented.
Takeaway: A limitation you record is information. A limitation you ignore becomes a wrong conclusion.
Source: AIUM abdomen and retroperitoneum practice parameter, 2026, Gallbladder and Biliary Tract; ACEP Sonoguide: Gallbladder
AB-05 · Domain 2 — Pathology, vascular, trauma & postoperative · Liver vascular abnormality: Budd-Chiari (outline 2.B.1)
A patient has new ascites and hepatomegaly. The hepatic veins are identified, contain thrombus and show no flow despite optimized color and spectral Doppler settings; intrahepatic collateral vessels are present, and the caudate lobe is enlarged. The main portal vein is patent. Which condition best fits?
Answer: B. Budd-Chiari syndrome is obstruction of hepatic venous outflow. Demonstrated hepatic-vein thrombosis with absent flow, intrahepatic collaterals and caudate hypertrophy supports that diagnosis. The caudate lobe enlarges because it drains through its own veins straight into the IVC, so it keeps draining when the main hepatic veins are blocked.
Why not the others:
- A — The portal vein is patent here; the demonstrated obstruction is in the hepatic veins.
- C — No shunt is described.
- D — A splenic infarct doesn't explain absent hepatic venous flow.
Takeaway: Know which way each vessel drains. Budd-Chiari is an outflow problem; portal vein thrombosis is an inflow problem.
Source: Date et al.: Budd-Chiari syndrome, 2023, case and Doppler findings; EFSUMB Course Book: Ultrasound of the liver, caudate anatomy and hepatic venous outflow
AB-06 · Domain 2 — Pathology, vascular, trauma & postoperative · TIPS surveillance (outline 2.D.7)
A patient with a TIPS has recurrent ascites. Peak velocities throughout the shunt now measure about 60 cm/s; the baseline study after placement measured about 130 cm/s. Which statement is most accurate?
Answer: D. Recurrent ascites and a substantial fall in shunt velocity from baseline raise concern for possible dysfunction. Exact criteria vary between institutions. Interpret Doppler findings with the clinical course and prior studies; Doppler alone does not establish shunt failure.
Why not the others:
- A — Patency alone doesn't mean adequate function.
- B — With a working TIPS, the intrahepatic portal branches commonly flow toward the shunt, so that reversal is expected. A change from the established post-TIPS pattern needs clinical and Doppler correlation.
- C — Spectral Doppler can measure velocities within the shunt and is used in its assessment.
Takeaway: Compare with the baseline study. A trend often tells you more than a single number.
Source: Duong et al.: Doppler ultrasound and TIPS revision, 2022; SVM/SVU Doppler waveform consensus, 2020
AB-07 · Domain 1 — Anatomy, perfusion & function · Pancreatic anatomy: uncinate process (outline 1.A.6)
On a transverse image through the pancreatic head, which part of the pancreas lies posterior to the superior mesenteric vein (SMV)?
Answer: D. The uncinate process is the hook-shaped extension of the head that curls behind the SMV. Complete pancreatic coverage includes it.
Why not the others:
- A — The neck lies anterior to the SMV and portal confluence, which is why the SMV is the landmark for the neck.
- B — The body runs to the left, anterior to the splenic vein.
- C — The tail extends toward the splenic hilum, far from the SMV.
Takeaway: Learn each organ by its vascular landmarks. They're how you prove you saw the whole thing.
Source: EFSUMB Course Book, Ch. 9: Ultrasound of the pancreas (anatomy section)
AB-08 · Domain 2 — Pathology, vascular, trauma & postoperative · Abdominal aortic aneurysm definition (outline 2.B.2)
The maximum anteroposterior diameter of the infrarenal abdominal aorta, measured outer wall to outer wall in an appropriate longitudinal plane, is 3.4 cm. There is no intimal flap. Which statement is correct?
Answer: A. An AAA is commonly defined as an infrarenal aortic diameter of 3.0 cm or more. A 3.4 cm aorta meets that definition.
Why not the others:
- B — 3.4 cm exceeds the 3.0 cm threshold.
- C — Aneurysm is defined by diameter, measured on gray-scale.
- D — Diameter alone does not establish dissection. An intimal flap and separate lumens are relevant imaging findings, but their absence on ultrasound does not reliably exclude dissection.
Takeaway: Apply the correct diameter measurement to classify an aneurysm. Diameter alone does not diagnose dissection.
Source: AIUM abdominal aorta practice parameter, 2025 revision, published 2026
AB-09 · Domain 1 — Anatomy, perfusion & function · Superior mesenteric artery: fasting vs fed (outline 1.B.8, 4.C.2)
In a fasting patient, the superior mesenteric artery (SMA) shows a normal high-resistance waveform with low diastolic flow. What is the expected normal change after a meal?
Answer: A. Digestion dilates the mesenteric vessels. The SMA waveform shifts toward a low-resistance pattern, with higher velocities, especially in diastole. That's why mesenteric studies are usually done fasting.
Why not the others:
- B — That's the opposite of the normal response to a meal.
- C — Diastolic flow increases after a meal; it doesn't reverse throughout diastole.
- D — The normal SMA waveform changes after a meal; the celiac artery normally has a low-resistance pattern in either state.
Takeaway: Before calling a waveform abnormal, ask whether physiology explains it. A meal, or a replaced right hepatic artery arising from the SMA, can make the proximal SMA look low-resistance.
Source: SVM/SVU Doppler waveform consensus, 2020; Kupinski: Mesenteric and renal arterial duplex ultrasound, 2023, Anatomic pitfalls
AB-10 · Domain 2 — Pathology, vascular, trauma & postoperative · Renal artery stenosis: direct criteria (outline 2.B.5, 4.C.2)
In a hypertensive patient, the proximal right renal artery peak systolic velocity (PSV) is 240 cm/s with post-stenotic turbulence. The aortic PSV at the level of the renal arteries is 60 cm/s. For this question, use PSV >180 cm/s and a renal-aortic ratio (RAR) >3.5 as the laboratory's direct criteria for ≥60% stenosis, and assume technically valid measurements without an aortic-flow abnormality. How should this be interpreted?
Answer: C. Renal-aortic ratio = 240 ÷ 60 = 4.0. The supplied criteria for significant stenosis are a PSV above 180 cm/s and a ratio above 3.5; both are met. Labs validate their own cutoffs, and published optimized values differ.
Why not the others:
- A — 240 cm/s with turbulence is not a normal finding.
- B — The resistive index adds information but isn't required for these direct criteria.
- D — The ratio threshold is exceeded, not undershot.
Takeaway: Know how to calculate the ratio and which way the threshold points.
Source: Direct duplex criteria for renal artery stenosis, Arq Bras Cardiol, 2006; SVM/SVU Doppler waveform consensus, 2020
AB-11 · Domain 3 — Abdominal physics · Twinkling artifact (outline 3.B.2, 2.A.19)
A small echogenic focus in the renal sinus shows a rapidly changing mix of red and blue directly behind it on color Doppler. Spectral Doppler at that spot shows noise-like vertical bands rather than an arterial or venous waveform. What does this most likely represent?
Answer: D. Twinkling artifact appears behind strongly reflecting, rough surfaces such as stones. It isn't real flow, which is why the spectral trace looks like noise. It helps find small stones, but it depends heavily on machine settings and can produce false positives.
Why not the others:
- A — An aneurysm produces a real vascular signal with a recognizable waveform.
- B — An AV fistula produces real, typically turbulent flow with a recognizable waveform.
- C — Tumor vascularity is real flow within tissue, not color confined behind an echogenic focus.
Takeaway: Use spectral Doppler and gray-scale together. A color mosaic alone does not prove blood flow or a calculus.
Source: ESR EPOS C-0588: Doppler artifacts and how to avoid them; Kamaya et al.: Twinkling artifact dependence on machine parameters, AJR, 2003
AB-12 · Domain 2 — Pathology, vascular, trauma & postoperative · Hypertrophic pyloric stenosis (outline 2.A.6)
A 5-week-old infant has repeated, forceful, nonbilious vomiting. The pylorus stays closed throughout a long observation period, the single-wall pyloric muscle measures 4.5 mm, and the pyloric channel length is 19 mm. Which diagnosis do these findings support?
Answer: A. Commonly used criteria are a muscle thickness greater than 3 mm and a channel length greater than 15 mm. Both are exceeded here. Interpret the measurements with the dynamic examination and clinical findings; standard size criteria may not be met in premature infants.
Why not the others:
- B — Pylorospasm is transient. Its measurements can overlap those of pyloric stenosis, but the appearance and measurements vary during observation and the channel may open.
- C — Intussusception is telescoped bowel, not a thickened pyloric muscle.
- D — Both measurements are abnormal.
Takeaway: Measure single-wall thickness on a transverse image, and watch long enough to see whether the canal opens.
Source: CAHS Pyloric Stenosis guideline, February 2026, pages 2–3; Cohen et al.: Pylorospasm may simulate hypertrophic pyloric stenosis, 1998
AB-13 · Domain 2 — Pathology, vascular, trauma & postoperative · Appendicitis on graded compression (outline 2.A.6)
Which finding most strongly supports acute appendicitis on graded-compression ultrasound?
Answer: B. A blind-ending, noncompressible appendix arising from the cecum, with an outer diameter over about 6 mm, supports appendicitis. Evaluate the entire appendix and look for secondary inflammatory findings.
Why not the others:
- A — A compressible appendix under 6 mm describes a normal appendix.
- C — Peristalsis in a bowel loop does not identify an inflamed appendix.
- D — Not seeing the appendix does not exclude appendicitis. A retrocecal appendix is easy to miss.
Takeaway: Know what a negative or nondiagnostic study can and can't rule out.
Source: ACEP Sonoguide: Appendicitis
AB-14 · Domain 2 — Pathology, vascular, trauma & postoperative · Thyroid nodule scoring with ACR TI-RADS (outline 2.A.9)
An adult has a previously unbiopsied thyroid nodule measuring 1.2 cm. It is solid, hypoechoic and taller-than-wide, with smooth margins and no echogenic foci. Using the ACR TI-RADS point chart, what category is it, and what does the chart recommend?
Answer: C. Points: solid 2 + hypoechoic 2 + taller-than-wide 3 + smooth margin 0 + no echogenic foci 0 = 7 points, which is TR5. ACR TI-RADS recommends FNA for TR5 nodules 1.0 cm or larger, so a 1.2 cm nodule meets the threshold.
Why not the others:
- A — The total is 7, not 3.
- B — The total is 7, not 4 to 6.
- D — Follow-up alone applies to TR5 nodules from 0.5 cm up to (not including) 1.0 cm.
Takeaway: Score every feature category, add them up, and only then apply the size threshold.
Source: ACR TI-RADS assessment categories and thresholds; ACR TI-RADS FAQ, questions 115–116
AB-15 · Domain 2 — Pathology, vascular, trauma & postoperative · Testicular torsion and urgent communication (outline 2.B.3, 4.B.1)
A 15-year-old has sudden, severe left scrotal pain. Gray-scale imaging shows a spiral twist of the spermatic cord. Color Doppler optimized for slow flow shows no intratesticular flow on the left and normal flow on the right. What should the sonographer do next?
Answer: A. A twisted cord (the whirlpool sign) with absent intratesticular flow is consistent with testicular torsion, a time-critical finding. Communicate it immediately through the department's urgent-findings pathway. Preserved arterial flow does not exclude early, partial, or intermittent torsion.
Why not the others:
- B — Delaying an urgent finding wastes time the testis may not have.
- C — The immediate task is to alert the responsible clinician through the urgent-findings pathway, not independently tell the patient that surgery is required.
- D — Waiting 24 hours could cost the testis.
Takeaway: When a finding is time-critical, communication is part of the exam, not an afterthought.
Source: EAU Paediatric Urology guideline, 2026, Acute Scrotum §§8.2–8.3; Joint Commission 2026 hospital requirements, critical results and preprocedure time-out
AB-16 · Domain 2 — Pathology, vascular, trauma & postoperative · FAST: right upper quadrant technique (outline 2.C.7)
During a FAST exam on a supine trauma patient, how should the right upper quadrant be evaluated to avoid missing a small amount of free fluid?
Answer: D. Morison's pouch is the classic RUQ window, but fluid is often seen around the caudal edge of the liver and the superior paracolic gutter. Fanning through these spaces reduces the chance of missing fluid confined to one recess.
Why not the others:
- A — A single static image can miss fluid at the liver tip.
- B — The gallbladder fossa isn't the dependent space you're looking for.
- C — The right upper quadrant is one of the highest-yield views.
Takeaway: The abdominal FAST views screen for free fluid. A negative scan does not exclude traumatic abdominal injury.
Source: Caudal edge of the liver in the RUQ FAST view, West J Emerg Med, 2017
AB-17 · Domain 3 — Abdominal physics · Doppler aliasing (outline 3.A.3)
Pulsed-wave spectral Doppler of a renal artery shows the peaks of the waveform wrapping around and displaying below the baseline. Which adjustment directly addresses this?
Answer: B. This is aliasing: the Doppler shift exceeds the Nyquist limit, which equals PRF ÷ 2. Raising the scale raises the Nyquist limit. Lowering the Doppler transmit frequency reduces the frequency shift. Shifting the spectral baseline may display more flow in one direction, but it does not increase PRF or the Nyquist limit.
Why not the others:
- A — A higher frequency increases the Doppler shift and worsens aliasing.
- C — Greater depth lowers the maximum PRF.
- D — Gain changes brightness, not the Nyquist limit.
Takeaway: Know which knob changes the Nyquist limit and which knobs only change the display.
Source: ESR EPOS C-0588: Doppler artifacts and how to avoid them
AB-18 · Domain 3 — Abdominal physics · Mirror image artifact (outline 3.B.1)
An echogenic liver lesion near the dome appears again, same shape, on the far side of the bright diaphragm line, as if it were in the lung base. Changing the angle of approach changes the duplicate. What explains the duplicate?
Answer: C. The diaphragm-lung interface acts as a strong specular reflector. Sound takes a longer, indirect path back, and the machine places a false copy deeper than the reflector.
Why not the others:
- A — Refraction shifts structures sideways rather than mirroring them across a reflector.
- B — Reverberation produces evenly spaced repeating lines.
- D — The matching duplicate across a strong reflector favors a mirror artifact. Confirm the finding in additional views rather than assuming it is a separate lung lesion.
Takeaway: If it changes when you change your angle, suspect an artifact.
Source: ACEP Sonoguide: Ultrasound Physics, Mirroring
AB-19 · Domain 4 — Clinical care, practice & QA · Procedure support: the time-out (outline 4.D.1, 4.D.2)
Before an ultrasound-guided liver biopsy, which statement about the time-out is correct?
Answer: B. Under The Joint Commission's Universal Protocol, the time-out happens immediately before an invasive procedure begins. At a minimum, the team agrees on patient identity, site, and procedure.
Why not the others:
- A — Pre-procedure verification starts earlier, but the time-out itself happens right before the procedure.
- C — It applies to invasive procedures generally, not only operating room cases.
- D — After the needle is in is too late to prevent a wrong-site procedure.
Takeaway: Verification happens before the first invasive step, every time.
Source: Joint Commission 2026 hospital requirements, critical results and preprocedure time-out
AB-20 · Domain 4 — Clinical care, practice & QA · Transducer reprocessing (outline Domain 4 (clinical practice and safety))
A transrectal prostate exam was done with an intact, single-use transducer cover. Before the transducer is used on the next patient, what is required?
Answer: B. Internal transducers are semicritical devices. AIUM guidance calls for cleaning and then high-level disinfection between patients, even when the cover looks intact, because covers can fail without visible damage. For chemical HLD, clean and dry the transducer first; follow the manufacturer's instructions for the compatible process, contact conditions, rinsing, drying, and storage.
Why not the others:
- A — Low-level disinfection is for external transducers on intact skin.
- C — A cover reduces contamination but doesn't replace disinfection.
- D — Do not autoclave a transducer unless its manufacturer specifically permits that process. The required routine process here is cleaning followed by approved HLD.
Takeaway: The contact type sets the disinfection level: intact skin calls for low-level; mucous membranes call for high-level.
Source: AIUM: Guidelines for cleaning and preparing transducers, 2025 revision
Scoring yourself: Note the outline code on every miss. Two or more misses in one area means that topic moves earlier in your plan, and each miss goes into the correction log.
Where your AB points are
| Domain (AB Content Outline V24.1) | Share | What you need to be able to do |
|---|---|---|
| Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy | 42% | Recognize disease, vascular lesions, trauma findings, and transplant and post-surgical anatomy in every organ on the outline |
| Anatomy, Perfusion, and Function | 30% | Normal anatomy, variants, congenital anomalies, normal flow patterns, and the scan technique for each organ |
| Clinical Care, Practice, and Quality Assurance | 20% | Indications, labs, patient prep, urgent-findings communication, measurements, Doppler waveforms, and procedure support |
| Abdominal Physics | 8% | Transducer and preset choice, image and Doppler optimization, gray-scale and Doppler artifacts |
Source: AB Content Outline V24.1, page 1.
Anatomy and pathology together make up 72% of the exam. Connect both with technique and clinical context as you study them.
"Abdomen" covers more than the abdomen. The outline also tests the breast, chest, neck (thyroid, parathyroid, salivary glands, lymph nodes), scrotum, prostate, penis, abdominal wall and subcutaneous tissue, joints (fluid), and the popliteal fossa. It also covers organ transplants, the surgical zones of the neck, and implanted devices such as TIPS. If your clinical time was light on small parts, that's where to add hours.
Your 6-week AB study plan
Assumptions: you've finished (or nearly finished) your program's abdominal coursework and clinical rotations, and you can give this about 7.5–10 hours a week, as five sessions of roughly 90–120 minutes. This is Castleport's planning framework, not an ARDMS recommendation, and finishing it doesn't by itself mean you're ready.
Every session follows the same pattern:
- Recall (10 min): With notes closed, write what you remember about today's organ or topic: anatomy, landmarks, normal flow, common pathology.
- Review (50–70 min): Work through the matching outline items with your textbook or course notes. Fill the gaps you just found.
- Practice (20–30 min): Answer questions on the topic. Explain each answer out loud before you check it.
- Log (10 min): Add every miss, and every lucky guess, to your correction log.
| Week | Focus | Outline areas | Sessions | Practice items |
|---|---|---|---|---|
| 1 | Baseline + physics | Domain 3; Doppler basics | (1) Download the outline, mark every item you've rarely scanned, and work all 20 questions cold. (2) Transducers, presets, harmonics, compound imaging. (3) Gray-scale artifacts: shadowing, enhancement, comet tail, mirror image. (4) Doppler: scale, baseline, wall filter, aliasing, twinkle, high- vs low-resistance waveforms. (5) Review the week's log. | AB-03, AB-09, AB-11, AB-17, AB-18 |
| 2 | Liver, biliary, pancreas, spleen | 1.A–1.B; 2.A.3, 2.A.8, 2.A.10, 2.A.17; 2.B.1, 2.B.4 | (1) Liver anatomy, hepatic and portal veins, flow direction. (2) Diffuse liver disease, masses, portal hypertension, Budd-Chiari. (3) Gallbladder and ducts: stones, polyps, sludge, cholecystitis, obstruction. (4) Pancreas by vascular landmarks, pancreatitis, masses; spleen. (5) Mixed review plus log. | AB-01, AB-02, AB-04, AB-05, AB-06, AB-07 |
| 3 | Kidneys, retroperitoneum, great vessels, adrenals | 2.A.2, 2.A.15, 2.A.19; 2.B.2, 2.B.5 | (1) Kidney regions, hydronephrosis and its mimics. (2) Stones, masses, infection, bladder. (3) Aorta and IVC: aneurysm, dissection, thrombus. (4) Renal artery stenosis criteria, mesenteric vessels, adrenals, nodes, retroperitoneal fibrosis. (5) Mixed review plus log. | AB-08, AB-10, AB-11 |
| 4 | GI tract, abdominal wall, neck, breast, chest, superficial | 2.A.1, 2.A.4–2.A.7, 2.A.9, 2.A.12–2.A.13, 2.A.18 | (1) Appendix, pyloric stenosis, intussusception, obstruction. (2) Hernias and the abdominal wall; superficial masses, collections, foreign bodies. (3) Thyroid, parathyroid, salivary glands, nodes; score nodules with TI-RADS. (4) Breast; chest fluid; joints and popliteal fossa. (5) Mixed review plus log. | AB-12, AB-13, AB-14 |
| 5 | Male pelvis, transplants, trauma, clinical care | 2.A.11, 2.A.14, 2.A.16, 2.B.3, 2.C, 2.D, Domain 4 | (1) Scrotum (torsion, varicocele, masses), prostate, penis. (2) Transplants, TIPS, postsurgical neck and breast; FAST. (3) Domain 4: indications, labs, prep, urgent findings, confidentiality. (4) Measurements, waveforms, consent, time-out, needle guidance, transducer reprocessing. (5) Mixed review plus log. | AB-15, AB-16, AB-19, AB-20 |
| 6 | Timed practice + weak spots | Everything | (1–2) Timed practice blocks at about one question per minute; use a full-length timed practice exam if you have one. (3–4) Re-study your two or three weakest outline areas from the log, using new examples rather than the same questions. (5) Re-explain all 20 items above without the answers, then confirm your appointment, ID, and any approved accommodations. | All 20 |
Adapting the plan:
- More time (8–10 weeks): keep the order and spread the 30 sessions across three or four sessions a week. Use any additional sessions for recall and weak areas.
- Less time (4 weeks): keep Week 1, combine Weeks 2–3 and 4–5, and keep Week 6. The combined weeks contain 10 sessions each, requiring about 15–20 hours. Start with the areas your cold run of the 20 questions showed were weakest. Don't drop small parts; they're part of the AB outline too.
- Retaking after a fail: start from the domains you struggled with, and use the 60-day waiting period for Weeks 1–5.
- Same mistake twice: stop adding questions on that topic and add a review session first.
Turn misses into your next study task
A score tells you how many you missed. A correction log tells you why. Use one row for every miss or lucky guess, and come back to each row on the date you set.
| Item or concept | What I concluded | What the evidence actually supports | My next action | Review on |
|---|---|---|---|---|
| AB-01 | No shadow means it's sludge | Sludge and polyps can both lack shadowing. Typical sludge shifts; a fixed wall focus favors a polyp, but adherent sludge and impacted stones complicate the distinction | Re-explain stone vs polyp vs sludge from memory using two features each | 3 days later |
| (your next miss) |
You've really fixed a mistake when you can explain the distinction on a different example, not just recognize the answer to the same question. A plain notebook or spreadsheet works fine; nothing here needs an account.
High-yield criteria to know
These are widely used teaching criteria, not universal rules. Labs and guidelines differ, so learn the reasoning behind each number as well as the number itself.
| Topic | Commonly used criterion | Source |
|---|---|---|
| Abdominal aortic aneurysm | Infrarenal diameter ≥3.0 cm, measured outer wall to outer wall in the appropriate plane | AIUM aorta parameter, 2025 revision |
| Acute cholecystitis | Stones + sonographic Murphy sign; supporting: wall >3 mm (measure the anterior wall), pericholecystic fluid. Wall thickening alone is nonspecific | ACEP Sonoguide |
| Stone vs polyp vs sludge | Typical appearances: stone shadows and moves; polyp is fixed and nonshadowing; sludge is nonshadowing and layers dependently. Adherent sludge and impacted stones can complicate the distinction | Joint gallbladder-polyp guideline, 2022; SRU consensus, 2022 |
| Adenomyomatosis | Intramural cystic spaces with echogenic foci and comet tails favor adenomyomatosis; comet-tail artifact alone is not unique | KSAR 2025, KQ23; Oh et al., 2019 |
| Appendicitis | Noncompressible, blind-ending appendix arising from the cecum, outer diameter >6 mm, with supporting inflammatory findings and clinical context; not seeing the appendix doesn't exclude it | ACEP Sonoguide |
| Hypertrophic pyloric stenosis | Muscle >3 mm; channel length >15 mm are commonly used. Assess persistent closure and clinical context; pylorospasm can overlap in size, and premature infants may not meet standard size criteria | CAHS guideline, 2026; Cohen et al., 1998 |
| Thyroid nodule FNA (ACR TI-RADS) | For adult, previously unbiopsied nodules using the ACR chart: TR3 ≥2.5 cm · TR4 ≥1.5 cm · TR5 (7+ points) ≥1.0 cm | ACR assessment chart; ACR FAQ |
| Renal artery stenosis (≥60%) | Example direct criteria supplied in AB-10: PSV >180 cm/s; renal-aortic ratio >3.5. Labs validate their own cutoffs | Direct-criteria study, 2006; SVM/SVU consensus, Table 15 |
| SMA waveform | Fasting: high resistance · After a meal: low resistance, more diastolic flow · Celiac: normally low resistance either way | SVM/SVU consensus, Table 13 |
| TIPS function | Assess symptoms, velocities and portal flow direction against baseline and local criteria; abnormal findings suggest possible dysfunction rather than establishing failure by themselves | Duong et al., 2022; SVM/SVU consensus, Table 17 |
| Testicular torsion | Twisted cord (whirlpool sign), with absent or reduced intratesticular flow, is concerning; preserved arterial flow does not exclude early, partial, or intermittent torsion | EAU guideline, 2026 |
| Aliasing | Nyquist limit = PRF ÷ 2. Raising the scale increases this limit; lowering transmit frequency reduces the shift. Baseline shifting redistributes the display without increasing PRF | ESR Doppler artifacts |
| Transducer reprocessing | Clean before disinfection. External on intact skin: low-level disinfection · Internal: high-level disinfection even with a cover. Dry before chemical HLD and follow manufacturer instructions | AIUM, 2025 |
What the outline covers: a domain checklist
Use this to check your coverage. If you can't explain an item out loud, it goes back into the plan. The full list is in the official outline.
Anatomy, Perfusion, and Function (30%). For each organ: normal anatomy and variants, sonographic appearance, landmarks, scan technique, congenital anomalies, and normal flow. The organs are the biliary system, breast, chest, liver, neck (thyroid, parathyroid, salivary glands, lymph nodes), pancreas, penis, peritoneal cavity (stomach, bowel, appendix), prostate, retroperitoneum (great vessels and branches), scrotum, spleen, superficial structures, and urinary system.
Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy (42%).
- Pathology: hernias; adrenal masses and hemorrhage; biliary infection, masses and obstruction; breast infection and masses; chest fluid; GI masses, obstruction, pyloric stenosis and intussusception; joint fluid; liver hepatitis, fatty infiltration, cirrhosis, neoplasm, abscess and cyst; neck disease and masses; pancreatic infection, masses and obstruction; penile abnormalities; peritoneal fluid; popliteal fossa masses and fluid; prostate disease (e.g., BPH); retroperitoneal fibrosis and lymphadenopathy; scrotal fluid, hernia, masses and infection; splenomegaly and masses; superficial foreign bodies and collections; urinary masses, obstruction and infection.
- Vascular: Budd-Chiari, AV fistula, portal vein thrombosis, collaterals; aneurysm, dissection, thrombus; torsion, varicocele; splenic infarction, hemangioma; renal artery stenosis.
- Trauma: liver, penis, scrotum, spleen, superficial structures, urinary system, and focused assessment for free fluid.
- Postoperative: transplant anatomy, perfusion, complications and rejection signs; anastomosis sites; post-surgical collections; surgical zones of the neck and recurrent disease; post-surgical breast; implanted devices such as TIPS.
Abdominal Physics (8%). Transducer choice (curvilinear, linear, phased array) by body habitus; B-mode, compound and harmonic imaging; color, power and pulsed-wave Doppler settings; gray-scale artifacts (shadowing, resonance, comet tail) and Doppler artifacts (twinkle, spectral broadening), and how to reduce or use them.
Clinical Care, Practice, and Quality Assurance (20%). Indications and contraindications; relevant labs and medications; history and symptoms; correlating prior imaging and other modalities; communicating urgent findings; patient prep (e.g., fasting for biliary imaging); confidentiality; adapting the exam and patient position; normal measurements and Doppler waveform analysis; consent, laterality and site verification, needle-path display, and post-procedure complications.
Hotspot questions
Some AB items show an image and ask you to click your answer directly on it: a structure, a measurement point, or an abnormality. ARDMS has a short video, How to Answer a Hotspot Question, linked from the official AB page, and Inteleos links a Pearson sample test tutorial that shows the testing interface.
To practice, use images from your training that you're permitted to use (de-identified) or textbook images with the captions covered. Name every structure, then the abnormality, then where you'd place calipers.
AB exam at a glance
| Item | Official detail |
|---|---|
| Questions and time | Approximately 165 questions over three hours, with multiple-choice and hotspot items. The official page also lists a five-minute survey (Inteleos AB page) |
| Pacing | For timed practice, use about one question per minute as a planning target, then adjust for longer items. This is Castleport's practice recommendation |
| Scoring | Pass/fail on a 300–700 scale; 555 or higher passes. It isn't a percentage correct and isn't graded on a curve (Passing standard) |
| Fee | $300 USD, which includes a $100 non-refundable processing fee. Testing outside the U.S., Canada, or Mexico adds a $50 fee (Fee schedule) |
| Credential | AB counts toward RDMS together with SPI. Pass both within five years of each other, in either order. The window runs by calendar year starting the day after your first pass: pass on June 6, 2026, and you have until December 31, 2031. The rule doesn't apply when you add a specialty to a credential you already hold (5-year rule) |
| Eligibility | You need a qualifying prerequisite pathway; check yours before applying (Prerequisites) |
| Results | Score report at the test center immediately after completion; the results policy lists online availability in Pearson and Inteleos one week after the appointment (Results and scoring) |
| If you don't pass | You can reapply after three days, but you must wait 60 days to retake. The wait can't be waived (Retake and reapply) |
| Accommodations | Request through the official process (Accommodations) |
Fees and policies change. Confirm on the official pages before you apply or pay.
Common questions
How hard is the ARDMS Abdomen exam?
For the January 1–December 31, 2025 administration period, the official AB pass rates were 73% for first-time takers, 45% for repeat takers, and 67% overall. This is the latest annual report linked from the official statistics hub as of October 28, 2026. (2025 performance report, AB row; Exam statistics)
The official AB page also publishes historical pass rates. For 2023, the most recent year listed on that exam page, 72% of first-time takers passed and 64% of all takers passed. In 2022, the figures were 69% and 61%. (Inteleos AB page, Statistics)
These figures describe different candidate cohorts. They do not establish your personal probability of passing or show that a study resource caused the outcome.
Should I take SPI or AB first?
Either order counts. Taking SPI first lets you build the physics foundation before the AB Doppler and artifact questions, but that's a preference, not a rule. What matters is passing both within the five-year window described above.
How long should I study?
Use the plan above as a starting point. If you've finished a sonography program, six weeks at 7.5–10 hours a week is a workable plan. Add time for any area your clinical rotations barely touched.
What should I do if I don't pass?
Use the 60-day wait to run Weeks 1–5 of the plan, starting with the areas that felt weakest on exam day and in your correction log. You can reapply after three days; schedule after approval using the eligibility dates on your Exam Confirmation Letter. (Retake and reapply)
Sources and verification
Official exam sources: Inteleos Abdomen (AB) exam page · AB Content Outline V24.1 · Passing standard · Exam fee schedule · 5-year rule · Retake and reapply guidelines · Prerequisites · Accommodations · Results and scoring · Exam statistics · 2025 performance report
Teaching references are linked beside each practice question and in the criteria table.
Last verified: October 28, 2026. We checked the official AB exam page, the Version 24.1 content outline, the passing standard, the fee schedule, the 5-year rule, the retake and results policies, and the 2025 performance report, along with the teaching references cited on this page. This was a source check, not a clinician's professional review. See how we check sources and practice content.
Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by ARDMS or Inteleos. Exam and credential names are used to identify their subjects; trademarks belong to their respective owners. All practice questions on this page are original and unofficial. This page is for exam preparation, not clinical guidance.
Castleport Test Prep Editorial Team