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

The seminiferous tubules are coiled structures located within the testes where spermatogenesis (sperm production) occurs. They are surrounded by Sertoli and Leydig cells that support spermatogenesis and testosterone production.

Gubernacula (A) are fetal structures involved in testicular descent.

Efferent ductules (B) connect the rete testis to the epididymis but are not located within the testicular parenchyma.

Aberrant ductules (C) are accessory ducts found outside the testis.

Reference Extracts:

Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. 7th ed. Lippincott Williams & Wilkins, 2013.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

Acute tubular necrosis (ATN) is the most common cause of early graft dysfunction following renal transplantation. It results from ischemia-reperfusion injury during the transplantation process. Ultrasound findings may be nonspecific but Doppler may show elevated resistive indices.

Ureterocele (A) is a congenital anomaly.

Transplant artery stenosis (C) is a late complication.

Transitional cell carcinoma (D) is rare and not typically an early complication.

Reference Extracts:

Middleton WD, Kurtz AB, Hertzberg BS. Ultrasound: The Requisites. 3rd ed. Elsevier, 2015.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

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Caput medusae refers to dilated paraumbilical veins due to portal hypertension. When portal venous pressure rises, collateral channels may open along the ligamentum teres and recanalized paraumbilical vein, resulting in visible dilated veins radiating from the umbilicus.

Esophageal varices (B) are gastroesophageal collaterals.

Coronary vein varices (C) involve gastric veins.

Splenic vein varices (D) are typically localized to the splenic hilum.

Reference Extracts:

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

Gore RM, Levine MS. Textbook of Gastrointestinal Radiology. 4th ed. Saunders, 2015.

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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.

Before performing a paracentesis, assessment of the patient's coagulation status is crucial to minimize bleeding risk. The International Normalized Ratio (INR) is the standard lab value used to assess coagulation. Elevated INR may increase the risk of bleeding complications during the procedure. ALT, AFP, and bilirubin levels evaluate liver function or cancer progression but are not directly relevant to bleeding risk for this procedure.

As per AASLD and SIR guidelines:

“An INR and platelet count should be evaluated before paracentesis to assess bleeding risk. Minor elevations in INR (<1.5) may not contraindicate the procedure.” (AASLD Practice Guidance, 2021; SIR Consensus Guidelines, 2019).

Ring-down artifact occurs when gas bubbles resonate or oscillate, creating continuous echoes distal to the structure that appear as a vertical, echogenic band extending posteriorly. This is distinct from reverberation, which produces multiple discrete reflections.

According to Zwiebel’s Introduction to Vascular Ultrasound:

“Ring-down artifact results from resonance of gas bubbles, producing a continuous, echogenic tail distal to the reflecting interface.”

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.”

The ultrasound image shows disruption of the normal fibrillar echotexture of a muscle or tendon, consistent with a soft tissue injury such as a muscle or tendon tear. There is likely hypoechoic fluid consistent with a hematoma or edema, which commonly results from blunt or direct trauma.

This image is typical of a traumatic injury (e.g., partial or complete tendon rupture or muscle strain/tear). These findings are frequently encountered in athletic injuries or blunt force trauma and correlate strongly with the clinical history of trauma.

Key sonographic features suggestive of trauma:

Discontinuity or heterogeneity of normal striated muscle or tendon pattern

Hypoechoic or anechoic area representing hematoma or fluid collection

Retraction of muscle or tendon ends (in full-thickness tears)

Surrounding soft tissue edema

Differentiation from other options:

B. Focal pain: While pain may be a symptom, trauma is the more definitive and primary clinical indication for the findings shown.

C. Palpable abnormality: May suggest a mass or cystic lesion (e.g., lipoma, abscess), not typically the appearance shown here.

D. Decreased range of motion: May be present secondarily, but not the most consistent or primary clinical indication in this case.

Thyroid adenomas typically present as well-defined nodules surrounded by a thin, hypoechoic peripheral halo representing compressed thyroid parenchyma or fibrous capsule. Irregular margins suggest malignancy.

According to Rumack’s Diagnostic Ultrasound:

“A thin hypoechoic halo is characteristic of benign thyroid adenomas.”