Pass AB-Abdomen Exam in First Attempt Guaranteed 100% Cover Real Exam Questions [Jan-2026]
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NEW QUESTION # 62
Which description best characterizes a normal systolic spectral waveform of the renal artery?
- A. Blunt peak
- B. Early reversal
- C. Rapid acceleration
- D. Slow acceleration
Answer: C
Explanation:
A normal renal artery waveform demonstrates rapid systolic upstroke (acceleration) with continuous forward flow in diastole due to the kidney's low-resistance vascular bed. Slow acceleration or blunted peaks may indicate significant renal artery stenosis.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Normal renal artery waveforms demonstrate a rapid systolic acceleration with a sharp systolic peak." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
ACR Practice Parameter for the Performance of a Duplex Doppler Examination, 2021.
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NEW QUESTION # 63
Which vascular condition is most likely associated with the sonographic findings demonstrated in this image?
- A. Recanalized umbilical vein
- B. Median arcuate ligament syndrome
- C. Budd-Chiari syndrome
- D. Splenic artery aneurysm
Answer: A
Explanation:
The ultrasound image demonstrates a tubular, anechoic structure coursing anterior to the left portal vein and heading toward the anterior abdominal wall. This is consistent with a recanalized umbilical vein, which is an important collateral pathway that reopens in cases of portal hypertension.
Normally, the umbilical vein becomes obliterated after birth and forms the ligamentum teres. However, in the setting of significant portal hypertension, the umbilical vein may recanalize and serve as a collateral route to decompress the portal system.
Sonographic features of a recanalized umbilical vein:
* Anechoic, tubular structure in the ligamentum teres fissure
* Seen anterior to the left portal vein
* Color Doppler confirms hepatofugal venous flow
* Associated with signs of portal hypertension (e.g., splenomegaly, varices) Differentiation from other options:
* A. Budd-Chiari syndrome: Involves hepatic vein outflow obstruction; ultrasound shows absent or narrowed hepatic veins and may have caudate lobe hypertrophy.
* B. Splenic artery aneurysm: Typically visualized near the splenic hilum as a pulsatile cystic mass; Doppler shows arterial flow.
* D. Median arcuate ligament syndrome: Involves compression of the celiac axis; best assessed with Doppler showing elevated velocities on expiration.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Portal Hypertension and Collaterals, pp. 101-104.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Vascular Ultrasound Examination, 2020.
Radiopaedia.org. Recanalized umbilical vein: https://radiopaedia.org/articles/recanalised-umbilical-vein
NEW QUESTION # 64
Which hernia characteristic is demonstrated in these images?
- A. Fat only
- B. Reducible
- C. Incarcerated
- D. Strangulated
Answer: B
Explanation:
The ultrasound images show two views of the same groin region - one without compression (left image labeled "W/O COMPRESSION") and one with graded probe compression (right image labeled "W/ COMPRESSION").
In the non-compression image, a hypoechoic mass-like structure is visible protruding through the abdominal wall, consistent with a hernia sac. On the compression image, the herniated content is no longer visible, indicating that the contents have been pushed back into the abdominal cavity. This is the hallmark feature of a reducible hernia.
Key characteristics of a reducible hernia on ultrasound:
* Herniated contents are visible without pressure.
* Contents disappear or reduce back into the abdomen with graded probe compression or Valsalva release.
* Typically includes omental fat or bowel, but reduction confirms lack of incarceration or strangulation.
Comparison of answer choices:
* A. Fat only refers to the hernia content type, not the behavior or reducibility shown here.
* B. Reducible - Correct. The change in hernia appearance between images demonstrates successful reduction with compression.
* C. Incarcerated hernia would remain visible and not compressible or reducible.
* D. Strangulated hernia would show signs of ischemia (bowel wall thickening, absent perfusion, hyperechoic mesentery), and would also not reduce with compression.
References:
Radswiki. Ultrasound evaluation of hernia. Radiopaedia.org
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination for Hernia (2021)
NEW QUESTION # 65
Which condition is demonstrated in this image?
- A. Portal vein thrombosis
- B. Tumor extension
- C. Cavernous transformation
- D. Portal hypertension
Answer: C
Explanation:
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.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Portal Venous System, pp. 107-110.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of a Vascular Ultrasound Examination, 2021.
Radiopaedia.org. Cavernous transformation of the portal vein: https://radiopaedia.org/articles/cavernous- transformation-of-the-portal-vein
NEW QUESTION # 66
Which condition is associated with multiple pancreatic cysts?
- A. Von Hippel Lindau syndrome
- B. Cystic fibrosis
- C. Beckwith Wiedemann syndrome
- D. Autosomal recessive polycystic kidney disease
Answer: A
Explanation:
Von Hippel-Lindau (VHL) syndrome is a genetic disorder associated with multiple pancreatic cysts, pancreatic neuroendocrine tumors, and other systemic neoplasms. While cystic fibrosis can produce thickened pancreatic secretions, it rarely causes true pancreatic cysts.
According to Rumack's Diagnostic Ultrasound:
"Multiple pancreatic cysts are strongly associated with Von Hippel Lindau syndrome." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Digestive System Tumors, 5th ed., IARC, 2019.
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NEW QUESTION # 67
Which scanning technique is most beneficial when imaging the appendix?
- A. Apply light pressure around the patient's area of pain
- B. Image small bowel transversely to evaluate for peristalsis
- C. Apply graded compression around the patient's area of pain
- D. Image in the longitudinal plane around the iliac vessels
Answer: C
Explanation:
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." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen, 2020.
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NEW QUESTION # 68
Which retroperitoneal finding is most likely associated with trauma?
- A. Fibrosis
- B. Urinoma
- C. Neuroblastoma
- D. Adenoma
Answer: B
Explanation:
Urinomas are collections of urine in the retroperitoneum that result from trauma, surgery, or obstruction causing urine leakage. Trauma is a frequent cause of urinoma formation due to disruption of the urinary tract.
According to Rumack's Diagnostic Ultrasound:
"Urinomas may develop as a complication of trauma, surgery, or obstructive uropathy with urinary extravasation into the retroperitoneum." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Renal Ultrasound, 2020.
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NEW QUESTION # 69
A patient presents with right lower quadrant pain and fever. Which condition is most likely indicated by the arrow on this image?
- A. Enlarged lymph node
- B. Bowel obstruction
- C. Intussusception
- D. Ruptured appendix
Answer: D
Explanation:
The ultrasound image demonstrates a tubular, non-compressible, blind-ending structure located in the right lower quadrant (RLQ) with associated echogenic periappendiceal fat and possibly adjacent fluid or phlegmon.
These features are consistent with appendicitis. Given the clinical history of fever and RLQ pain, along with the irregular borders and complex periappendiceal findings, the diagnosis of a ruptured appendix is most likely.
Key sonographic features of ruptured appendicitis include:
* Non-visualization or distortion of the normal appendiceal wall architecture
* Periappendiceal fluid collection or abscess
* Disruption of the echogenic submucosal layer
* Surrounding fat stranding (hyperechoic inflammatory changes)
* Clinical correlation with fever and peritonitis
Comparison of answer choices:
* A. Bowel obstruction typically shows dilated bowel loops with air-fluid levels, not a tubular structure like the appendix.
* B. Intussusception presents with a target or "donut" sign in a transverse view, not a linear tubular structure.
* C. Enlarged lymph nodes are usually round or oval and hypoechoic with a central echogenic hilum, without a tubular appearance.
* D. Ruptured appendix - Correct. The ultrasound features and clinical presentation match.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Jeffrey RB, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology.
1988;167(2):327-329.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of the Ultrasound Examination for Appendicitis (2020).
NEW QUESTION # 70
Which renal condition is commonly associated with pyuria and leukocytosis?
- A. Renal cell carcinoma
- B. Acute pyelonephritis
- C. Nephrocalcinosis
- D. Staghorn calculus
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 # 71
Where in the neck are most thyroid cancer recurrences found?
- A. Contralateral
- B. Ipsilateral
- C. Subauricular
- D. Bilateral
Answer: B
Explanation:
Most thyroid cancer recurrences are found in the ipsilateral neck-particularly in the central (level VI) or lateral (levels II-V) compartments on the same side as the original malignancy.
According to AIUM Practice Parameters:
"Post-thyroidectomy recurrence most frequently occurs ipsilateral to the original tumor, commonly involving regional lymph nodes." Reference:
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
American Thyroid Association (ATA) Guidelines for Thyroid Cancer Management, 2015.
NEW QUESTION # 72
Which scanning technique would best reduce reverberation artifact when assessing the gallbladder?
- A. Decrease the overall gain
- B. Turn on harmonics
- C. Decrease the sector width
- D. Turn on penetration
Answer: B
Explanation:
Tissue harmonic imaging significantly reduces reverberation and side-lobe artifacts by utilizing nonlinear propagation of ultrasound waves. This produces clearer images of fluid-filled structures like the gallbladder, improving visualization of wall thickness and intraluminal contents.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Harmonic imaging effectively reduces reverberation artifact, improving image quality in gallbladder and cystic structure evaluation." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Abdominal Ultrasound, 2020.
NEW QUESTION # 73
Which finding is demonstrated in this image?
- A. Acute medical renal disease
- B. Medullary sponge kidney
- C. Acute hepatitis
- D. Hepatic steatosis
Answer: D
Explanation:
The ultrasound image demonstrates diffuse increased echogenicity of the liver parenchyma with posterior beam attenuation (acoustic shadowing), findings that are consistent with hepatic steatosis (fatty liver disease).
The liver appears brighter than normal, and the vascular markings, particularly of the portal veins, are obscured due to the increased parenchymal echogenicity.
Hepatic steatosis refers to the abnormal accumulation of fat within hepatocytes and is commonly associated with obesity, diabetes, alcohol use, and metabolic syndrome.
Classic sonographic features of hepatic steatosis include:
* Diffuse hyperechogenicity ("bright liver")
* Poor visualization of intrahepatic vessels and diaphragm
* Posterior acoustic attenuation
* Increased hepatic echogenicity relative to the renal cortex
Differentiation from other options:
* A. Acute hepatitis: Usually presents with normal or slightly decreased echogenicity, "starry sky" appearance due to prominent portal triads and periportal edema.
* C. Medullary sponge kidney: A renal condition with echogenic medullary pyramids, not hepatic.
* D. Acute medical renal disease: Affects the kidneys, often with bilateral renal enlargement and increased cortical echogenicity-again not related to liver imaging.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Liver, pp. 93-97.
American College of Radiology (ACR) Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2021.
Radiopaedia.org. Fatty liver (ultrasound): https://radiopaedia.org/articles/fatty-liver-ultrasound
NEW QUESTION # 74
Which disease process may cause numerous shadowing calcifications to form within the spleen?
- A. Thalassemia
- B. Sickle cell anemia
- C. Non-Hodgkin lymphoma
- D. Histoplasmosis
Answer: D
Explanation:
Histoplasmosis is a fungal infection that can lead to granulomatous disease. Chronic granulomatous infections may result in multiple splenic calcifications that appear as small echogenic foci with shadowing on ultrasound. Other infectious granulomas (e.g., tuberculosis) may present similarly.
According to Rumack's Diagnostic Ultrasound:
"Granulomatous infections such as histoplasmosis and tuberculosis may produce multiple splenic calcifications, often with shadowing." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Abdominal Ultrasound Examinations, 2020.
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NEW QUESTION # 75
Which technique is best for demonstrating the characteristic of the small hepatic lesion identified by the arrow on this image?
- A. Scan in upright position
- B. Use a standoff pad
- C. Move the transducer focus
- D. Decrease depth
Answer: B
Explanation:
The image shows a small hepatic lesion located very close to the anterior liver capsule, as indicated by the arrow. When imaging very superficial or near-field structures like subcapsular hepatic lesions, using a standoff pad is the most effective technique for optimizing visualization.
A standoff pad (also known as an acoustic stand-off or gel pad) helps increase the distance between the transducer and the superficial target. This improves the focus and beam shape for near-field imaging and minimizes reverberation and ring-down artifacts. It allows better evaluation of superficial lesions by positioning them within the focal zone of the transducer, which is usually set a few millimeters below the probe surface.
Differentiation from other options:
* A. Decrease depth: While reducing depth can help center deeper lesions in the field of view, it does not address issues with near-field resolution.
* B. Scan in upright position: This may help in gallbladder or fluid positioning but is not optimal for improving visualization of superficial liver lesions.
* C. Move the transducer focus: Adjusting focus deeper into the image won't enhance resolution of very superficial structures unless a standoff is used to bring the lesion into the focal zone.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Liver, pp. 80-84.
Kremkau FW. Sonography: Principles and Instruments. 9th Edition. Elsevier, 2015. Chapter: Image Formation and Optimization, pp. 114-117.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.
NEW QUESTION # 76
Which lymph node shape is concerning for malignancy in the post-thyroidectomy neck?
- A. Wider than tall
- B. Oval
- C. Taller than wide
- D. Round
Answer: D
Explanation:
Malignant lymph nodes are often round in shape (short axis/long axis ratio approaches 1), while benign lymph nodes are typically oval (short axis/long axis ratio < 0.5). Rounded shape in post-thyroidectomy patients raises suspicion for metastatic disease.
According to AIUM and ACR Thyroid Imaging Guidelines:
"A rounded lymph node shape is suspicious for malignancy, especially in patients with thyroid cancer." Reference:
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
ACR Thyroid Imaging Reporting and Data System (TI-RADS), 2017.
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NEW QUESTION # 77
Which vessel is typically seen with an echogenic ring of fat when imaging the upper abdominal mesenteric circulation?
- A. Splenic artery
- B. Gastroduodenal artery
- C. Common hepatic artery
- D. Superior mesenteric artery
Answer: D
Explanation:
The superior mesenteric artery (SMA) is typically visualized surrounded by an echogenic fat pad in the mesentery, producing a characteristic "echogenic ring" appearance on ultrasound. This is a helpful landmark for identifying the SMA in the transverse abdominal aortic plane.
According to Rumack's Diagnostic Ultrasound:
"The superior mesenteric artery is often seen as a round anechoic structure surrounded by echogenic fat at its origin from the anterior aorta." 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.
NEW QUESTION # 78
Which syndrome is characterized by right upper quadrant pain, ascites, and hepatocellular dysfunction?
- A. Budd-Chiari
- B. Ehlers-Danlos
- C. Calciphylaxis
- D. Klippel-Trenaunay
Answer: A
Explanation:
Budd-Chiari syndrome is caused by hepatic venous outflow obstruction, resulting in hepatomegaly, ascites, right upper quadrant pain, and liver dysfunction. It may be due to thrombosis or compression of the hepatic veins or IVC.
According to Rumack's Diagnostic Ultrasound:
"Budd-Chiari syndrome results from hepatic venous outflow obstruction and presents with hepatomegaly, ascites, and right upper quadrant pain." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Liver Ultrasound, 2020.
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NEW QUESTION # 79
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