Free ARDMS Abdomen Practice Test (60 Questions)

Answer: D. Common bile duct

On a transverse view the distal common bile duct sits at the posterior (dorsal) lateral edge of the pancreatic head, and the gastroduodenal artery sits at the anterior (ventral) lateral edge. Remembering "artery in front, duct behind" sorts these two out fast.

• A is the anterolateral structure, not the posterolateral one.
• B runs along the posterior body and tail, not the head.
• C runs at the pancreatic neck, medial to the head, not at its lateral border.

Source: EFSUMB Course Book, Ch. 9 Pancreas, p. 5

Answer: A. Portal veins have bright, echogenic walls

Portal veins travel inside a fibrous sheath with the hepatic artery and bile duct, so their walls look like bright echogenic lines. Hepatic veins have thin walls and look like thin-walled channels running toward the IVC.

• B reverses the two.
• C describes hepatic veins, which drain into the IVC near the diaphragm.
• D describes the portal triad — that's portal veins, not hepatic veins.

Sources: StatPearls, Hepatic Doppler Ultrasonography — Technique; ACEP Sonoguide — Liver anatomy

Answer: C. Left renal vein

The left renal vein passes anterior to the aorta and posterior to the SMA on its way to the IVC. Compression in that angle is the nutcracker phenomenon. Seeing the left renal vein in this "sandwich" is a reliable landmark on a transverse view.

• A passes posterior to the IVC, not between the SMA and aorta.
• B runs anterior to the SMA along the back of the pancreas.
• D drains into the splenic vein or SMV and doesn't take this path.

Sources: StatPearls, Nutcracker Syndrome — Introduction; EFSUMB Course Book, Renal vascular — Anatomy

Answer: A. Common hepatic, splenic, and left gastric arteries

The first anterior branch is the celiac trunk, which arises around T12 and splits into the common hepatic, splenic, and left gastric arteries. The common hepatic and splenic branches form the "seagull" on a transverse view. The SMA arises just below it.

• B lists renal and gonadal arteries, not branches of the celiac trunk.
• C names vessels farther along the hepatic arterial tree, not the three primary celiac branches.
• D are SMA branches.

Sources: StatPearls, Anatomy: Celiac Trunk — Structure and Function; ACEP Sonoguide — Aortic branch anatomy

Answer: C. Medical renal disease

Normal adult renal cortex is equal to or less echogenic than normal liver. Cortex brighter than a normal liver is abnormal and points to parenchymal (medical) renal disease.

• A is wrong for adults; brighter-than-liver cortex is not normal.
• B shows a dilated collecting system, not a brighter cortex.
• D would make the liver brighter, so the kidney would look relatively darker — the opposite comparison. The stem tells you the liver is normal.

Source: BMC Nephrology 2020 — Background

Answer: B. Esophagus

The cervical esophagus usually sits behind the left thyroid lobe and shows a layered, bowel-like appearance. Having the patient swallow changes its shape and confirms it — a simple way to avoid calling it a nodule.

• A is a solid hypoechoic nodule, not a layered structure showing peristalsis with swallowing.
• C is lateral and pulsatile with color flow.
• D is a flat muscle against the spine, not a layered round structure.

Sources: EFSUMB Course Book, Thyroid — Normal anatomy, pp. 5–6; EFSUMB GIUS Recommendations — Cervical esophagus, pp. E15–E16

Answer: D. Mediastinum testis

The mediastinum testis is where the seminiferous tubules drain toward the rete testis. It shows up as a bright linear structure along the back of the testis, toward the upper part. It's normal anatomy, so don't call it a mass.

• A is a small anechoic cyst at the testicular surface.
• B sits at the upper pole outside the testis.
• C is a small nodule near the upper pole, not a long band.

Source: EFSUMB Course Book, Scrotum chapter, p. 5

Answer: D.

About 70–75% of prostate cancers arise in the peripheral zone, and benign prostatic hyperplasia arises from the transition zone. That split is why the peripheral zone gets so much attention in prostate imaging.

• A: the central zone gives rise to a small minority of cancers.
• B swaps the zones.
• C: the transition zone accounts for roughly a quarter of cancers, not most.

Source: ACR PI-RADS v2.1 — Zonal anatomy, p. 7

Answer: A. Gut signature

Normal bowel wall shows five alternating echogenic and hypoechoic layers — the "gut signature." Recognizing it helps you identify gastrointestinal tissue.

• B and C describe target-like or kidney-like patterns, such as those seen in intussusception, rather than naming the five wall layers.
• D describes fluid-filled small bowel with prominent folds, usually in obstruction.

Sources: EFSUMB Course Book, Gastrointestinal tract — Normal wall layers, pp. 3–5; ACEP Sonoguide — Target and pseudokidney signs; BMUS Gastrointestinal POCUS — Small-bowel folds, pp. 6 and 11

Answer: A. Cooper ligaments

Cooper ligaments are suspensory ligaments that show up as thin echogenic bands running from the gland toward the superficial fascia and skin. The gland itself lies between the superficial and deep layers of fascia.

• B are tubular structures converging on the nipple.
• C is the deep layer behind the gland, not bands toward the skin.
• D are oval nodes with a fatty hilum.

Sources: Rehnke et al. 2018 — Breast fascial anatomy; Geddes 2009 — Normal ultrasonic appearances

Answer: C. Corpus spongiosum

The corpus spongiosum is the single ventral body and carries the urethra. The paired corpora cavernosa lie dorsally, each with a cavernosal artery in its center.

• A and B contain the cavernosal arteries, not the urethra.
• D is the fibrous sheath around the corpora.

Source: Radiologia Brasileira 2018; 51(4), pp. 257–258 — Anatomy and physiology

Answer: C. Splenic vein

The splenic vein runs along the back of the pancreatic body and tail and joins the SMV behind the pancreatic neck to form the portal vein. Find the splenic vein and you've found the posterior edge of the pancreas.

• A is tortuous and runs along the superior border, so it's a less reliable landmark.
• B lies posterior to the pancreatic head, not the body and tail.
• D marks the anterolateral pancreatic head.

Source: EFSUMB Course Book, Ch. 9 Pancreas, pp. 2–5

Answer: B. Cholecystokinin causes the gallbladder to contract

Fat and protein entering the duodenum trigger cholecystokinin (CCK) release, which contracts the gallbladder. That's why patients fast before a gallbladder exam: a distended gallbladder shows the wall and lumen far better.

• A: secretin mainly stimulates bicarbonate-rich pancreatic secretion.
• C and D don't drive gallbladder emptying.

Sources: StatPearls, Biochemistry, Cholecystokinin; ACEP Sonoguide — Gallbladder preparation and pitfalls

Answer: C. Triphasic

Hepatic veins drain straight into the IVC near the right atrium, so their waveform mirrors right atrial pressure changes. The typical normal pattern is triphasic.

• A describes a dampened waveform that can occur with liver disease or outflow obstruction; inspiratory breath-holding can also flatten the waveform in healthy people.
• B and D are arterial patterns.

Sources: BMC Gastroenterology 2011; 11:84; Lee et al., J Ultrasound Med 2007 — Respiratory effects on hepatic vein waveforms

Answer: D. Hepatopetal with mild phasic variation

Normal portal venous flow goes toward the liver (hepatopetal), continuous with mild velocity variation.

• A and C (away from the liver) suggest portal hypertension.
• B is bidirectional flow, an abnormal transition pattern.

Source: SVM/SVU Doppler waveform consensus — Tables 16–17

Answer: A. Normal low-resistance waveform

The kidney is a low-resistance organ, so intrarenal arteries keep forward flow through diastole. In adults, 0.70 is a commonly used upper limit for RI; 0.62 is within normal range.

• B would require increased resistance, which the described waveform and RI do not show.
• C means a slow systolic upstroke and low peak, which the stem doesn't describe.
• D contradicts the continuous diastolic flow.

Source: EFSUMB Course Book, Ch. 41 Renal vascular, pp. 6 and 8

Answer: B. Low-resistance with continuous diastolic flow

Normal intratesticular arteries show a low-resistance pattern with forward flow in diastole. That's why you compare both testes side by side: a clear difference in flow between the two sides is a red flag.

• A and C are high-resistance patterns seen in muscle-supplying arteries.
• D is wrong; normal adult testes have detectable intratesticular flow.

Sources: EFSUMB Course Book, Scrotum chapter, p. 7; AIUM Practice Parameter for Scrotal Ultrasound (2025), p. 2

Answer: C. Normal aerated lung with lung sliding

The moving pleural line is lung sliding, and the repeating horizontal lines are A-lines — reverberations of the pleural line. Sliding shows the pleural layers are touching, which rules out pneumothorax at that probe position.

• A causes absent lung sliding.
• B shows an anechoic collection above the diaphragm.
• D looks like solid, tissue-like lung.

Source: ACEP Sonoguide — Lung sliding, A-lines, and pleural pathology

Answer: D. Acute calculous cholecystitis

Stones plus a sonographic Murphy sign is the classic combination, and the wall thickening (≥4 mm under the Tokyo Guidelines) and pericholecystic fluid support it. No single sign is perfect — a Murphy sign can be absent, and opioid analgesia can make it less reliable — so you weigh them together.

• A causes wall thickening with intramural cysts and comet-tail artifacts; those features are not described here.
• B needs a stone in the duct; the findings here center on the gallbladder.
• C is a calcified wall with shadowing, not an acute inflammatory picture.

Sources: Tokyo Guidelines 2018 — Diagnostic criteria and imaging findings, pp. 43–45; Goldstein et al. 2025 — Sonographic Murphy sign and analgesia; SRU consensus 2022 — Gallbladder wall lesion definitions, p. 279

Answer: A. Gallbladder adenomyomatosis

Adenomyomatosis creates intramural Rokitansky-Aschoff sinuses that trap cholesterol crystals, which produce comet-tail reverberation artifacts. That artifact is the key clue.

• B can appear as a mass or irregular thickening; the intramural comet-tail pattern here favors adenomyomatosis.
• C shows gas with dirty shadowing and ring-down in a sick patient.
• D is layering, nonshadowing echoes in the lumen, not wall foci.

Sources: SRU consensus 2022 — Adenomyomatosis and sludge definitions, p. 279; Annals of Translational Medicine 2020; 8(23) — Diagnosis, US

Answer: C. Diffuse fatty infiltration

Steatosis brightens the liver against the kidney, blurs the portal vein walls, and attenuates the beam so the deep liver and diaphragm fade. Grading systems use exactly these features.

• A can make the liver darker, with brighter-looking portal vein walls ("starry sky").
• B is suggested by dilated hepatic veins and IVC, rather than this steatosis pattern.
• D: a normal liver doesn't blur vessel walls or attenuate the beam like this.

Sources: Musa et al., Egyptian Liver Journal 2019 — Methods and Figure 2; EFSUMB Course Book, Liver — Steatosis and hepatitis, pp. 16–17 and 24

Answer: B. Typical cavernous hemangioma

A typical hemangioma is small, sharply marginated, homogeneous, and hyperechoic, may show acoustic enhancement, and has little or no detectable internal flow because blood moves through it very slowly.

• A usually arises in a cirrhotic liver and is often hypoechoic or mixed, with internal flow.
• C is anechoic, not hyperechoic.
• D is often complex with debris, in a patient with signs of infection.

Source: EFSUMB Course Book, Liver — Hemangioma, pp. 59–60; Abscess, p. 92

Answer: D.

Cirrhosis makes the surface nodular and the texture coarse, and the caudate lobe often enlarges while the right lobe shrinks. A caudate-to-right-lobe ratio above 0.65 is a commonly cited cutoff.

• A is the opposite of the cirrhotic pattern.
• B suggests acute hepatitis.
• C lacks the nodular surface and altered lobe proportions in D.

Sources: Soresi et al., World Journal of Gastroenterology 2014 — Gray-scale US: Size; EFSUMB Course Book, Liver — Cirrhosis, pp. 21–22

Answer: C. Pancreatic pseudocyst

Under the revised Atlanta classification, a pseudocyst is an encapsulated fluid collection with a well-defined wall and no non-liquid component, usually forming more than four weeks after interstitial edematous pancreatitis.

• A is the early (under four weeks) unencapsulated collection.
• B follows necrotizing pancreatitis and contains solid debris.
• D is a neoplasm, not a post-pancreatitis collection; the history points away from it.

Source: EFSUMB Course Book, Pancreas — pp. 13 and 26–27

Answer: B. Hypertrophic pyloric stenosis

A pyloric muscle thickness of 3 mm or more is abnormal; persistent thickening with a channel that stays closed supports hypertrophic pyloric stenosis. This infant has a 4 mm muscle and an elongated 18 mm channel, at the typical age, with the typical vomiting.

• A can mimic it, but the muscle doesn't stay this thick and the channel eventually opens.
• C involves twisting of the midgut, not a persistently thickened pyloric muscle.
• D: these measurements are abnormal.

Sources: Costa Dias et al., Insights into Imaging 2012 — p. 249; ACEP Sonoguide — Pediatric Pyloric Stenosis, Pathology and Pitfalls

Answer: A. Ileocolic intussusception

Bowel telescoping into bowel makes a target (doughnut) sign in transverse and a pseudokidney sign in longitudinal. It is most commonly diagnosed between 6 months and 2 years.

• B is a noncompressible blind-ending tube in the right lower quadrant.
• C occurs in young infants and involves the pylorus, not a large target mass.
• D shows enlarged mesenteric nodes, not a layered mass.

Source: ACEP Sonoguide — Intussusception, Introduction and Sonographic Findings

Answer: A. Acute appendicitis

A noncompressible appendix more than 6 mm in diameter is a direct sign of appendicitis; cecal origin, wall hyperemia, and inflamed surrounding fat support the diagnosis here.

• B compresses and is usually 6 mm or less.
• C peristalses, is compressible, and isn't blind-ending.
• D can't be "confirmed" from these findings; the stem fits appendicitis.

Source: ACEP Sonoguide — Appendicitis, Anatomy, Pathology and Pitfalls

Answer: D. TR5; fine-needle aspiration

Points: solid 2 + hypoechoic 2 + taller-than-wide 3 + smooth margin 0 + punctate echogenic foci 3 = 10. Seven or more points is TR5, and TR5 nodules 1.0 cm or larger get FNA. At 1.2 cm, this one qualifies.

• A and B undercount the points.
• C: TR5 is follow-up only from 0.5 cm up to under 1.0 cm.

Source: ACR TI-RADS official assessment chart — points and size thresholds

Answer: D. Parathyroid adenoma

Hypercalcemia plus an oval hypoechoic nodule behind the thyroid with a polar feeding vessel is the classic adenoma picture.

• A lies within the thyroid and often has comet tails.
• B is midline and cystic, near the hyoid.
• C has an echogenic fatty hilum with central flow, not a polar vessel.

Source: EFSUMB Course Book, Ch.44 Parathyroid — pp. 7–10 and 16–17

Answer: B. Angiomyolipoma

Fat makes angiomyolipoma very echogenic. Some show posterior shadowing, but only a minority (about a fifth to a third). Because some renal cell carcinomas are also echogenic, fat is confirmed with CT (negative attenuation) or MRI.

• A: shadowing doesn't confirm RCC; it actually favors AML.
• C is anechoic, not hyperechoic.
• D is a stone in the collecting system with clean shadowing, not a 1.5 cm parenchymal mass.

Sources: Journal of Ultrasonography 2021; 21:e248 — Discussion; BMC Nephrology 2018; 19:123; Canadian Urological Association best practice report — Diagnosis, Recommendation 1

Answer: A. BI-RADS 2 — benign

These are the lexicon features of a simple cyst, which is a benign finding.

• B is for probably benign findings that need short-interval follow-up, not a classic simple cyst.
• C and D need suspicious features such as irregular or spiculated margins.

Source: ACR BI-RADS v2025 Ultrasound Lexicon summary form — Simple cyst and Assessment Categories

Answer: C. Indirect inguinal hernia

The inferior epigastric vessels are the dividing landmark: indirect hernias arise lateral to them through the deep inguinal ring, and direct hernias arise medial to them.

• A is medial to the vessels.
• B passes below the inguinal ligament, medial to the femoral vein.
• D is higher, at the lateral edge of the rectus sheath.

Source: University of Washington Hernia Ultrasound Protocol, 3/2024

Answer: B. Baker cyst

A Baker cyst is a fluid-filled bursa whose neck runs between the medial gastrocnemius head and the semimembranosus tendon. Showing that neck is how you tell it from other popliteal masses.

• A is continuous with the popliteal artery, rather than arising from this bursa.
• C is thrombus in a noncompressible vein.
• D is solid fatty tissue, not fluid.

Sources: Revista Brasileira de Ortopedia 2011; 46(6) — Anatomy; RadioGraphics 2016 — US of the Knee, Figure 12

Answer: C. Treat as torsion and communicate immediately

Absent flow compared with the other side plus a twisted cord ("whirlpool sign") means torsion, a surgical emergency. Salvage rates fall as treatment is delayed, so this gets communicated right away.

One trap to remember: the reverse isn't true. Some flow inside the testis does not rule out torsion — partial torsion can preserve flow, so the cord itself always needs a look.

• A wastes time the testis doesn't have.
• B: uncomplicated epididymitis usually shows increased flow, not absent flow. (A testis that twists and untwists can also look hyperemic and mimic epididymitis.)
• D treats symptoms and ignores an emergency.

Sources: Xu et al., Frontiers in Pediatrics 2022 — torsion with preserved flow; Howe et al., Translational Andrology and Urology 2017 — duration and salvage; EFSUMB Course Book, Scrotum — pp. 12 and 20–22

Answer: D. Extend the scan to the abdomen

Most varicoceles are on the left. An isolated right-sided one, or one that doesn't decompress lying down, can be caused by something compressing the veins higher up, so European urogenital radiology guidance supports extending the exam to the abdomen.

• A misses a possible retroperitoneal cause.
• B is management, not imaging, and skips the red flag.
• C is part of a varicocele exam but doesn't address the red flag.

Source: ESUR-SPIWG varicocele recommendations, Eur Radiol 2020 — Recs 15–16, 22

Answer: D. Its veins drain directly into the IVC

This is Budd-Chiari syndrome (hepatic venous outflow obstruction). The caudate lobe drains through small veins straight into the IVC, so it escapes the obstruction and enlarges.

• A, B, and C aren't the reason for caudate sparing.

Source: EFSUMB Course Book, Liver — pp. 6–7 and 46–47

Answer: B.

Reversed (hepatofugal) portal flow, a recanalized paraumbilical vein, splenomegaly, collaterals, and ascites are the classic signs.

• A is normal.
• C describes normal hepatic veins.
• D is biliary disease, not portal hypertension.

Sources: Ditchfield et al. 1992 — Duplex Doppler signs of portal hypertension; SVM/SVU Doppler waveform consensus 2020 — Table 17; EFSUMB Course Book, Liver — Portal hypertension

Answer: A. Significant renal artery stenosis

Renal-to-aortic ratio = 240 ÷ 60 = 4.0. Commonly used criteria include a renal PSV above 180–200 cm/s and a ratio above 3.5; both are exceeded here. Exact stenosis grading depends on the laboratory's validated criteria and the complete Doppler examination.

• B: both numbers are above threshold.
• C is a venous problem; this is an arterial measurement.
• D cannot be established from these two peak systolic velocities alone.

Source: Schäberle et al., Gefässchirurgie 2016 — Direct criteria and Table 1

Answer: A. Splenic infarct

An acute infarct is a peripheral, wedge-shaped, hypoechoic, avascular area that reaches the capsule. Atrial fibrillation is a classic embolic source. Older infarcts turn brighter and scar.

• B is usually a well-defined echogenic nodule.
• C is an infected collection; the wedge-shaped perfusion defect and embolic history favor infarction.
• D is a separate round nodule near the hilum with the same echotexture as spleen.

Sources: EFSUMB Case of the Month, March 2025 — Splenic infarction; EFSUMB Course Book, Spleen — pp. 34–36; Schattner et al. 2015 — Acute splenic infarction, Abstract

Answer: D. Morison pouch

Morison pouch is the hepatorenal space assessed in the right upper quadrant view, and scanning down to the caudal tip of the liver improves detection. A negative FAST can still miss smaller amounts of blood.

• A is the left upper quadrant view.
• B is the cardiac (subxiphoid) view, not intraperitoneal.
• C is part of the right upper quadrant survey, but it lies above the liver rather than between the liver and right kidney.

Source: ACEP Sonoguide — FAST, Abdominal and Lower Thoracic Views

Answer: B. Shunt dysfunction

A commonly cited intrashunt velocity range is about 90–190 cm/s; thresholds vary by protocol. Velocities below 90 cm/s, or a drop of more than 40 cm/s from baseline, raise concern for dysfunction. This shunt meets both. In a working TIPS, the intrahepatic portal branches usually flow toward the shunt; flow turning back toward the liver is another warning sign.

• A and C ignore two abnormal criteria.
• D concerns the hepatic artery, which isn't what was measured.

Sources: Ricci et al., J Ultrasound 2007; 10(1):22–27 — Functioning and compromised shunts; Owen and Gaba, J Clin Imaging Sci 2016 — Doppler surveillance and limitations

Answer: C. Hepatic artery stenosis or thrombosis upstream

A tardus-parvus waveform — RI under 0.5 with a systolic acceleration time over 0.08 s — points to a narrowing upstream. Upstream thrombosis with collateral flow can also produce this pattern. Hepatic artery complications threaten the graft and the bile ducts, so this must be reported promptly.

• A: both values are abnormal.
• B is a portal venous finding.
• D doesn't explain this arterial waveform change.

Sources: Zheng et al., Abdominal Radiology 2018; 43:1634–1641 — Introduction; Brookmeyer et al., RadioGraphics 2022; 42:702–721 — Figure 8

Answer: C. Lymphocele

Lymphocele is the most common peritransplant collection and typically appears weeks after surgery as an anechoic collection near the graft.

• A usually appears in the first days to two weeks, from a ureteric leak.
• B is usually early post-op and initially echogenic or complex, but can become cystic as it ages.
• D may be complex with debris; signs of infection can be absent in immunosuppressed patients.

Sources: Mehrabi et al., BJS 2020 — Timing and definition of lymphocele; Kolofousi et al., 2013 — Sections 4.3.1 and 4.4, peritransplant collections

Answer: C. Linear array at about 10–14 MHz or higher

The thyroid is superficial, so a high-frequency linear transducer gives the best resolution. Practice parameters prefer mean frequencies of 10–14 MHz or greater.

• A and B trade resolution for depth you don't need here.
• D is for internal approaches, not the neck.

Source: AIUM Thyroid and Extracranial Head and Neck Ultrasound, 2023 — Equipment Specification, p. E59

Answer: A. Tissue harmonic imaging

Harmonic imaging improves contrast and reduces near-field reverberation and side-lobe artifact, which often clears false echoes from cysts — especially in technically difficult patients.

• B adds noise and makes the cyst look worse.
• C removes tools that help.
• D affects color flow only, not grayscale echoes.

Source: Krupski et al., Annales UMCS 2003 — Discussion

Answer: B. Raise the scale or lower the baseline

This is aliasing: the Doppler shift exceeds the Nyquist limit (half the PRF). Raising the PRF or shifting the baseline makes room for the high velocities. A lower-frequency transducer or a larger insonation angle also reduces the shift. For velocity measurements, keep the angle at or below 60°.

• A makes aliasing worse.
• C increases the Doppler shift, making aliasing worse.
• D (smaller angle) increases the shift too.

Sources: BMUS, Basic principles of Doppler — Aliasing; AIUM Native Renal Vessels, 2024 — Color and Spectral Doppler Evaluation

Answer: D. Twinkling artifact from a stone

Twinkling is a flickering color mosaic deep to a strong, rough reflector such as a stone, and it helps detect small calculi, but twinkling alone cannot confirm a stone.

• A shows organized swirling flow in a round anechoic structure.
• B are organized vessels, not a mosaic behind a bright focus.
• C shows true high-velocity flow with a perivascular bruit, confirmed on spectral Doppler.

Sources: AIUM Abdomen and/or Retroperitoneum, 2026 — Kidneys; Dillman et al., Radiology 2011; 259:911–916 — CT correlation

Answer: A. Mirror-image artifact

The diaphragm–lung interface is a strong reflector. Sound bounces off it, and the machine places a duplicate of the liver above the diaphragm.

• B produces equally spaced repeating lines.
• C produces shadows at curved edges.
• D brightens tissue behind fluid; it doesn't copy an organ.

Sources: ACEP Sonoguide, Ultrasound Physics — Artifacts; ACEP Sonoguide, Lung — Mirror image artifact

Answer: B. A focal solid liver lesion

AFP is a blood marker used alongside ultrasound to watch for liver cancer in people with cirrhosis. A rising AFP raises concern for hepatocellular carcinoma, so you search the liver carefully for a focal lesion. A rising AFP also calls for diagnostic multiphasic contrast-enhanced CT or MRI under AASLD guidance, even if ultrasound shows no mass; AFP alone cannot diagnose HCC.

• A, C, and D aren't related to AFP.

Source: AASLD 2023 HCC Practice Guidance — Recall algorithm and Guidance Statements 15–16

Answer: A. Bile duct caliber and obstruction level

Conjugated hyperbilirubinemia with high ALP points to cholestasis or biliary obstruction. Ultrasound is the first-line imaging test to look for dilated ducts and a cause.

• B, C, and D don't address a cholestatic lab pattern.

Source: American Family Physician 2017;95(3):164 — Evaluation of jaundice

Answer: D. Get the indication, then perform the appropriate exam

The ordering provider is expected to supply clinical information with the request. The indication decides what the exam needs to cover and what to look at closely. Finding it first — from the record or the referring office — lets you do the right study instead of guessing.

• A guesses at the question and may miss the real problem.
• B is an arbitrary narrowing of the exam.
• C leaves the patient without care when one call or record check may fix the gap.

Source: AIUM Abdomen and/or Retroperitoneum, 2026 — Request for Examination

Answer: B. Document and follow protocol

For an elective exam, fasting at least four hours usually allows adequate gallbladder distension. A contracted gallbladder after eating can mimic wall thickening, so note the intake and follow your department's protocol — often rescheduling.

• A risks a false-positive wall-thickening report.
• C won't refill the gallbladder in minutes.
• D hides an important limitation.

Source: AIUM Abdomen and/or Retroperitoneum, 2026 — Gallbladder and Biliary Tract

Answer: C. Notify immediately and document

Findings that need immediate intervention require nonroutine, direct communication that reasonably ensures timely receipt, and that communication is documented. Follow your facility's critical-result chain.

• A and D delay an emergency.
• B is outside the sonographer's role and unsafe.

Source: AIUM Documentation of an Ultrasound Examination, 2025 Revision — Reporting of Critical Results, pp. E27–E28

Answer: C. Decline without authorization

Under the HIPAA Privacy Rule, a covered provider generally can't give health information to an employer without the patient's authorization unless a specific legal exception applies. Even confirming the visit discloses information; a supervisor's concern alone does not authorize it.

• A and D are unauthorized disclosures.
• B still discloses protected information.

Sources: HHS, Employers and Health Information in the Workplace; HHS, Workers’ compensation and legally permitted disclosures

Answer: D. Gallbladder polyp

A solid, nonmobile, nonshadowing protrusion from the gallbladder wall is a polyp. Repositioning the patient is the key step: stones are generally mobile and shadow. Flow within a stalk supports tissue rather than sludge.

• A should move with position and usually shadows.
• B produces dirty shadowing or ring-down.
• C can be nonmobile and mimic a polyp, but it does not have a vascular stalk.

Source: Kamaya et al., SRU consensus on gallbladder polyps, Radiology 2022; 305:277–289 — definitions, p. 279; Figures 4 and 9

Answer: B. 60° or less, cursor parallel to flow

Velocity error rises steeply above 60°. Align the angle cursor with the vessel and keep the angle at or below 60°.

• A gives almost no Doppler shift.
• C: correction only works if the cursor is aligned and the angle is reasonable.
• D is above 60°, where error rises sharply.

Sources: BMUS, Basic principles of Doppler — Angle; AIUM Native Renal Vessels, 2024 — Color and Spectral Doppler Evaluation

Answer: D. Outer to outer, perpendicular; ≥3.0 cm

Measure the greatest diameter from outer wall to outer wall, with the transverse measurement perpendicular to the aorta's long axis, so thrombus and wall are included and an oblique cut doesn't overestimate it. An infrarenal aorta of 3 cm or more is an aneurysm. (The same practice parameter also counts a segment at least 1.5 times the diameter of the more proximal infrarenal aorta.)

• A excludes the wall and uses an oblique plane that skews the number.
• B and C use the wrong technique and thresholds; measuring the lumen only misses mural thrombus.

Source: AIUM Abdominal Aorta in Adults, 2025 Revision — Measurements and positive screening criteria

Answer: B. About 33 mL

Ellipsoid volume = length × width × height × 0.52. 4.5 × 4.0 × 3.5 = 63; 63 × 0.52 = 32.76, about 33 mL.

• A halves the correct answer.
• C forgets the 0.52 coefficient.
• D divides by 0.52 instead of multiplying.

Source: BMC Urology 2019 — Background

Answer: A.

Before an ultrasound-guided invasive procedure, the team verifies the correct patient, procedure, and location, and a time-out confirms it right before the needle goes in. Getting consent and reviewing the patient's lab results beforehand are listed tasks for this part of the AB exam. Kidney biopsy carries a real bleeding risk, which is why clotting-related labs are checked against facility protocol first.

• B skips a required safety step.
• C makes consent meaningless.
• D: lab review is standard, not optional.

Sources: AIUM Standards and Guidelines for Accreditation of Ultrasound Practices — Invasive Procedures; AB Content Outline v24.1, item 4.D.1; KHA-CARI Renal Biopsy Guideline, 2019 — Pre-biopsy laboratory testing and bleeding risk

Answer: B. Perinephric hematoma

Bleeding is the most common complication after renal biopsy, and a perinephric hematoma is a common finding. Ultrasound is used to look for it, along with any growing collection.

• A, C, and D aren't caused by the biopsy and are less likely to explain new pain right after it.

Sources: Pombas et al., Kidney and Blood Pressure Research 2020; 45(1):122–130 — Results; KHA-CARI Renal Biopsy Guideline, 2019 — Bleeding and post-biopsy care