ARDMS Abdomen (AB) Exam Flashcards

Q: How many questions are on the ARDMS Abdomen (AB) exam and how much time do I get?

The AB exam has approximately 165 multiple-choice questions with a 3-hour (180-minute) time limit. Questions are organized into four task-based domains: Anatomy, Perfusion, and Function (30%); Pathology, Vascular Abnormalities, Trauma, and Postop (42%); Abdominal Physics (8%); and Clinical Care, Practice, and QA (20%).

Q: What is the passing score for the RDMS Abdomen exam?

You need a scaled score of 555 or higher on ARDMS's 300-700 point scale. This is not a straight percentage - ARDMS statistically scales scores across different exam forms to keep difficulty comparable across test dates, so 555 does not correspond to one fixed raw percentage.

Q: What is the pass rate for the ARDMS Abdomen exam?

Per ARDMS/Inteleos published 2023 data, the first-time pass rate was 72%, with an overall pass rate (including retakes) of 64%. Pass rates can shift year to year as ARDMS updates exam forms, so always check the current Candidate Information Bulletin for the latest figures.

Q: What are the prerequisites for taking the AB exam?

You must pass the SPI (Sonography Principles and Instrumentation) exam and the AB exam within five years of each other, in either order, plus meet one of ARDMS's eligibility pathways (graduate of an accredited sonography program, degree plus qualifying clinical experience, or equivalent documented clinical hours). No employer sponsorship is required.

Q: How long must I wait to retake the AB exam if I fail?

ARDMS requires a flat 60-day wait before retaking the AB exam after any failed attempt. There is no escalating penalty for multiple failures the way some other certifying bodies structure retakes, and there is no cap on the total number of attempts allowed.

Q: How do I keep my RDMS Abdomen certification active?

RDMS credentials must be renewed every 3 years by completing 30 continuing medical education (CME) credits during that cycle through ARDMS-approved providers such as SDMS or AIUM, or by retaking the specialty exam.

Question 1

What is the normal liver span measured at the midclavicular line (MCL)?

Accepted Answer

13-15.5 cm is normal. A span greater than 15.5 cm meets the sonographic threshold for hepatomegaly.

Question 2

Which liver segment is typically spared in cirrhosis, and why does this matter sonographically?

Accepted Answer

The caudate lobe (Couinaud segment I), because it has an independent vascular supply. Relative caudate hypertrophy compared to a shrunken right lobe is a classic cirrhosis clue.

Question 3

What does the ligamentum teres (round ligament) represent, and where is it seen?

Accepted Answer

The fibrosed remnant of the fetal umbilical vein, seen as an echogenic focus in the left intersegmental fissure (free edge of the falciform ligament), which separates the medial (segment IV) and lateral segments of the left lobe.

Question 4

How is the common bile duct (CBD) measured, and what is its normal diameter?

Accepted Answer

Measured inner-wall-to-inner-wall; normal is under 6-7 mm. Diameter can normally increase up to about 10 mm after cholecystectomy.

Question 5

How does normal CBD diameter change with age after 60?

Accepted Answer

Add roughly 1 mm per decade of life after age 60 - a diameter that would be borderline-abnormal in a 40-year-old can be normal in an 80-year-old.

Question 6

What is the normal gallbladder wall thickness, and when should thickening raise concern?

Accepted Answer

Under 3 mm is normal when the gallbladder is distended. Thickening beyond this in a properly fasted patient raises suspicion for cholecystitis or other GB pathology.

Question 7

What is the normal upper limit for the main pancreatic duct diameter?

Accepted Answer

Under 2-3 mm. A duct dilated beyond this raises concern for obstruction, chronic pancreatitis, or a pancreatic head/periampullary mass.

Question 8

What splenic length defines splenomegaly?

Accepted Answer

A spleen measuring over 12-13 cm in length is enlarged; normal splenic length is under 12 cm.

Question 9

What is the normal adult renal length range?

Accepted Answer

9-12 cm is the normal range for adult kidney length. A size discrepancy greater than about 2 cm between the two kidneys is abnormal and warrants further evaluation.

Question 10

How does normal renal cortex echogenicity compare to the liver?

Accepted Answer

Normal renal cortex is hypoechoic (less echogenic) relative to the liver. Cortex that is iso- or hyperechoic to the liver suggests medical renal disease.

Question 11

Which part of the kidney is normally the most echogenic, and why?

Accepted Answer

The renal sinus, because it is composed largely of fat surrounding the collecting system and vessels, and fat is highly echogenic on ultrasound.

Question 12

At what abdominal aortic diameter is elective surgical repair typically indicated in men versus women?

Accepted Answer

5.5 cm in men and 5.0 cm in women - the lower threshold in women reflects their higher rupture risk at smaller diameters.

Question 13

What is the normal direction of portal venous flow called, and what does reversal indicate?

Accepted Answer

Normal portal flow is hepatopetal (toward the liver). Reversed, hepatofugal flow is abnormal and is classically seen with portal hypertension.

Question 14

What is the normal hepatic vein waveform pattern, and what does a flattened waveform suggest?

Accepted Answer

A triphasic waveform reflecting transmitted right atrial pressure changes through the cardiac cycle. A flattened or monophasic pattern suggests decreased liver compliance, such as from cirrhosis or fibrosis.

Question 15

What is the normal resistive index (RI) range for the main renal artery, and what value is elevated?

Accepted Answer

Normal renal RI is under 0.7. An RI over 0.7 is abnormal and can indicate intrinsic renal disease, obstruction, or - in a transplant - rejection.

Question 16

What is the classic sonographic appearance of hepatic steatosis (fatty liver)?

Accepted Answer

Diffusely increased (hyperechoic) parenchymal echogenicity compared to the renal cortex, with poor sound penetration and beam attenuation into the deeper liver and diaphragm.

Question 17

What sonographic triad characterizes cirrhosis?

Accepted Answer

A small, nodular, coarse-echotexture liver with a shrunken right lobe and compensatory caudate/left lobe hypertrophy, plus signs of portal hypertension such as ascites and splenomegaly.

Question 18

What is the classic sonographic appearance of a hepatic hemangioma?

Accepted Answer

A well-defined, homogeneously hyperechoic mass - the most common benign liver tumor, typically small and asymptomatic.

Question 19

What causes Budd-Chiari syndrome, and what is its sonographic hallmark?

Accepted Answer

Thrombosis or obstruction of the hepatic veins (or IVC), causing impaired venous outflow. Sonography shows absent, reversed, or turbulent hepatic vein flow with an enlarged, congested liver.

Question 20

What does the WES sign indicate, and what are its three components?

Accepted Answer

It indicates a gallbladder packed with stones: the GB Wall, a bright reflector Echo from the stone surface, and posterior acoustic Shadowing, with little to no visible bile between them.

Question 21

What is a sonographic Murphy sign, and what does it indicate?

Accepted Answer

Focal tenderness elicited when the transducer is pressed directly over a sonographically visualized gallbladder. A positive sign strongly supports acute cholecystitis.

Question 22

What is the Courvoisier sign, and what does it classically suggest?

Accepted Answer

A palpable, painless, distended gallbladder in a jaundiced patient - classically associated with a malignant distal biliary/pancreatic head obstruction rather than gallstone disease.

Question 23

What is a Klatskin tumor, and where does it occur?

Accepted Answer

A cholangiocarcinoma arising at the biliary hilum (confluence of right and left hepatic ducts), causing intrahepatic ductal dilation without gallbladder or extrahepatic CBD dilation.

Question 24

What distinguishes a Bosniak I renal cyst from a Bosniak II cyst?

Accepted Answer

Bosniak I is a simple, anechoic, thin-walled benign cyst with no septa or calcification. Bosniak II is minimally complex - it may have a few thin septa or fine calcification - but is still considered benign.

Question 25

What does a Bosniak IIF classification mean for patient management?

Accepted Answer

IIF ('F' for follow-up) describes a cyst with slightly more complexity than category II. It requires periodic follow-up imaging rather than immediate intervention, since a small percentage prove malignant over time.

Question 26

How does Bosniak III differ from Bosniak IV in required management?

Accepted Answer

Bosniak III is indeterminate/complex and warrants surgical evaluation because a substantial proportion are malignant. Bosniak IV is clearly malignant, showing enhancing soft-tissue components, and is treated as cancer.

Question 27

What is the classic sonographic appearance of a renal angiomyolipoma (AML), and why does it matter?

Accepted Answer

A small, well-defined, uniformly echogenic mass due to its fat content. The echogenic appearance helps distinguish it from a solid renal cell carcinoma, though overlap can occur.

Question 28

What Doppler artifact occurs when velocity exceeds the Nyquist limit, and how is it corrected?

Accepted Answer

Aliasing - a wraparound artifact where high velocities wrap to the opposite end of the color or spectral scale. Correct it by increasing the scale/PRF, shifting the baseline, lowering the transducer frequency, or increasing the Doppler angle.

Question 29

What sonographic finding suggests acute renal vein thrombosis?

Accepted Answer

An enlarged, edematous kidney with absent or reversed venous flow on Doppler; arterial waveforms may show elevated resistance or reversed diastolic flow.

Question 30

What is Nutcracker syndrome, and which vessel compresses the left renal vein?

Accepted Answer

Compression of the left renal vein between the aorta and the superior mesenteric artery (SMA), causing dilation proximal to the compression and symptoms such as hematuria and flank pain.

Question 31

What sonographic findings suggest portal hypertension?

Accepted Answer

Splenomegaly, ascites, portosystemic varices, a dilated and often non-compressible portal vein, and possible hepatofugal (reversed) portal flow.

Question 32

What four views make up a standard FAST exam, and what is it screening for?

Accepted Answer

Perihepatic (Morrison's pouch), perisplenic, pelvic, and cardiac (subxiphoid) views - screening for free intraperitoneal or pericardial fluid after trauma.

Question 33

Why is Morrison's pouch usually the first place free fluid accumulates in a supine trauma patient?

Accepted Answer

It is the most dependent potential space in the peritoneal cavity in the supine position (the hepatorenal recess), so even small volumes of free fluid pool there first.

Question 34

What Doppler finding in a transplanted kidney raises concern for acute rejection?

Accepted Answer

A rising resistive index (RI), often with graft swelling and loss of corticomedullary differentiation, compared to the patient's prior baseline scan.

Question 35

Where does an inguinal hernia occur relative to the inguinal ligament?

Accepted Answer

At or above the level of the inguinal ligament, distinguishing it from a femoral hernia, which occurs below the ligament.

Question 36

What maneuver helps sonographically provoke and confirm a suspected abdominal wall hernia?

Accepted Answer

The Valsalva maneuver - having the patient bear down increases intra-abdominal pressure, pushing bowel or fat through the defect and making the hernia bulge more visible.

Question 37

Why is a curvilinear (curved array) transducer preferred for general abdominal imaging over a linear transducer?

Accepted Answer

Its lower operating frequency and wider, diverging field of view give better penetration for deep abdominal organs, whereas linear transducers run at higher frequency and suit superficial structures.

Question 38

What causes a comet-tail (ring-down) artifact in gallbladder imaging, and what condition does it suggest?

Accepted Answer

Reverberation off small crystalline or cholesterol deposits in the gallbladder wall; it is the classic sign of adenomyomatosis.

Question 39

A patient with a large body habitus has poor image penetration on abdominal ultrasound - what adjustment improves visualization?

Accepted Answer

Lower the transducer frequency to increase depth of penetration, accepting a tradeoff in resolution; harmonic or compound imaging can also help reduce noise.

Question 40

What is the key tradeoff between color Doppler and power Doppler?

Accepted Answer

Color Doppler shows flow direction but is angle-dependent and prone to aliasing. Power Doppler is more sensitive for detecting low-flow states but does not display flow direction.

Question 41

What patient preparation is required before a biliary/upper abdominal ultrasound, and why?

Accepted Answer

NPO (nothing by mouth) for 6-8 hours before the exam. Fasting lets the gallbladder distend with bile for better evaluation and reduces bowel gas from digestion that could obscure the pancreas and other structures.

Question 42

Why is a full urinary bladder needed before a pelvic or renal ultrasound?

Accepted Answer

A distended bladder acts as an acoustic window, displacing bowel gas out of the pelvis and improving visualization of pelvic organs and the distal ureters.

Question 43

Which lab values should a sonographer correlate with hepatobiliary and renal ultrasound findings?

Accepted Answer

Liver function tests such as bilirubin, AST/ALT, and alkaline phosphatase for hepatobiliary studies; BUN and creatinine for renal studies - abnormal labs help focus and interpret the scan.

Question 44

What is the ideal Doppler angle of insonation for accurate velocity measurement, and why?

Accepted Answer

60 degrees or less. Beyond this, small errors in angle measurement cause increasingly large errors in the calculated velocity, since the Doppler equation depends on the cosine of the angle.

Question 45

Where should the pulsed-wave Doppler sample volume (gate) be placed for an accurate spectral waveform?

Accepted Answer

Within the lumen of the vessel being interrogated, ideally centered in the flow stream, to avoid wall artifact and get a representative velocity measurement.

Question 46

What must be verified immediately before an image-guided needle procedure such as a biopsy or drainage?

Accepted Answer

Correct patient identity, procedure site, and laterality, along with documented informed consent - a pre-procedure 'time-out' confirms these before the needle is placed.

Question 47

What federal law governs protection of a patient's health information during and after a sonography exam?

Accepted Answer

HIPAA (Health Insurance Portability and Accountability Act) - it protects the privacy and security of patient health information and restricts who can access or share exam findings and records.

Question 48

Why might a sonographer scan a patient in multiple positions, such as supine, decubitus, and upright, during an abdominal exam?

Accepted Answer

Repositioning can move bowel gas out of the way, confirm that mobile debris (like sludge) redistributes with gravity rather than staying fixed, and help distinguish gravity-dependent findings from true fixed masses.

Question 49

What must a sonographer obtain before performing an invasive procedure such as an ultrasound-guided biopsy?

Accepted Answer

Documented informed consent - the patient or authorized representative must be informed of the procedure's risks, benefits, and alternatives before it is performed.

Question 50

What should be assessed immediately after an ultrasound-guided procedure, such as a biopsy or paracentesis?

Accepted Answer

The patient should be monitored for complications such as bleeding, hematoma formation, or new pain, and a post-procedure image is often obtained to document the needle path and rule out immediate complications.

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