Sonography ARDMS Exam Questions & Answers 2026 (1–10)

Question 1

The liver is divided into right and left lobes by which structure on its visceral surface?

TheoryPractice · Accepted Answer

Falciform ligament / ligamentum teres. 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.

Question 2

Which hepatic vein drains directly into the inferior vena cava and runs between the right and left lobes?

TheoryPractice · Accepted Answer

Middle hepatic vein. 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.

Question 3

On a transverse sonogram, the main lobar fissure connecting the gallbladder fossa to the right portal vein creates which appearance?

TheoryPractice · Accepted Answer

Exclamation mark sign. 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.

Question 4

According to the Couinaud segmental system, segment I refers to which portion of the liver?

TheoryPractice · Accepted Answer

Caudate lobe. 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.

Question 5

Which Couinaud segments comprise the left lateral section of the liver?

TheoryPractice · Accepted Answer

II and III. 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.

Question 6

What percentage of hepatic blood flow is supplied by the portal vein?

TheoryPractice · Accepted Answer

75%. 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.

Question 7

On color Doppler, normal portal venous flow in the main portal vein is best described as:

TheoryPractice · Accepted Answer

Continuous low-velocity flow toward the liver (hepatopetal). 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.

Question 8

The classic sonographic appearance of hepatic steatosis (fatty liver) is:

TheoryPractice · Accepted Answer

Increased echogenicity (hyperechoic liver) with decreased beam penetration. 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.

Question 9

Which sonographic finding is MOST specific for advanced hepatic cirrhosis?

TheoryPractice · Accepted Answer

Nodular liver surface contour with ascites. 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.

Question 10

A simple hepatic cyst on ultrasound characteristically demonstrates:

TheoryPractice · Accepted Answer

Anechoic interior, thin imperceptible wall, and posterior acoustic enhancement. 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.

Sonography ARDMS Exam Questions & Answers 2026 (1–10)

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