TheorySonography ARDMS
Practice Test
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Sonography ARDMS exam — full Q&A walkthrough
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30 free Sonography ARDMS questions
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Abdominal Sonography
The liver is divided into right and left lobes by which structure on its visceral surface?
Correct — A. The falciform ligament (containing the ligamentum teres, the obliterated umbilical vein) divides the liver into right and left lobes on the anterior surface. The IVC marks the right posterior boundary but does not divide the lobes. -
Abdominal Sonography
Which hepatic vein drains directly into the inferior vena cava and runs between the right and left lobes?
Correct — C. The middle hepatic vein lies in the main lobar fissure and drains directly into the IVC, separating the right and left lobes. The right and left hepatic veins drain their respective lobes. -
Abdominal Sonography
On a transverse sonogram, the main lobar fissure connecting the gallbladder fossa to the right portal vein creates which appearance?
Correct — B. The main lobar fissure seen in continuity with the gallbladder neck and the right portal vein produces an 'exclamation mark' or 'golf-club' appearance on transverse imaging, a reliable landmark for the interlobar division. -
Abdominal Sonography
According to the Couinaud segmental system, segment I refers to which portion of the liver?
Correct — D. In the Couinaud classification, segment I is the caudate lobe, which has independent blood supply from both portal veins and hepatic veins draining directly into the IVC. -
Abdominal Sonography
Which Couinaud segments comprise the left lateral section of the liver?
Correct — A. Segments II and III form the left lateral section, lying to the left of the left hepatic vein. Segment IV (quadrate lobe) is the left medial section, and segments V–VIII comprise the right lobe. -
Abdominal Sonography
What percentage of hepatic blood flow is supplied by the portal vein?
Correct — C. Approximately 75% of total hepatic blood flow comes from the portal vein, while the remaining 25% is delivered by the hepatic artery. Despite lower volume, the hepatic artery supplies about 50% of hepatic oxygen. -
Abdominal Sonography
On color Doppler, normal portal venous flow in the main portal vein is best described as:
Correct — B. Normal portal flow is hepatopetal (toward the liver), continuous, and low velocity (typically 15–40 cm/s). Hepatofugal (reversed) flow is a sign of portal hypertension. -
Abdominal Sonography
The classic sonographic appearance of hepatic steatosis (fatty liver) is:
Correct — D. Fatty infiltration increases hepatic echogenicity (brighter than the renal cortex), and the excess fat attenuates the sound beam, causing poor deep penetration and reduced visualization of intrahepatic vessels. -
Abdominal Sonography
Which sonographic finding is MOST specific for advanced hepatic cirrhosis?
Correct — A. A nodular liver surface (due to regenerative nodules and fibrosis) combined with ascites is the most specific sonographic combination for cirrhosis. Hyperechogenicity alone suggests steatosis. -
Abdominal Sonography
A simple hepatic cyst on ultrasound characteristically demonstrates:
Correct — B. A simple cyst has no internal echoes, paper-thin walls, and shows posterior acoustic enhancement because sound passes through fluid with minimal attenuation. Any internal complexity warrants further evaluation. -
Abdominal Sonography
A hepatic hemangioma most typically appears on gray-scale ultrasound as:
Correct — C. Hepatic hemangiomas are typically uniformly hyperechoic with well-defined margins and may show mild posterior enhancement due to their blood-filled sinusoids. This appearance is most common in non-fatty livers. -
Abdominal Sonography
A 52-year-old with chronic hepatitis B presents with a 3 cm arterially enhancing liver mass. Which finding on gray-scale sonography would MOST raise suspicion for hepatocellular carcinoma (HCC)?
Correct — D. HCC in a cirrhotic liver often appears as a hypoechoic or heterogeneous mass with a peripheral hypoechoic halo (fibrous capsule) and internal vascularity on Doppler. Uniform hyperechogenicity is more typical of hemangioma. -
Abdominal Sonography
The normal intrahepatic bile duct diameter relative to the adjacent portal vein branch should be:
Correct — B. Normal intrahepatic ducts are less than 40% of the adjacent portal vein diameter (usually < 2 mm). Ducts appearing parallel to portal veins ('parallel channel sign') suggest biliary dilatation. -
Abdominal Sonography
What is the upper limit of normal for the common bile duct (CBD) diameter in an adult without prior cholecystectomy?
Correct — C. The CBD is considered normal up to 6–7 mm in adults without cholecystectomy. Post-cholecystectomy the duct may measure up to 10 mm. Values > 7 mm (non-surgical patient) warrant further investigation. -
Abdominal Sonography
Choledocholithiasis (stone in the common bile duct) is best characterized sonographically by:
Correct — D. CBD stones appear as echogenic foci that produce posterior acoustic shadowing, identical to gallstones. The absence of vascular flow (versus a polyp) and the shadow help differentiate stone from sludge or polyp. -
Abdominal Sonography
A Klatskin tumor is best described as a cholangiocarcinoma arising at which location?
Correct — A. Klatskin tumors are hilar cholangiocarcinomas that arise at or near the confluence of the right and left hepatic ducts. They typically obstruct the biliary system at the hilum and are associated with a poor prognosis. -
Abdominal Sonography
The normal gallbladder wall thickness, measured in a fasting patient, should not exceed:
Correct — B. In a properly fasted patient (minimum 6 hours), the gallbladder wall should measure ≤ 3 mm. Wall thickening > 3 mm is abnormal, though it can be caused by many conditions beyond cholecystitis. -
Abdominal Sonography
Which sonographic finding is considered pathognomonic for acute cholecystitis?
Correct — C. A positive sonographic Murphy's sign (maximal tenderness with direct probe pressure over the gallbladder) combined with gallstones is considered pathognomonic for acute cholecystitis, having high specificity. -
Abdominal Sonography
Adenomyomatosis of the gallbladder is characterized by which specific sonographic finding?
Correct — D. Adenomyomatosis shows cholesterol crystals and Rokitansky-Aschoff sinuses within the wall that produce ring-down (comet-tail) artifacts. This finding helps distinguish adenomyomatosis from acute cholecystitis. -
Abdominal Sonography
A 'WES' (wall-echo-shadow) triad on sonography of the gallbladder indicates:
Correct — A. The WES sign (echogenic curvilinear near wall, then echo, then acoustic shadow) occurs when stones fill the gallbladder lumen, making it appear contracted with no visible bile. This is often called a 'porcelain gallbladder' mimic. -
Abdominal Sonography
Which vessel lies immediately posterior to the body of the pancreas and is a key landmark for pancreatic identification?
Correct — C. The splenic vein courses along the posterior surface of the pancreatic body and tail, making it the primary landmark for identifying the pancreas on transverse sonography. -
Abdominal Sonography
The pancreatic head is defined anteriorly by the gastroduodenal artery and posteriorly by which vessel?
Correct — D. The inferior vena cava lies posterior to the pancreatic head. The portal vein is formed just posterior-superior to the head by the confluence of the SMV and splenic vein, but the IVC is the direct posterior relationship. -
Abdominal Sonography
Acute pancreatitis most commonly appears on ultrasound as:
Correct — A. In acute pancreatitis the pancreas typically enlarges and becomes hypoechoic due to edema; peripancreatic fluid collections may be present. However, bowel gas frequently obscures the pancreas so a normal US does not exclude pancreatitis. -
Abdominal Sonography
Chronic pancreatitis is sonographically characterized by all of the following EXCEPT:
Correct — B. Chronic pancreatitis produces a shrunken, hyperechoic (fibrotic) or heterogeneous gland with calcifications and duct dilation. A hypoechoic enlarged pancreas is the hallmark of ACUTE pancreatitis, not chronic disease. -
Abdominal Sonography
A 67-year-old male with painless jaundice and weight loss has a hypoechoic mass at the pancreatic head with upstream bile duct and pancreatic duct dilation. This 'double duct sign' is MOST consistent with:
Correct — C. The double duct sign (simultaneous dilatation of the CBD and main pancreatic duct) strongly suggests obstruction at the head of the pancreas, most commonly from pancreatic ductal adenocarcinoma. Insulinomas are typically small and hypervascular. -
Abdominal Sonography
On ultrasound, the normal spleen echotexture is:
Correct — A. The normal spleen has homogeneous, fine-grained echogenicity that is slightly greater than the normal liver and greater than the renal cortex. Comparing spleen to liver is a quick reference for both organs. -
Abdominal Sonography
The upper limit of normal splenic length in adults measured by sonography is:
Correct — B. A splenic length > 12 cm is considered splenomegaly in adults. The spleen is measured in its long axis on a coronal or oblique view. Values 12–15 cm represent mild-to-moderate enlargement; > 15 cm is marked splenomegaly. -
Abdominal Sonography
Splenic calcifications producing curvilinear shadowing along the periphery of the spleen are MOST consistent with:
Correct — C. Peripheral or punctate splenic calcifications most often represent healed granulomatous disease (histoplasmosis, tuberculosis) or old infarcts. Hemangiomas calcify centrally and angiosarcomas have aggressive imaging features. -
Abdominal Sonography
An accessory spleen (splenunculus) is most commonly located:
Correct — D. Accessory spleens are congenital ectopic splenic tissue found in up to 30% of individuals, most frequently at the splenic hilum or along the splenic pedicle. They are identical in echogenicity to the main spleen. -
Abdominal Sonography
The abdominal aorta bifurcates into the common iliac arteries at approximately which vertebral level?
Correct — A. The abdominal aorta bifurcates at approximately the L4 vertebral level (near the umbilicus) into the right and left common iliac arteries. The celiac axis arises at T12–L1.
Sonography ARDMS sample questions
Tap any question below to reveal the answer and a plain-English explanation.
Abdominal Sonography An abdominal aortic aneurysm (AAA) is defined as an aortic diameter of:
A. ≥ 2.5 cm
B. ≥ 3.0 cm (or > 50% increase over normal diameter) ✓
C. ≥ 4.0 cm
D. ≥ 5.0 cm
Correct — B. An AAA is defined as a focal aortic dilation ≥ 3.0 cm (outer wall to outer wall) or an increase > 50% of the expected normal diameter. Surgical repair is typically considered when the AAA reaches 5.5 cm.
Anatomy Which lobe of the liver is located between the gallbladder fossa and the ligamentum venosum fissure?
A. Right lobe
B. Left lobe
C. Caudate lobe ✓
D. Quadrate lobe
Correct — C. The caudate lobe (segment I) lies posteriorly between the IVC, the ligamentum venosum fissure, and the porta hepatis; the quadrate lobe lies between the gallbladder fossa and the ligamentum teres. The correct answer here is the caudate lobe.
Sonography ARDMS Which vessel is the first unpaired branch of the abdominal aorta?
A. Celiac artery ✓
B. Superior mesenteric artery
C. Inferior mesenteric artery
D. Renal arteries
Correct — A. The celiac artery (celiac trunk) is the first unpaired (ventral) branch of the abdominal aorta, arising at approximately the T12/L1 level. It divides into the left gastric, splenic, and common hepatic arteries.
Artifacts Acoustic shadowing occurs posterior to which of the following structures?
A. Soft tissue cyst
B. Fluid-filled bladder
C. Gallstone ✓
D. Normal liver parenchyma
Correct — C. Highly reflective or absorptive structures such as gallstones, calcifications, and gas block the transmission of sound, producing a dark shadow posterior to them. Cysts and fluid-filled structures produce enhancement, not shadowing.
Instrumentation What is the speed of sound in soft tissue, as used in most ultrasound systems?
A. 1540 m/s ✓
B. 1480 m/s
C. 1600 m/s
D. 330 m/s
Correct — A. The assumed propagation speed in soft tissue is 1540 m/s (or 1.54 mm/µs). This value is used by scanners to calculate depth from echo return time.
OB/GYN Sonography Which measurement is considered MOST accurate for gestational age estimation in the first trimester?
A. Crown-rump length (CRL) ✓
B. Biparietal diameter (BPD)
C. Femur length (FL)
D. Abdominal circumference (AC)
Correct — A. CRL is the most accurate biometric for dating in the first trimester (up to ~13.6 weeks), with a margin of error of ±5–7 days. BPD, FL, and AC are used in the second and third trimesters.
Pathology A 35-year-old woman has a 2 cm well-defined hepatic mass that is uniformly hyperechoic on ultrasound with no internal vascularity. The most likely diagnosis is:
A. Hepatic hemangioma ✓
B. Hepatocellular carcinoma
C. Focal nodular hyperplasia
D. Hepatic abscess
Correct — A. Cavernous hemangiomas are the most common benign hepatic tumors and classically appear as uniformly hyperechoic well-defined lesions. Lack of internal vascularity on Doppler and no central scar distinguishes this from FNH.
Patient Care Which document specifically grants a patient the right to make their own healthcare decisions, including the right to refuse treatment?
A. HIPAA Privacy Rule
B. Patient Self-Determination Act ✓
C. Emergency Medical Treatment and Labor Act
D. Health Insurance Portability and Accountability Act
Correct — B. The Patient Self-Determination Act (1990) requires healthcare facilities to inform patients of their right to make healthcare decisions, including refusing treatment, and to document any advance directives. HIPAA governs privacy, not decision-making rights.
About the Sonography ARDMS test
Pass your Sono Exam with confidence. Sonography ARDMS Prep gives you 700+ realistic practice questions with clear, detailed explanations for every answer.
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Ultrasound Physics, Instrumentation, Artifacts, Abdominal Sonography, OB/GYN Sonography, Anatomy — and more.
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You will be tested on
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
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Topics in this question bank
Safe and effective care environment
Health promotion and maintenance
Psychosocial and physiological integrity
Pharmacology, infection control and patient safety
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