최신업데이트된AB-Abdomen최신업데이트버전공부문제덤프

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최신 ARDMS RDMS AB-Abdomen 무료샘플문제 (Q132-Q137):

질문 # 132
Which condition is associated with multiple pancreatic cysts?

A. Cystic fibrosis
B. Von Hippel Lindau syndrome
C. Beckwith Wiedemann syndrome
D. Autosomal recessive polycystic kidney disease

정답：B

설명：
Von Hippel-Lindau (VHL) syndrome is a genetic disorder associated with multiple pancreatic cysts, pancreatic neuroendocrine tumors, and other systemic neoplasms. While cystic fibrosis can produce thickened pancreatic secretions, it rarely causes true pancreatic cysts.
According to Rumack's Diagnostic Ultrasound:
"Multiple pancreatic cysts are strongly associated with Von Hippel Lindau syndrome." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
WHO Classification of Digestive System Tumors, 5th ed., IARC, 2019.
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질문 # 133
Which finding is most likely demonstrated in these images of a hypertensive patient with a history of hematuria?

A. Nephroblastoma
B. Pheochromocytoma
C. Renal cell carcinoma
D. Adenoma

정답：C

설명：
The ultrasound images show a heterogeneous, solid-appearing mass within the right kidney. The patient has a history of hypertension and hematuria-classic clinical features that raise suspicion for renal cell carcinoma (RCC), especially in an adult.
Renal cell carcinoma is the most common primary malignant tumor of the kidney in adults. Common presenting symptoms include:
* Hematuria (most frequent symptom)
* Flank pain
* Palpable abdominal mass
* Hypertension (due to increased renin secretion)
* Sometimes paraneoplastic syndromes (e.g., polycythemia due to erythropoietin production) Ultrasound Features of RCC:
* Solid renal mass, often with heterogeneous echotexture
* May contain cystic components, calcifications, or necrotic areas
* May distort the renal contour
* Doppler may show internal vascularity
Differentiation from other options:
* B. Adenoma: Rare and typically small, benign cortical lesions. They do not typically present with hematuria or hypertension and cannot be reliably distinguished from RCC on ultrasound.
* C. Nephroblastoma (Wilms tumor): Pediatric renal tumor seen almost exclusively in children under age
5.
* D. Pheochromocytoma: Arises from the adrenal gland (not the kidney); associated with hypertension but not hematuria.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Urinary Tract, pp. 210-222.
American College of Radiology (ACR) Appropriateness Criteria - Hematuria, 2022.
Radiopaedia.org. Renal cell carcinoma: https://radiopaedia.org/articles/renal-cell-carcinoma

질문 # 134
Which artifact is seen within the gallbladder in this image?

A. Banding
B. Reverberation
C. Attenuation
D. Shadowing

정답：B

설명：
The ultrasound image demonstrates multiple parallel echogenic lines within the gallbladder lumen, extending distally and diminishing in intensity. These equidistant lines are classic for a reverberation artifact.
Reverberation occurs when the ultrasound beam reflects multiple times between two strong reflectors (such as the anterior gallbladder wall and the transducer), creating repeating echoes that appear as equally spaced lines.
This is frequently seen in:
* The gallbladder (especially when collapsed or near the wall)
* Near air-filled structures
* With metallic objects or surgical clips
Reverberation does not represent a true anatomical structure and should be distinguished from real pathology.
Comparison of answer choices:
* A. Banding refers to speed displacement or slice-thickness artifacts and typically does not appear as repetitive lines.
* B. Shadowing is a dark band posterior to highly attenuating structures like gallstones or bone, not present here.
* C. Attenuation is a general term for the reduction in sound energy as it travels-posterior acoustic shadowing is one type.
* D. Reverberation - Correct. The characteristic bright, parallel lines within the gallbladder lumen confirm this artifact.
References:
Kremkau FW. Sonography Principles and Instruments, 9th ed. Elsevier; 2015.
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.

질문 # 135
Which structure is indicated by the arrow on this image?

A. Proper hepatic artery
B. Inferior vena cava
C. Middle hepatic vein
D. Left portal vein

정답：C

설명：
The structure indicated by the arrow is the middle hepatic vein. This is confirmed by both its anatomical location within the liver and its Doppler waveform characteristics.
Key ultrasound and Doppler features:
* The middle hepatic vein runs between the right and left hepatic lobes and drains into the inferior vena cava (IVC). On grayscale imaging, it appears as a tubular anechoic structure extending toward the IVC.
* On spectral Doppler, hepatic veins (including the middle hepatic vein) demonstrate a characteristic triphasic waveform due to pressure changes in the right atrium. This triphasic pattern is clearly visible in the Doppler tracing below the image.
* This differs significantly from the monophasic low-resistance flow of the hepatic artery or the continuous hepatopetal flow of the portal vein.
Differentiation from other options:
* A. Left portal vein: Would show continuous, hepatopetal flow (toward the liver) and lies more anterior and medial within the liver.
* C. Proper hepatic artery: Small-caliber vessel with low-resistance pulsatile waveform (not triphasic).
* D. Inferior vena cava: Lies posterior to the liver and demonstrates phasic flow with respiration, but this vessel is more centrally located and not shown in this field of view.
References:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018.
Chapter: Hepatic Vasculature, pp. 90-95.
AIUM Practice Parameter for the Performance of Hepatic Doppler Ultrasound Examinations, 2020.
Radiopaedia.org. Hepatic vein Doppler waveform: https://radiopaedia.org/articles/hepatic-vein-doppler- waveform

질문 # 136
Which scanning technique is most beneficial when imaging the appendix?

A. Apply graded compression around the patient's area of pain
B. Apply light pressure around the patient's area of pain
C. Image in the longitudinal plane around the iliac vessels
D. Image small bowel transversely to evaluate for peristalsis

정답：A

설명：
Graded compression technique is the gold standard for ultrasound evaluation of the appendix. It displaces gas and compresses overlying bowel loops to visualize the noncompressible, blind-ending tubular appendix directly at the point of maximal tenderness.
According to Rumack's Diagnostic Ultrasound:
"Graded compression using steady, increasing pressure displaces gas and bowel to optimize visualization of the appendix." Reference:
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th ed. Elsevier, 2017.
AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen, 2020.
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질문 # 137
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