ARDMS AB-Abdomen Exam Dumps

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.''

Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis, 2021.

American Society of Nephrology (ASN) Nephrology Board Review, 2021.

Portal veins course horizontally within the liver and have echogenic walls due to their fibrous sheath. In contrast, hepatic veins course vertically toward the IVC and lack echogenic walls. Hepatic veins also demonstrate a triphasic waveform.

According to Rumack's Diagnostic Ultrasound:

''Portal veins course horizontally within the liver and are easily recognized by their echogenic walls.''

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.

AIUM Practice Parameter for Liver Ultrasound, 2020.

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The FAST exam is primarily used to detect free intraperitoneal or pericardial fluid in trauma patients, serving as a rapid, bedside assessment tool. While organ injuries may be suspected, the FAST exam is not primarily designed to assess for solid organ lacerations.

According to AIUM and ACEP guidelines:

''The primary goal of the FAST exam is to detect the presence of free fluid suggestive of hemorrhage in trauma patients.''

American College of Emergency Physicians (ACEP) Ultrasound Guidelines, 2016.

AIUM Practice Parameter for the Performance of the FAST Examination, 2020.

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The ultrasound image shown is a transverse endorectal (transrectal) ultrasound, commonly used to evaluate the prostate and adjacent structures. The two hypoechoic (dark) oval-shaped structures seen superior and posterior to the prostate are characteristic of the seminal vesicles.

The seminal vesicles are paired, elongated glands located superior and posterior to the base of the prostate and are best visualized in transverse planes on endorectal imaging. They appear as hypoechoic or anechoic structures with internal septations, depending on the degree of fluid content.

In contrast:

The urethra appears as a central echogenic linear structure within the prostate.

The prostate base is more inferior in the scan and is visualized just above the urethra.

The ejaculatory ducts are usually not as prominently visualized and are located medial to the seminal vesicles, entering the prostate near the verumontanum.

This image most clearly demonstrates the bilateral seminal vesicles.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

ACR--AIUM--SRU Practice Parameter for the Performance of an Ultrasound Examination of the Prostate (2021).

Hagen-Ansert SL. Textbook of Diagnostic Sonography, 8th ed. Elsevier; 2017.

The ultrasound image demonstrates bowel loops with peristalsis visualized within the inguinal canal, which is diagnostic of an inguinal hernia---more specifically, an indirect inguinal hernia. Indirect hernias pass through the deep inguinal ring and may extend into the scrotum, appearing sonographically as bowel-containing masses adjacent to or within the scrotal sac. Peristaltic motion confirms the presence of viable bowel content.

This finding is typical in indirect inguinal hernias, which are more common in males and often congenital due to a patent processus vaginalis. The herniated bowel can be traced through the inguinal canal, as seen in this image.

Comparison of answer choices:

A . Hematocele presents as a complex fluid collection surrounding the testis, often due to trauma---no complex fluid or trauma is apparent here.

B . Testicular rupture shows discontinuity of the tunica albuginea and irregular testicular contour---none of which is seen.

C . Orchiectomy would show an absent testis---this is not the case here.

D . Indirect hernia is correct. The presence of bowel with peristalsis in the inguinal canal is diagnostic.

Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound, 5th ed. Elsevier; 2017.

AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations (2021).

Dogra VS, Gottlieb RH, Rubens DJ, Oka M. Sonography of the scrotum. Radiology. 2003;227(1):18--36