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ARDMS AB-Abdomen 認定試験の出題範囲：
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質問 # 29
Which condition is most likely depicted in this image?
- A. Intussusception
- B. Appendicitis
- C. Bowel obstruction
- D. Diverticulitis
正解：A
解説：
The ultrasound image shows a classic "target sign" or "donut sign," characterized by concentric rings of alternating echogenicity. This sonographic finding is pathognomonic for intussusception, particularly when seen in the transverse plane.
Intussusception occurs when a segment of bowel telescopes into an adjacent segment, typically in children aged 6 months to 3 years. It commonly presents with intermittent abdominal pain, vomiting, and sometimes
"red currant jelly" stools.
Key ultrasound features of intussusception:
* Target sign in transverse view (concentric rings of bowel layers)
* Pseudokidney or sandwich sign in longitudinal view
* May show intraluminal mesenteric fat or vessels dragged in with the intussusceptum Comparison of answer choices:
* A. Bowel obstruction may show dilated loops of bowel with air-fluid levels and to-and-fro peristalsis but lacks the concentric ring sign.
* B. Diverticulitis typically shows bowel wall thickening and pericolic fat stranding; not the concentric target appearance.
* C. Appendicitis may appear as a blind-ending tubular structure (>6 mm), not with concentric ring pattern.
* D. Intussusception - Correct. The image demonstrates the classic target sign seen with this condition.
References:
Coley BD. US of gastrointestinal tract abnormalities in infants and children. Radiographics. 2005;25(1):27-47.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of Pediatric Ultrasound (2021).
質問 # 30
Which of the following would optimize visualization of a bladder mass?
- A. Have patient empty bladder
- B. Utilize a high-frequency linear transducer
- C. Compression technique to move bowel gas
- D. Have patient fill bladder
正解：D
解説：
A full bladder provides an acoustic window that displaces bowel gas and distends the bladder walls, allowing optimal visualization of any bladder masses or lesions. An empty bladder may collapse, obscuring masses.
According to Rumack's Diagnostic Ultrasound:
"Bladder evaluation should be performed with the bladder optimally distended to visualize its walls and any intraluminal masses." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
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質問 # 31
In which segment is the solid mass located in this transverse image of the liver?
- A. Right posterior
- B. Left lateral
- C. Right anterior
- D. Left medial
正解：A
解説：
The transverse ultrasound image of the liver shows a solid, hypoechoic mass located in the posterior aspect of the right lobe of the liver. In this view:
* The anterior aspect of the liver is at the top of the image (near the transducer).
* The posterior aspect is at the bottom (deeper).
* The right lobe occupies the majority of the screen on transverse imaging when the probe is placed in the epigastrium or right upper quadrant.
Anatomically, the right lobe of the liver is divided into anterior and posterior segments by the right hepatic vein in the coronal plane. In transverse imaging:
* The right anterior segment lies closer to the anterior abdominal wall.
* The right posterior segment lies deeper (posteriorly).
Given that the mass is seen deep within the liver on the right side of the image, it is best localized to the right posterior segment (Segment VI or VII depending on the exact craniocaudal level).
Comparison of answer choices:
* A. Left lateral is located far to the left of the image and typically appears higher and more anterior on transverse scans.
* B. Left medial lies near the midline and would appear adjacent to the ligamentum teres or falciform ligament.
* C. Right anterior lies closer to the transducer (top of the image), not posteriorly.
* D. Right posterior - Correct. This is the segment shown deep in the right lobe of the liver.
References:
Couinaud C. Liver anatomy: portal (and hepatic) segmentation. Trans Assoc Am Physicians. 1957.
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
質問 # 32
What is the most common cause of nutcracker syndrome?
- A. Compression of left renal vein between inferior vena cava and aorta
- B. Compression of right renal vein between inferior vena cava and aorta
- C. Compression of left renal vein between superior mesenteric artery and aorta
- D. Compression of right renal vein between superior mesenteric artery and aorta
正解：C
解説：
Nutcracker syndrome results from compression of the left renal vein between the superior mesenteric artery (SMA) and the aorta. This can cause hematuria, flank pain, and pelvic congestion due to impaired venous drainage.
According to Zwiebel's Introduction to Vascular Ultrasound:
"In nutcracker syndrome, the left renal vein is compressed between the aorta and SMA, resulting in venous hypertension." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Abdominal Vascular Ultrasound, 2020.
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質問 # 33
Which sections of the liver are divided by the structure indicated by the arrow on this image?
- A. Left superior and inferior
- B. Right anterior and posterior
- C. Left medial and lateral
- D. Right and left lobes
正解：D
解説：
The ultrasound image shows the liver in a transverse view with the arrow pointing to the middle hepatic vein (MHV). The MHV is a key sonographic landmark that anatomically divides the right and left lobes of the liver.
According to Couinaud's segmental anatomy, which is the basis for surgical and radiological liver segmentation:
* The middle hepatic vein runs within the main lobar fissure.
* It separates the right lobe (segments V-VIII) from the left lobe (segments II-IV).
* This division is crucial in liver surgery and interventional procedures.
Comparison of answer choices:
* A. Right anterior and posterior segments are divided by the right hepatic vein, not the middle hepatic vein.
* B. Right and left lobes - Correct. The middle hepatic vein, shown by the arrow, defines this boundary.
* C. Left medial and lateral segments are divided by the left hepatic vein or falciform ligament.
* D. Left superior and inferior is not a standard anatomic division in liver segmentation.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
Couinaud C. Liver anatomy: portal (and hepatic) segmentation. In: Trans. Assoc. Am. Physicians. 1957.
Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.
質問 # 34
Which exam type would be most beneficial for evaluating an elderly male patient who is complaining of dysuria and nocturia?
- A. Scrotal
- B. Pelvis limited
- C. Penile Doppler
- D. Renal Doppler
正解：B
解説：
In elderly men, dysuria and nocturia often suggest lower urinary tract symptoms such as benign prostatic hyperplasia (BPH). A pelvis limited ultrasound is most appropriate to evaluate the bladder and prostate for enlargement, residual urine volume, or other causes of obstructive symptoms.
According to AIUM Practice Guidelines:
"Pelvic ultrasound can evaluate bladder volume, post-void residual, and prostate size in men with lower urinary tract symptoms." Reference:
AIUM Practice Parameter for the Performance of Ultrasound of the Prostate, 2020.
Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
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質問 # 35
Which sonographic finding is commonly associated with transitional cell cancer of urinary bladder?
- A. Flat sessile lesion
- B. Diffuse wall thickening
- C. Ulcerated solid infiltrative lesion
- D. Polypoidal non-mobile focal mass
正解：D
解説：
Transitional cell carcinoma (TCC) typically presents as a non-mobile, polypoidal, focal intraluminal mass projecting from the bladder wall. Mobility of the lesion helps differentiate TCC from blood clots or debris.
According to Rumack's Diagnostic Ultrasound:
"Bladder TCC most often appears as a non-mobile, polypoid mass attached to the bladder wall." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Bladder Ultrasound, 2020.
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質問 # 36
Which type of choledochal cyst is the most common?
- A. Type I: Fusiform dilatation of the common bile duct
- B. Type IV: Multiple cystic dilatations of the hepatic ducts
- C. Type II: Diverticula extending off of the common bile duct
- D. Type III: Duodenal choledochocele
正解：A
解説：
Type I choledochal cyst, characterized by fusiform dilatation of the common bile duct, is the most common form, accounting for 80-90% of cases. Other types are much less frequent.
According to Rumack's Diagnostic Ultrasound:
"Type I fusiform dilatation of the extrahepatic bile duct is the most common type of choledochal cyst." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Hepatobiliary Ultrasound, 2020.
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質問 # 37
A patient presents with ampulla of Vater obstruction, distention of the gallbladder, and painless jaundice.
Which condition is most likely associated with these findings?
- A. Choledochal cyst
- B. Courvoisier sign
- C. Porcelain gallbladder
- D. Mirizzi syndrome
正解：B
解説：
Courvoisier sign describes the clinical finding of painless jaundice combined with a palpable, distended gallbladder. This typically results from obstruction at the distal common bile duct, often due to pancreatic head carcinoma or cholangiocarcinoma, leading to bile accumulation and gallbladder distention. In contrast, Mirizzi syndrome involves compression of the common hepatic duct by an impacted stone in the cystic duct.
According to Rumack's Diagnostic Ultrasound and standard clinical references:
"Courvoisier sign refers to a palpable, enlarged gallbladder due to obstruction of the distal bile duct, often from malignancy." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
Moore KL. Clinically Oriented Anatomy. 8th ed. Wolters Kluwer, 2018.
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質問 # 38
Which finding is an indication for renal biopsy to assess for renal failure?
- A. Proteinuria
- B. Hematuria
- C. Leukocytosis
- D. Hypercalcemia
正解：A
解説：
Significant proteinuria, especially if persistent or in the nephrotic range, may indicate glomerular disease and is a common indication for renal biopsy. Leukocytosis and hypercalcemia are not specific for renal biopsy.
Hematuria may warrant biopsy if accompanied by proteinuria.
According to KDIGO Clinical Practice Guidelines:
"Persistent proteinuria is one of the strongest indications for renal biopsy to evaluate underlying glomerular pathology." Reference:
Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis,
2021.
American Society of Nephrology (ASN) Nephrology Board Review, 2021.
質問 # 39
Which condition presents sonographically as an anechoic mass between the umbilicus and the bladder?
- A. Mesenteric cyst
- B. Urinoma
- C. Urachal cyst
- D. Bladder abscess
正解：C
解説：
A urachal cyst arises from incomplete closure of the urachus, a remnant of the fetal allantoic duct connecting the bladder to the umbilicus. It appears as a midline, anechoic, nonvascular mass located between the bladder dome and the umbilicus.
According to Rumack's Diagnostic Ultrasound:
"A urachal cyst is a midline, anechoic structure located between the bladder and umbilicus, resulting from incomplete obliteration of the urachus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of Ultrasound of the Pelvis, 2020.
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質問 # 40
Which hernia characteristic is demonstrated in these images?
- A. Strangulated
- B. Fat only
- C. Incarcerated
- D. Reducible
正解：D
解説：
The ultrasound images show two views of the same groin region - one without compression (left image labeled "W/O COMPRESSION") and one with graded probe compression (right image labeled "W/ COMPRESSION").
In the non-compression image, a hypoechoic mass-like structure is visible protruding through the abdominal wall, consistent with a hernia sac. On the compression image, the herniated content is no longer visible, indicating that the contents have been pushed back into the abdominal cavity. This is the hallmark feature of a reducible hernia.
Key characteristics of a reducible hernia on ultrasound:
* Herniated contents are visible without pressure.
* Contents disappear or reduce back into the abdomen with graded probe compression or Valsalva release.
* Typically includes omental fat or bowel, but reduction confirms lack of incarceration or strangulation.
Comparison of answer choices:
* A. Fat only refers to the hernia content type, not the behavior or reducibility shown here.
* B. Reducible - Correct. The change in hernia appearance between images demonstrates successful reduction with compression.
* C. Incarcerated hernia would remain visible and not compressible or reducible.
* D. Strangulated hernia would show signs of ischemia (bowel wall thickening, absent perfusion, hyperechoic mesentery), and would also not reduce with compression.
References:
Radswiki. Ultrasound evaluation of hernia. Radiopaedia.org
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.
AIUM Practice Parameter for the Performance of a Focused Ultrasound Examination for Hernia (2021)
質問 # 41
Which outcome would be present if the sample volume gate is larger than the examined vessel?
- A. Spike turbulence
- B. Aliasing
- C. Spectral noise
- D. Indeterminate flow direction
正解：C
解説：
When the sample volume (gate) is too large, it captures signals from both the vessel and surrounding tissues or adjacent flows. This leads to a broadening of the spectral waveform and produces "spectral noise" or
"spectral broadening," reducing the accuracy of velocity measurements and waveform analysis. Aliasing results from high velocity relative to the Nyquist limit, not from gate size.
According to Zwiebel's Introduction to Vascular Ultrasound:
"Increasing the sample volume beyond the vessel size causes spectral broadening, resulting in spectral noise and inaccurate Doppler measurements." Reference:
Zwiebel WJ, Pellerito JS. Introduction to Vascular Ultrasound. 6th ed. Elsevier, 2019.
AIUM Practice Parameter for Spectral Doppler Ultrasound, 2021.
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質問 # 42
Which mechanism is used for a fine needle aspiration?
- A. Packing of cells in the needle
- B. Injection of saline and suction
- C. Cutting needle obtains core tissue
- D. Automated spring loaded device
正解：A
解説：
Fine needle aspiration (FNA) uses a thin needle to aspirate cells, which are then packed into the lumen of the needle for cytological evaluation. It is distinct from core biopsy, which uses cutting needles to obtain tissue cores.
According to AIUM Practice Parameters:
"Fine needle aspiration involves insertion of a thin needle into a lesion to aspirate cells for cytologic analysis.
The cells are collected inside the needle lumen."
Reference:
AIUM Practice Parameter for the Performance of Ultrasound-Guided Percutaneous Needle Biopsy, 2020.
Rumack CM, Diagnostic Ultrasound, 5th ed. Elsevier, 2017.
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質問 # 43
Which lymph node shape is concerning for malignancy in the post-thyroidectomy neck?
- A. Round
- B. Wider than tall
- C. Oval
- D. Taller than wide
正解：A
解説：
Malignant lymph nodes are often round in shape (short axis/long axis ratio approaches 1), while benign lymph nodes are typically oval (short axis/long axis ratio < 0.5). Rounded shape in post-thyroidectomy patients raises suspicion for metastatic disease.
According to AIUM and ACR Thyroid Imaging Guidelines:
"A rounded lymph node shape is suspicious for malignancy, especially in patients with thyroid cancer." Reference:
AIUM Practice Parameter for Thyroid and Neck Ultrasound, 2020.
ACR Thyroid Imaging Reporting and Data System (TI-RADS), 2017.
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質問 # 44
Which condition is most likely in a patient presenting with weight loss and fatigue along with elevated liver enzymes, elevated potassium, and decreased sodium?
- A. Addison disease
- B. Conn syndrome
- C. Acute pancreatitis
- D. Hepatocellular carcinoma
正解：A
解説：
Addison disease (primary adrenal insufficiency) results in insufficient production of cortisol and aldosterone.
The hallmark laboratory findings include:
* Hyponatremia (low sodium)
* Hyperkalemia (high potassium)
* Elevated liver enzymes (due to nonspecific hepatic involvement)
* Fatigue, weight loss, and hypotension are common clinical features.
* Conn syndrome (B) causes hyperaldosteronism, leading to hypokalemia (not hyperkalemia).
* Acute pancreatitis (C) would typically show elevated amylase/lipase.
* Hepatocellular carcinoma (D) may present with elevated liver enzymes but not the electrolyte pattern described.
Reference Extracts:
* Nieman LK. "Diagnosis and Treatment of Primary Adrenal Insufficiency." J Clin Endocrinol Metab.
2011;96(7):1957-1966.
* Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
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質問 # 45
Which term best describes the common bile duct measured in this image of a postcholecystectomy patient?
- A. Inflamed
- B. Atretic
- C. Normal
- D. Dilated
正解：C
解説：
The ultrasound image shows a measured common bile duct (CBD) diameter of 7.9 mm in a postcholecystectomy patient. In patients who have undergone cholecystectomy, mild dilation of the CBD is considered normal and is a well-recognized post-surgical change.
Normal upper limits for CBD diameter:
* In patients with a gallbladder: #6 mm is generally considered normal.
* In postcholecystectomy patients: up to 10 mm is considered within normal limits, as the CBD compensates for the absence of the gallbladder and slightly enlarges over time.
* With aging, the CBD may enlarge by approximately 1 mm per decade after age 60.
Therefore, a CBD diameter of 7.9 mm in a patient without a gallbladder is considered normal.
Differentiation from other options:
* B. Dilated: This would typically refer to a CBD diameter >10 mm in postcholecystectomy patients, or
>6 mm in patients with an intact gallbladder.
* C. Inflamed: Inflammation refers to wall thickening or hyperemia, which is not evaluated simply by measuring diameter.
* D. Atretic: Describes a congenitally absent or severely narrowed duct - not applicable here.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Biliary System, pp. 143-146.
American Institute of Ultrasound in Medicine (AIUM) Practice Parameter for the Performance of a Hepatobiliary Ultrasound Examination, 2020.
Radiopaedia.org. Common bile duct: https://radiopaedia.org/articles/common-bile-duct
質問 # 46
Which structure is located between the fundus of the stomach and the diaphragm?
- A. Caudate lobe of the liver
- B. Left lobe of the liver
- C. Spleen
- D. Right kidney
正解：C
解説：
The spleen lies in the left hypochondrium, superior and lateral to the fundus of the stomach, and directly contacts the diaphragm. It occupies the space between the stomach and diaphragm. The liver and kidneys are located more medially or inferiorly.
According to Gray's Anatomy for Students:
"The spleen lies posterolateral to the fundus of the stomach, separated from the diaphragm by its fibrous capsule." Reference:
Gray's Anatomy for Students, 4th ed., Elsevier, 2019.
Moore KL, Clinically Oriented Anatomy, 8th ed.
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質問 # 47
What is the location of the left lobe of the thyroid gland?
- A. Posterior to the longus colli muscle
- B. Anterior to the trachea
- C. Anterior to the left jugular vein
- D. Anterolateral to the esophagus
正解：D
解説：
The left lobe of the thyroid is located anterolateral to the esophagus. On transverse ultrasound imaging, the esophagus can often be seen posterior to the left thyroid lobe as a circular structure with echogenic mucosa and hypoechoic muscular layer. The longus colli muscle lies posterior to the thyroid. The thyroid is anterior to the trachea but this refers more to the isthmus or midline portion.
According to Rumack's Diagnostic Ultrasound:
"The esophagus is seen as a target-shaped structure posterior to the left thyroid lobe; thus, the thyroid lobe is anterolateral to the esophagus." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for Thyroid Ultrasound, 2020.
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質問 # 48
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