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  1. Home
  2. ARDMS Certification
  3. AB-Abdomen Exam
  4. ARDMS.AB-Abdomen.v2026-04-21.q55 Dumps
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Question 11

Which renal anomaly is demonstrated on this image?

Correct Answer: C
The ultrasound image labeled "SAG RUQ KIDNEY" demonstrates a midline sagittal view showing a renal parenchymal structure that extends across the midline anterior to the aorta and vertebral bodies, suggesting the presence of a horseshoe kidney.
A horseshoe kidney is a congenital renal anomaly in which the lower poles of both kidneys are fused across the midline by a parenchymal or fibrous isthmus. This isthmus typically lies anterior to the aorta and inferior vena cava and can be seen as a hypoechoic band of tissue crossing the midline on ultrasound.
Ultrasound findings characteristic of a horseshoe kidney:
* Abnormally low position of the kidneys in the abdomen
* Renal tissue (isthmus) bridging the lower poles anterior to the great vessels
* Renal axes may be more horizontal than usual
* Kidneys may appear closer together or "kissing" the spine anteriorly
Differentiation from other options:
* A. Duplicated collecting system: Manifests as two separate collecting systems within one kidney, often with a central renal sinus split into two - not typically midline bridging.
* B. Crossed renal ectopia: Involves one kidney crossing midline and fusing with the other on the opposite side, but they do not form a midline isthmus.
* D. Pelvic kidney: A single kidney located in the pelvis due to failed ascent - it does not appear as midline fusion of two kidneys.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Urinary Tract, pp. 215-218.
American Institute of Ultrasound in Medicine (AIUM). Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum. 2020.
Radiopaedia.org. Horseshoe kidney: https://radiopaedia.org/articles/horseshoe-kidney
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Question 12

Which condition is most consistent with thinning of the renal cortex, reduction in renal length, and prominence of the renal sinus fat in a patient presenting four months after renal transplant with slightly reduced renal function?

Correct Answer: B
Chronic rejection presents sonographically as cortical thinning, decreased renal size, and increased echogenicity of the renal sinus fat. Acute rejection typically causes an enlarged, edematous kidney with increased parenchymal echogenicity but preserved size early on.
According to Zwiebel's Introduction to Vascular Ultrasound:
"In chronic rejection, the allograft becomes smaller with cortical thinning, increased echogenicity, and prominence of the central sinus fat." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Renal Transplant Ultrasound, 2020.
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Question 13

Which diagnosis is most accurate based on the findings in this image from an adult patient?

Correct Answer: C
The ultrasound images (sagittal and transverse views of the left kidney) demonstrate a large, well-defined, heterogeneous mass within the renal parenchyma. This is highly characteristic of renal cell carcinoma (RCC), the most common primary renal malignancy in adults.
Renal cell carcinoma accounts for approximately 85% of all malignant renal tumors in adults. RCC often appears as:
* A solid, heterogeneous, hypoechoic to isoechoic mass within the kidney
* May contain areas of necrosis or hemorrhage (seen as mixed echogenicity)
* Distortion of the normal renal contour
* May have internal vascularity on Doppler imaging
Clear cell carcinoma (choice B) is the most common histological subtype of RCC but is not a separate diagnosis from RCC in imaging terms. Therefore, the most accurate answer is choice C: Renal cell carcinoma.
Differentiation from other options:
* A. Nephroblastoma (Wilms tumor): A pediatric renal tumor, typically seen in children under 5 years of age-not applicable in adults.
* B. Clear cell carcinoma: Histological subtype of RCC, not a distinct radiologic diagnosis.
* D. Transitional cell carcinoma: Arises from the renal pelvis or ureter, typically appears as a central or collecting system mass rather than a cortical/parenchymal one.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Kidneys, pp. 215-222.
Radiopaedia.org. Renal cell carcinoma: https://radiopaedia.org/articles/renal-cell-carcinoma American College of Radiology (ACR) Appropriateness Criteria - Hematuria, 2022.
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Question 14

Which scanning technique is most beneficial when imaging the appendix?

Correct Answer: A
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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Question 15

Which renal condition is commonly associated with pyuria and leukocytosis?

Correct Answer: D
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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