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RDMS Abdomen study materials
RDMS Abdomen study resources

RDMS Abdomen practice questions

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Question 1Basic abdominal anatomy

Which peritoneal fold divides the anterior surface of the liver into right and left lobes?

  1. Gastrosplenic ligament
  2. Falciform ligament Correct answer.
  3. Coronary ligament
  4. Hepatoduodenal ligament

Explanation

The falciform ligament extends from the anterior abdominal wall and undersurface of the diaphragm to the liver, marking the surface boundary between the right and left hepatic lobes. Its free inferior edge contains the ligamentum teres.

Question 2Basic abdominal anatomy

The ligamentum teres of the liver is a fibrous remnant of which fetal vessel?

  1. Ductus venosus
  2. Ductus arteriosus
  3. Umbilical artery
  4. Umbilical vein Correct answer.

Explanation

After birth the intra-abdominal portion of the left umbilical vein fibroses to form the ligamentum teres, which lies in the free edge of the falciform ligament.

Question 3Basic abdominal anatomy

The gallbladder normally rests in a fossa on which aspect of the liver?

  1. Anterior surface
  2. Superior dome
  3. Posterior bare area between the coronary ligaments
  4. Visceral (inferior) surface Correct answer.

Explanation

The gallbladder fossa lies on the inferior visceral surface of the liver, between the right lobe and the quadrate lobe, and is the usual site of the gallbladder.

Question 4Basic abdominal anatomy

Which three structures constitute the portal triad?

  1. Hepatic artery, cystic duct, portal vein
  2. Portal vein, hepatic vein, bile duct
  3. Portal vein, inferior vena cava, hepatic artery
  4. Portal vein, hepatic artery, bile duct Correct answer.

Explanation

The portal triad consists of the main portal vein, the hepatic artery and the bile duct, and it runs within the hepatoduodenal ligament.

Question 5Basic abdominal anatomy

Which organ lies in the left upper quadrant, posterior and lateral to the stomach?

  1. Liver
  2. Spleen Correct answer.
  3. Right kidney
  4. Gallbladder

Explanation

The spleen occupies the left hypochondrium behind the stomach and below the diaphragm, related to the left ribs 9 to 11.

Question 6Basic abdominal anatomy

The head of the pancreas is cradled within the loop of which structure?

  1. Stomach
  2. Transverse colon
  3. Duodenum Correct answer.
  4. Jejunum

Explanation

The head of the pancreas sits within the C-shaped loop of the duodenum, with the uncinate process extending behind the superior mesenteric vessels.

Question 7Basic abdominal anatomy

The kidneys are located within which anatomical compartment?

  1. Intraperitoneal cavity
  2. Retroperitoneum Correct answer.
  3. Greater omentum
  4. Lesser sac

Explanation

The kidneys develop and remain behind the parietal peritoneum, covered anteriorly by peritoneum but not suspended within the peritoneal cavity.

Question 8Basic abdominal anatomy

Which segment of the small intestine is the longest?

  1. Ileum Correct answer.
  2. Pylorus
  3. Duodenum
  4. Jejunum

Explanation

The ileum makes up roughly the distal three-fifths of the small bowel and is the longest segment, measuring about 3 to 4 metres.

Question 9Basic abdominal anatomy

The left renal vein typically passes between which two structures?

  1. Between the IVC and the psoas muscle
  2. Between the left renal artery and the left crus
  3. Between the SMA and the aorta Correct answer.
  4. Between the pancreas and the splenic vein

Explanation

The left renal vein is longer than the right and crosses anterior to the aorta, passing through the narrow angle between the superior mesenteric artery and the aorta before entering the IVC.

Question 10Basic abdominal anatomy

At which vertebral level does the abdominal aorta bifurcate into the common iliac arteries?

  1. T12
  2. L2
  3. S1
  4. L4 Correct answer.

Explanation

The aortic bifurcation occurs at the L4 level, roughly corresponding to the umbilical level and the iliac crests.

Question 11Basic abdominal anatomy

The superior mesenteric artery primarily supplies which embryonic segment of the gut?

  1. Hindgut
  2. Foregut
  3. Midgut Correct answer.
  4. Spleen and pancreas only

Explanation

The superior mesenteric artery arises from the anterior aorta at about L1 and supplies the midgut, from the distal duodenum to the splenic flexure of the colon.

Question 12Basic abdominal anatomy

The inferior vena cava is formed by the union of which vessels?

  1. Hepatic veins
  2. Common iliac veins Correct answer.
  3. Renal veins
  4. Common iliac arteries

Explanation

The right and left common iliac veins unite anterior to the body of L5 to form the inferior vena cava, which then ascends on the right of the aorta.

Question 13Basic abdominal anatomy

Within the porta hepatis, which structure lies most posteriorly?

  1. Common bile duct
  2. Proper hepatic artery
  3. Main portal vein Correct answer.
  4. Cystic duct

Explanation

At the porta hepatis the main portal vein lies posterior, with the hepatic artery anteromedial and the bile duct anterolateral.

Question 14Basic abdominal anatomy

Morison's pouch (the hepatorenal recess) lies between which two structures?

  1. Stomach and pancreas
  2. Bladder and rectum
  3. Liver and right kidney Correct answer.
  4. Spleen and left kidney

Explanation

Morison's pouch is the potential space between the right lobe of the liver and the right kidney. In a supine patient it is the most dependent part of the peritoneal cavity, so free fluid collects there first.

Question 15Basic abdominal anatomy

In the Couinaud classification, segment I corresponds to which part of the liver?

  1. Caudate lobe Correct answer.
  2. Right anterior sector
  3. Quadrate lobe
  4. Left lateral segment

Explanation

Segment I is the caudate lobe, which lies on the posterior surface and drains directly into the inferior vena cava through its own short veins.

Question 16Basic abdominal anatomy

The common bile duct is formed by the union of which two structures?

  1. Common hepatic duct and main pancreatic duct
  2. Cystic duct and intrahepatic ducts
  3. Cystic duct and common hepatic duct Correct answer.
  4. Right and left hepatic ducts

Explanation

The cystic duct joins the common hepatic duct, usually within the hepatoduodenal ligament, to form the common bile duct.

Question 17Basic abdominal anatomy

The lesser sac (omental bursa) communicates with the greater sac through which opening?

  1. Epiploic foramen (foramen of Winslow) Correct answer.
  2. Fossa ovalis
  3. Aortic hiatus of the diaphragm
  4. Oesophageal hiatus

Explanation

The epiploic foramen is the only natural communication between the lesser sac and the greater sac, bounded anteriorly by the hepatoduodenal ligament.

Question 18Basic abdominal anatomy

How is the right adrenal gland typically related to the right kidney?

  1. Lies superior to the upper pole Correct answer.
  2. Lies anterior to the upper pole
  3. Lies inferior to the lower pole
  4. Lies lateral to the renal hilum

Explanation

The right adrenal gland is pyramidal and sits directly on the superior aspect of the upper pole of the right kidney. The left gland is more crescentic and lies anteromedial to the left upper pole.

Question 19Basic abdominal anatomy

The portal vein is formed by the union of which two veins?

  1. Right and left gastric veins
  2. Hepatic veins and inferior vena cava
  3. Splenic vein and inferior mesenteric vein
  4. Superior mesenteric vein and splenic vein Correct answer.

Explanation

The superior mesenteric vein and the splenic vein unite behind the neck of the pancreas at about the L2 level to form the main portal vein.

Question 20Basic abdominal anatomy

The uncinate process of the pancreas lies posterior to which vessel?

  1. Splenic vein
  2. Left renal vein
  3. Portal vein
  4. Superior mesenteric vein Correct answer.

Explanation

The uncinate process hooks medially behind the superior mesenteric vein and artery, so these vessels lie anterior to it as they emerge below the pancreatic neck.

Question 21Basic abdominal anatomy

At which vertebral level does the aortic hiatus of the diaphragm lie, and which structures pass through it?

  1. L1 - abdominal aorta and inferior vena cava
  2. T10 - oesophagus and vagal trunks
  3. T8 - aorta and oesophagus
  4. T12 - aorta, azygos, thoracic duct Correct answer.

Explanation

The aortic hiatus lies at T12 and transmits the aorta, azygos vein and thoracic duct. The oesophageal hiatus lies at T10 and the caval opening at T8.

Question 22Basic abdominal anatomy

Which statement best describes the bare area of the liver?

  1. Anterior surface covered by visceral peritoneum
  2. The central fissure transmitting the portal triad
  3. Posterior hepatic surface bare of peritoneum Correct answer.
  4. The gallbladder fossa on the visceral surface

Explanation

The bare area is the part of the posterior liver surface that lies in direct contact with the diaphragm and is not covered by visceral peritoneum. It is bounded by the anterior and posterior layers of the coronary ligament.

Question 23Basic abdominal anatomy

The left and right gonadal veins differ in their venous drainage. Which statement is correct?

  1. Left into portal vein; right into IVC
  2. Left into left renal vein; right into IVC Correct answer.
  3. Left into IVC; right into left renal vein
  4. Both into the IVC

Explanation

The left gonadal vein drains into the left renal vein at a right angle, whereas the right gonadal vein drains directly into the inferior vena cava. This asymmetry underlies the greater frequency of left-sided varicocele.

Question 24Basic abdominal anatomy

What are the relations of the third (horizontal) part of the duodenum?

  1. Anterior to the SMA; posterior to the portal vein
  2. Anterior to the pancreas; posterior to the stomach
  3. Anterior to the IVC/aorta; posterior to SMA Correct answer.
  4. Anterior to the aorta; posterior to the IVC

Explanation

The third part of the duodenum crosses the midline at about L3, passing anterior to the inferior vena cava and aorta and posterior to the superior mesenteric artery and vein.

Question 25Basic abdominal anatomy

Which hepatic vein divides the right lobe into anterior and posterior sectors?

  1. Middle hepatic vein
  2. Left hepatic vein
  3. Inferior phrenic vein
  4. Right hepatic vein Correct answer.

Explanation

The right hepatic vein runs in the right intersegmental fissure and separates the anterior sector (segments V and VIII) from the posterior sector (segments VI and VII). By contrast, the middle hepatic vein marks the principal plane between right and left lobes.

Question 26Basic abdominal anatomy

Which vessel typically courses along the superior border of the pancreas on its way to the spleen?

  1. Left gastric artery
  2. Common hepatic artery
  3. Splenic artery Correct answer.
  4. Gastroduodenal artery

Explanation

The celiac trunk gives rise to the left gastric, splenic, and common hepatic arteries. The splenic artery is the tortuous branch that runs along the superior border of the pancreatic body and tail to reach the splenic hilum, which is why the pancreas is described in relation to this vessel.

Question 27Perfusion and function

On spectral Doppler of a normal native hepatic artery, which waveform pattern is expected?

  1. Continuous venous flow without pulsatility
  2. Reversed flow during systole
  3. High-resistance flow with absent diastolic flow
  4. Low-resistance flow with continuous diastole Correct answer.

Explanation

The normal hepatic artery supplies a low-resistance capillary bed, so it shows a broad systolic peak with continuous forward diastolic flow. The resistive index is typically about 0.55 to 0.70. High-resistance or reversed systolic flow is abnormal.

Question 28Perfusion and function

Normal main portal vein spectral Doppler shows flow in which direction and pattern?

  1. Hepatofugal, continuous
  2. Hepatopetal, triphasic
  3. Hepatopetal, continuous Correct answer.
  4. Hepatofugal with marked pulsatility

Explanation

The portal vein carries splanchnic blood toward the liver, so normal flow is hepatopetal. It is low-velocity and continuous with mild respiratory variation rather than triphasic.

Question 29Perfusion and function

A normal hepatic vein Doppler waveform is best described as:

  1. High-resistance biphasic flow
  2. Triphasic atrial-systolic-diastolic pattern Correct answer.
  3. Continuous hepatopetal venous flow
  4. Monophasic with absent cardiac pulsatility

Explanation

Hepatic veins reflect right atrial pressure and normally produce a triphasic pattern with atrial, systolic, and diastolic components. The waveform should be pulsatile with the cardiac cycle. Loss of pulsatility suggests an abnormality.

Question 30Perfusion and function

In advanced cirrhosis with portal hypertension, which Doppler finding is most specific for portal hypertension?

  1. Reversed (hepatofugal) portal vein flow Correct answer.
  2. Loss of respiratory variation in the IVC
  3. Increased portal vein velocity above 40 cm/s
  4. Hepatic artery RI below 0.5

Explanation

Elevated portal pressure can reverse flow through the portal vein, producing hepatofugal flow. This is an abnormal finding that strongly supports portal hypertension. Velocity changes and IVC variation are less specific.

Question 31Perfusion and function

Normal renal artery spectral Doppler demonstrates:

  1. Low-resistance flow with forward diastolic flow Correct answer.
  2. Absent diastolic flow with a sharp systolic peak
  3. High-resistance flow with early diastolic reversal
  4. Venous-type continuous nonpulsatile flow

Explanation

The kidney is a low-resistance vascular bed, so the normal renal artery waveform has continuous forward diastolic flow. High resistance with diastolic reversal is abnormal. Venous-type continuous flow does not describe a renal artery.

Question 32Perfusion and function

An adult kidney has an intrarenal resistive index of 0.82. What does this value most likely indicate?

  1. An artifact caused by using a low wall filter
  2. Elevated RI from raised parenchymal resistance Correct answer.
  3. A value diagnostic of renal vein thrombosis
  4. A normal finding in a healthy adult kidney

Explanation

Normal intrarenal RI is approximately 0.58 to 0.70, so 0.82 is elevated. An elevated RI suggests increased parenchymal vascular resistance from renal disease or other causes. It is not by itself diagnostic of renal vein thrombosis.

Question 33Perfusion and function

Which spectral Doppler waveform is expected in a renal artery distal to a hemodynamically significant stenosis?

  1. Normal low-resistance waveform with brisk upstroke
  2. Continuous venous flow with respiratory phasicity
  3. Tardus-parvus with delayed systolic acceleration Correct answer.
  4. Biphasic with early systolic reversal

Explanation

A severe stenosis dampens downstream pressure, causing a delayed systolic upstroke and low-amplitude waveform known as tardus-parvus. The stenosis site itself may show focally increased velocity. Downstream flow does not remain normally brisk.

Question 34Perfusion and function

Which peak systolic velocity is commonly used as a threshold for significant SMA stenosis?

  1. 70 cm/s
  2. 275 cm/s Correct answer.
  3. 120 cm/s
  4. 200 cm/s

Explanation

A peak systolic velocity above approximately 275 cm/s is commonly used as a threshold for hemodynamically significant superior mesenteric artery stenosis. Lower values are more typical of normal or mildly increased flow. The diagnosis is usually supported by additional findings.

Question 35Perfusion and function

Normal renal vein color and spectral Doppler shows flow:

  1. Toward the IVC, phasic with respiration Correct answer.
  2. Reversed during inspiration in all normal kidneys
  3. Away from the IVC, continuous and pulsatile
  4. Absent because renal veins are too small to detect

Explanation

The renal veins drain into the inferior vena cava, so normal flow is directed toward the IVC. It is low-velocity and phasic with respiration and the cardiac cycle. Normal renal veins are routinely detectable.

Question 36Perfusion and function

Loss of normal IVC respiratory phasicity with continuous monophasic flow suggests:

  1. Obstruction or raised right atrial pressure Correct answer.
  2. Normal finding in a fasting patient
  3. Increased renal artery diastolic flow velocity
  4. Hepatic artery buffer response

Explanation

IVC flow normally varies with respiration and cardiac activity. Continuous monophasic flow suggests proximal obstruction, thrombosis, or elevated right-sided pressure. It is not a normal fasting finding.

Question 37Perfusion and function

Marked pulsatility of portal vein flow is most associated with:

  1. Renal artery stenosis
  2. Tricuspid regurgitation or right heart failure Correct answer.
  3. SMA stenosis after a meal
  4. Severe portal hypertension with hepatofugal flow

Explanation

The portal vein normally shows only gentle variation, but right heart dysfunction can transmit marked pulsatility into the portal system. Tricuspid regurgitation is a classic cause. Portal hypertension more often alters velocity or direction rather than causing marked pulsatility.

Question 38Perfusion and function

If portal venous flow to the liver decreases, what compensatory change occurs?

  1. Portal vein velocity increases markedly
  2. Hepatic artery flow increases Correct answer.
  3. Renal artery flow increases
  4. Hepatic artery flow decreases

Explanation

The hepatic arterial buffer response causes hepatic arterial vasodilation when portal flow falls. This increases hepatic arterial flow to help maintain total hepatic perfusion. It is a compensatory mechanism, not a decrease in arterial supply.

Question 39Perfusion and function

After liver transplantation, absence of color and spectral flow in the hepatic artery should raise concern for:

  1. SMA stenosis
  2. Portal vein thrombosis with cavernous change
  3. Hepatic artery thrombosis Correct answer.
  4. Budd-Chiari syndrome with hepatic vein obstruction

Explanation

Hepatic artery thrombosis is an important early complication after liver transplantation and can produce absent arterial flow. The finding should be confirmed with additional imaging because low-flow states can mimic thrombosis. Portal vein thrombosis and Budd-Chiari affect different vessels.

Question 40Perfusion and function

Which finding is most consistent with chronic portal vein thrombosis?

  1. High-resistance hepatic artery spectral waveform
  2. Marked portal vein pulsatility
  3. Periportal cavernous collaterals Correct answer.
  4. Triphasic hepatic vein flow

Explanation

Chronic portal vein thrombosis can lead to cavernous transformation, with multiple periportal collateral vessels forming around the occluded vein. Acute thrombosis may instead show echogenic thrombus and absent portal flow. Marked pulsatility suggests right heart disease.

Question 41Perfusion and function

Budd-Chiari syndrome on Doppler is characterized by:

  1. High-velocity flow in the SMA
  2. Obstructed hepatic veins with reversed flow Correct answer.
  3. Hepatofugal portal flow with normal hepatic veins
  4. Normal triphasic hepatic veins

Explanation

Budd-Chiari syndrome is hepatic venous outflow obstruction, so hepatic veins may be nonvisualized, narrowed, or show reversed or collateral flow. Portal flow may also become abnormal. Normal triphasic hepatic veins argue against the diagnosis.

Question 42Perfusion and function

Which Doppler finding suggests hepatic artery stenosis at the transplant anastomosis?

  1. Portal vein velocity greater than 100 cm/s
  2. Low RI in the hepatic artery with normal PSV
  3. High focal PSV with tardus-parvus Correct answer.
  4. Absent arterial flow throughout the liver

Explanation

An anastomotic hepatic artery stenosis produces a focal high-velocity jet at the narrowing. Downstream intrahepatic arterial flow may become damped with a tardus-parvus pattern. Absent flow throughout the liver would suggest thrombosis instead.

Question 43Perfusion and function

Compared with the fasting state, normal SMA Doppler after a meal shows:

  1. Decreased diastolic flow and higher resistive index
  2. Increased diastolic flow and lower resistive index Correct answer.
  3. No change in waveform
  4. Reversal of flow throughout diastole

Explanation

Postprandial splanchnic vasodilation reduces vascular resistance in the superior mesenteric artery distribution. This increases diastolic flow and lowers the resistive index. Fasting flow is relatively higher resistance.

Question 44Perfusion and function

Which parameter is most useful for detecting a hemodynamically significant renal artery stenosis?

  1. Intrarenal RI less than 0.5
  2. Loss of IVC pulsatility
  3. Renal-aortic PSV ratio above 3.5 Correct answer.
  4. Renal vein velocity greater than 100 cm/s

Explanation

A renal-aortic peak systolic velocity ratio above approximately 3.5 supports hemodynamically significant renal artery stenosis. A high renal artery PSV is also used. Renal vein velocity and IVC pulsatility are not direct stenosis parameters.

Question 45Perfusion and function

Median arcuate ligament syndrome typically produces which Doppler pattern in the celiac artery?

  1. Variable stenosis that worsens during expiration Correct answer.
  2. Absent celiac artery flow with normal SMA
  3. Reversed celiac artery flow during inspiration
  4. Fixed high-velocity stenosis that is unchanged by respiration

Explanation

Median arcuate ligament compression is dynamic, and the celiac artery velocity often increases more during expiration. It may improve with inspiration as the ligament moves. This respiratory variation helps distinguish it from a fixed atherosclerotic stenosis.

Question 46Perfusion and function

To obtain accurate peak systolic velocity, the Doppler angle should be:

  1. 75 degrees with a large sample volume
  2. 60 degrees or less Correct answer.
  3. 65 degrees with color gain increased
  4. 90 degrees, perpendicular to flow

Explanation

Doppler velocity accuracy depends on the cosine of the angle between the beam and flow. An angle of 60 degrees or less is recommended, ideally as close to parallel as possible. At 90 degrees there is no detectable Doppler shift.

Question 47Perfusion and function

Color Doppler aliasing in an abdominal vessel is best reduced by:

  1. Decreasing the pulse repetition frequency
  2. Increasing the color gain until noise fills the vessel
  3. Using a lower velocity scale
  4. Increasing the pulse repetition frequency Correct answer.

Explanation

Aliasing occurs when flow velocity exceeds the Nyquist limit. Increasing the pulse repetition frequency raises that limit and reduces aliasing. Decreasing PRF or lowering the scale would worsen aliasing.

Question 48Perfusion and function

A spectral Doppler sample volume that is too large can cause:

  1. Spectral broadening from multiple flow profiles Correct answer.
  2. Underestimation of peak velocity owing to angle correction
  3. Complete loss of color Doppler signal
  4. Aliasing only in the venous system

Explanation

A large sample volume can insonate several vessels or a broad range of velocities within the same vessel. This produces spectral broadening and can obscure the true waveform. It is not the same as angle-correction error.

Question 49Perfusion and function

Which setting is most appropriate when evaluating slow portal venous flow?

  1. Doppler angle of 90 degrees
  2. High PRF with a low color gain
  3. Low wall filter and low scale Correct answer.
  4. Highest possible wall filter

Explanation

Slow portal venous flow requires a low wall filter so low-velocity signals are not removed. A low velocity scale also improves sensitivity to slow flow. A high wall filter or 90-degree angle would degrade the evaluation.

Question 50Perfusion and function

Compared with color Doppler, power Doppler is more sensitive for:

  1. Determining flow direction
  2. Measuring peak systolic velocity accurately
  3. Showing aliasing at high velocities
  4. Detecting low-velocity tissue perfusion Correct answer.

Explanation

Power Doppler displays the amplitude of the Doppler signal rather than frequency shift. This makes it more sensitive to low-velocity flow in small vessels and parenchymal tissue. It does not provide reliable direction or velocity measurement.