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ARDMS Abdomen Sonography Examination Sample Questions (Q137-Q142):
NEW QUESTION # 137
Which condition is most likely in a patient presenting with weight loss and fatigue along with elevated liver enzymes, elevated potassium, and decreased sodium?
Answer: D
Explanation:
Addison disease (primary adrenal insufficiency) results in insufficient production of cortisol and aldosterone.
The hallmark laboratory findings include:
* Hyponatremia (low sodium)
* Hyperkalemia (high potassium)
* Elevated liver enzymes (due to nonspecific hepatic involvement)
* Fatigue, weight loss, and hypotension are common clinical features.
* Conn syndrome (B) causes hyperaldosteronism, leading to hypokalemia (not hyperkalemia).
* Acute pancreatitis (C) would typically show elevated amylase/lipase.
* Hepatocellular carcinoma (D) may present with elevated liver enzymes but not the electrolyte pattern described.
Reference Extracts:
* Nieman LK. "Diagnosis and Treatment of Primary Adrenal Insufficiency." J Clin Endocrinol Metab.
2011;96(7):1957-1966.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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NEW QUESTION # 138
Which sonographic finding indicates the need for immediate surgical intervention following testicular trauma?
Answer: A
Explanation:
The tunica albuginea is a dense fibrous capsule surrounding the testis. Discontinuity of the tunica albuginea on ultrasound is diagnostic of testicular rupture - a urologic emergency that requires immediate surgical repair to preserve testicular function and viability. Early surgical intervention within 72 hours has a high success rate for testicular salvage (up to 90%).
* Intratesticular hematoma (A) may be managed conservatively if the tunica albuginea is intact.
* Heterogeneity of the parenchyma (C) indicates injury but not necessarily rupture.
* Increased vascularity (D) may be seen with inflammation or reperfusion but does not mandate surgery unless rupture is present.
Reference Extracts:
* Dogra VS, Bhatt S. "Acute painful scrotum: ultrasound evaluation." Radiologic Clinics of North America. 2004; 42(2):349-363.
* Middleton WD, Kurtz AB, Hertzberg BS.Ultrasound: The Requisites. 3rd ed. Elsevier, 2015.
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NEW QUESTION # 139
Which sonographic finding is most consistent with scrotal inflammation?
Answer: B
Explanation:
Scrotal inflammation, such as epididymitis or orchitis, typically presents with increased blood flow (hyperemia) on color Doppler sonography. This finding reflects the inflammatory process and vascular dilation. Abscesses, granulomas, or hydroceles may be present but are not as consistent or specific for inflammation.
According to AIUM Practice Parameters and Rumack's Diagnostic Ultrasound:
"In acute inflammation, color Doppler ultrasound demonstrates prominent hyperemia of the epididymis or testis." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Scrotal Ultrasound, 2020.
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NEW QUESTION # 140
Which best describes the Doppler waveform findings in this image?
Answer: A
Explanation:
The Doppler spectral waveform shown in this image of the right testis demonstrates low-resistance, forward- flowing arterial waveforms with continuous diastolic flow - this is characteristic of normal testicular perfusion. The presence of both color Doppler flow and a resistive index (RI) of 0.66 further supports normal testicular arterial circulation.
Key Doppler features of a normal testicular waveform:
* Low-resistance waveform (RI typically 0.5-0.75)
* Continuous diastolic flow
* No reversal of flow or spectral broadening
* Color Doppler confirms uniform intratesticular vascularity
Clinical context:
* Normal testicular flow on Doppler imaging excludes testicular torsion, infarction, or significant inflammation.
* Testicular torsion would show either absent or very high-resistance (reduced or absent diastolic flow) waveform.
* Epididymo-orchitis may show hyperemia with low resistance but often presents with other gray-scale findings like heterogeneous echotexture or scrotal wall thickening.
Differentiation from other options:
* B. Increased resistance: RI >0.75 and reduced or reversed diastolic flow; may indicate impending torsion or ischemia.
* C. Tardus parvus: A slow systolic upstroke and diminished amplitude; indicates proximal arterial stenosis.
* D. Triphasic: Normal waveform in peripheral arteries, such as extremities, not seen in testicular circulation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Male Pelvis - Testis and Scrotum, pp. 793-800.
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations, 2020.
Radiopaedia.org. Testicular Doppler assessment: https://radiopaedia.org/articles/testicular-doppler-assessment
NEW QUESTION # 141
Which pancreatic condition is commonly associated with complete or partial atresia of the duodenum?
Answer: D
Explanation:
Annular pancreas is a congenital anomaly in which pancreatic tissue encircles the second part of the duodenum, potentially causing partial or complete duodenal obstruction (atresia). It is due to abnormal migration of the ventral pancreatic bud.
According to Rumack's Diagnostic Ultrasound:
"Annular pancreas results from failure of the ventral pancreatic bud to rotate properly, leading to encirclement of the duodenum." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Moore KL, Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
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NEW QUESTION # 142
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