ARDMS Abdomen Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The ARDMS Abdomen (AB) exam is a 170-question, 3-hour specialty exam covering abdominal sonography including liver, gallbladder, kidneys, spleen, pancreas, and abdominal vasculature. This comprehensive guide covers the exam format, all four content domains, 10 free practice questions, registration steps, and proven study strategies to help you earn your RDMS credential.
Table of Contents
What is the Abdomen Exam?
Why the Abdomen is Challenging
The Abdomen is often considered one of the more challenging exams because:
- Extensive anatomy: You must master the sonographic appearance of multiple organ systems and their anatomical relationships
- Pathology recognition: 42% of the exam focuses on identifying diseases, abnormalities, and post-surgical changes
- Clinical decision-making: Questions often require integrating anatomy knowledge with clinical scenarios
- Vascular assessment: Understanding Doppler evaluation of abdominal vessels including portal, hepatic, and renal vasculature
Abdomen Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 165 multiple-choice |
| Time Limit | 3 hours (180 minutes) |
| Passing Score | 555 (on a 300-700 scale) |
| Format | Multiple choice and hotspot questions with ultrasound images |
| Testing Centers | Pearson VUE (in-person or online proctoring) |
| Exam Fee | $300 (as of 2026) |
Understanding the 4 Content Domains
The Abdomen exam is divided into 4 content domains, each weighted differently. Knowing these weights helps you prioritize your study time.
Content Domain Weights
Question estimates based on total question count. Focus study time proportionally.
Study tip: Spend the most time on the largest domain—it makes up the biggest portion of your exam.
Domain 1: Hepatobiliary System (25%)
Approximately 41 questions
Liver, gallbladder, biliary tract
Domain 2: Urinary System (20%)
Approximately 33 questions
Kidneys, bladder, ureters
Domain 3: Spleen & Retroperitoneum (15%)
Approximately 25 questions
Spleen, adrenals, retroperitoneal structures
Domain 4: Gastrointestinal & Abdominal Vasculature (40%)
Approximately 66 questions
GI tract, aorta, IVC, mesenteric vessels
Normal liver span (MCL): < 15.5 cm
Normal CBD diameter: < 6 mm (add 1 mm per decade after age 60)
Normal gallbladder wall: < 3 mm
Normal spleen length: < 12 cm
Normal kidney length: 9-12 cm
Normal aorta diameter: < 3 cm (aneurysm if > 3 cm)
Normal IVC diameter: < 2.5 cm
Normal hepatic artery RI: 0.55-0.70
Normal renal artery RI: < 0.70
Renal artery stenosis: PSV > 180-200 cm/s, RAR > 3.5
Portal vein: Hepatopetal flow, 15-40 cm/s
Hepatic veins: Triphasic waveform toward IVC
Free Abdomen Practice Test Questions
Test your knowledge with these sample Abdomen exam questions. Answers and explanations are provided below.
Question 1
Which ligament separates the left lobe of the liver from the caudate lobe?
Question 2
A patient presents with right upper quadrant pain, fever, and a positive Murphy's sign. Sonographically, the gallbladder wall measures 5 mm with pericholecystic fluid. What is the most likely diagnosis?
Question 3
What is the most common location for ectopic kidneys?
Question 4
Which of the following structures is NOT part of the portal triad?
Question 5
A 55-year-old male presents with jaundice. Sonography reveals dilated intrahepatic bile ducts, dilated CBD measuring 12 mm, and a dilated pancreatic duct. The gallbladder is distended. What is the most likely level of obstruction?
Question 6
Hepatofugal flow in the portal vein is associated with:
Question 7
Which sonographic finding is most characteristic of a simple hepatic cyst?
Question 8
The 'WES' sign (wall-echo-shadow) is indicative of:
Question 9
In evaluating for renal artery stenosis, a renal-to-aortic ratio (RAR) greater than what value is considered significant?
Question 10
A hyperechoic mass in the liver with posterior acoustic enhancement is most likely:
Answer Key with Explanations
The ligamentum venosum (fissure for ligamentum venosum) separates the caudate lobe from the left lobe of the liver. The falciform ligament and ligamentum teres separate the right and left lobes. The ligamentum venosum is the remnant of the fetal ductus venosus.
The clinical presentation (RUQ pain, fever, positive Murphy's sign) combined with sonographic findings of gallbladder wall thickening > 3 mm and pericholecystic fluid are classic signs of acute cholecystitis. Cholelithiasis alone would not cause wall thickening or pericholecystic fluid.
The pelvis is the most common location for ectopic kidneys. During fetal development, the kidneys ascend from the pelvis to their normal retroperitoneal position. Failure to complete this migration results in a pelvic kidney.
The portal triad consists of the portal vein, hepatic artery, and bile duct. The hepatic veins are NOT part of the portal triad; they drain blood from the liver into the IVC and are located separately in the liver parenchyma.
Obstruction at the ampulla of Vater (head of pancreas region) causes dilation of both the CBD and pancreatic duct (double duct sign), along with intrahepatic biliary dilation and gallbladder distension (Courvoisier sign). This presentation is concerning for pancreatic head mass.
Hepatofugal (away from the liver) portal venous flow indicates portal hypertension. Normal portal flow is hepatopetal (toward the liver). Portal hypertension causes reversal of flow as blood seeks alternate pathways through portosystemic collaterals.
Simple hepatic cysts demonstrate classic cyst criteria: anechoic (no internal echoes), smooth thin walls, posterior acoustic enhancement, and edge shadowing. Any internal echoes, thick walls, or septations suggest a complex cyst requiring further evaluation.
The WES (wall-echo-shadow) sign occurs when the gallbladder is completely filled with stones. You visualize the gallbladder wall, a bright echogenic line from stones, and posterior acoustic shadowing. The gallbladder lumen is not visible because it's entirely occupied by calculi.
A renal-to-aortic ratio (RAR) greater than 3.5 is considered significant for renal artery stenosis. The RAR is calculated by dividing the peak systolic velocity in the renal artery by the peak systolic velocity in the aorta. Values > 3.5 indicate > 60% stenosis.
Hemangiomas are the most common benign liver tumor and typically appear as well-defined, hyperechoic masses with posterior acoustic enhancement due to their vascular composition. They are usually found incidentally and demonstrate no significant change on follow-up imaging.
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Abdomen Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Abdomen first-time pass rate is approximately 73%. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Breadth of content: The exam covers anatomy, pathology, physics, and clinical practice across multiple organ systems
- Pathology emphasis: 42% of questions focus on recognizing disease processes and abnormalities
- Clinical integration: Many questions require applying knowledge to realistic patient scenarios
- Vascular assessment: Understanding normal and abnormal Doppler findings in abdominal vessels
Understanding Your Score Report
Your score report includes:
- Overall scaled score (pass/fail)
- Performance breakdown by content domain
- Percentile ranking compared to other examinees
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: 60 days before you can retake
- Maximum attempts: 3 attempts per 12-month period
- Re-application: You must submit a new application and fee for each attempt
How to Register for the Abdomen Exam
Step 1: Ensure You've Passed the SPI Exam
The RDMS credential requires passing both the SPI exam and a specialty exam (Abdomen). Many candidates take the SPI first while physics concepts are fresh.
Step 2: Verify Your Eligibility
ARDMS offers several pathways to Abdomen exam eligibility:
- Pathway 1: Graduate from a CAAHEP-accredited sonography program with abdomen concentration
- Pathway 2: Currently enrolled in final semester of accredited program
- Pathway 3: Hold qualifying credential (ARRT, CCI) with documented abdomen experience
- Pathway 4: Documented clinical sonography work experience in abdominal sonography
Step 3: Submit Your Application
Log in to myARDMS.org, select 'Abdomen Examination' from available exams, choose your eligibility pathway, upload required documentation, and pay the examination fee ($275 as of 2026).
Step 4: Receive Your Authorization to Test (ATT)
ARDMS reviews applications within 2-4 weeks. Upon approval, you'll receive an ATT via email. Your ATT is valid for 90 days.
Step 5: Schedule with Pearson VUE
Visit Pearson VUE, choose in-person or online proctoring, select your preferred date and time, and confirm your appointment.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get 7-8 hours of sleep the night before
- Eat a balanced meal before the exam
- Arrive 30 minutes early to allow time for check-in
- Bring two forms of valid ID (one with photo and signature)
At the testing center:
- Check in with the test administrator
- Store personal belongings in a locker (no phones, watches, or notes allowed)
- Palm vein scan or photo may be taken for security
During the exam:
- You'll have 3 hours (180 minutes) for 170 questions
- Pace yourself at approximately 63 seconds per question
- Flag difficult questions and return to them if time permits
- Breaks count against your exam time
For Online Proctoring
System requirements:
- Reliable high-speed internet connection
- Webcam and microphone (built-in or external)
- Windows or Mac computer (tablets not permitted)
- Quiet, private room with no interruptions
Environment requirements:
- Clear desk with only your computer
- No dual monitors allowed
- Well-lit room where your face is clearly visible
- No one else may enter the room during testing
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Currently in school (content fresh) | 6-8 weeks |
| Recent graduate (< 1 year) | 8-10 weeks |
| Working sonographer (1-3 years) | 10-12 weeks |
| Returning after break (3+ years) | 12-16 weeks |
Sample Study Schedule
Week 1-2: Anatomy Foundation
- Review liver anatomy and segmental anatomy (Couinaud classification)
- Study biliary system: gallbladder, CBD, intrahepatic ducts
- Master kidney anatomy and normal variants
- Complete 150-200 practice questions on normal anatomy
Complete 150-200 practice questions
Week 3-4: Hepatobiliary Pathology
- Study liver pathology: focal lesions, diffuse disease, masses
- Master gallbladder pathology: stones, cholecystitis, polyps, carcinoma
- Review biliary obstruction and causes of jaundice
- Practice identifying pathology on sample images
Complete 200-250 practice questions
Week 5-6: Kidneys, Spleen & Pancreas
- Study renal pathology: cysts, masses, hydronephrosis, stones
- Review splenic pathology and splenomegaly causes
- Master pancreatic anatomy and pathology
- Focus on retroperitoneal structures and lymphadenopathy
Complete 200-250 practice questions
Week 7-8: Vascular Assessment & Doppler
- Study hepatic vasculature: portal vein, hepatic veins, hepatic artery
- Master renal artery evaluation and stenosis criteria
- Review aorta and IVC pathology
- Practice Doppler interpretation and waveform analysis
Complete 200 practice questions
Week 9-10: Clinical Integration & Mock Exams
- Take 2-3 full-length timed mock exams
- Review all missed questions thoroughly
- Focus on weak areas identified in practice tests
- Light review of key concepts and measurements
- Rest the day before your exam
Free Video Lessons
Free Video Lessons
Watch these free video lessons to help you prepare for the Abdomen.
Tips to Pass the Abdomen Exam
1. Master Normal Anatomy First
You cannot recognize abnormal if you don't thoroughly know normal. Spend significant time reviewing normal sonographic appearance, measurements, and anatomical relationships before diving into pathology.
2. Focus Heavily on Pathology (42% of Exam)
Domain 2 (Pathology) is the largest content area. Create flashcards for each organ with common pathologies, their sonographic appearance, and associated clinical findings.
3. Learn Pattern Recognition
Many pathologies have characteristic appearances: target lesion (GI malignancy), starry sky liver (hepatitis), comet tail artifact (adenomyomatosis). Memorize these classic patterns.
4. Understand Clinical Correlations
The exam tests clinical decision-making. Know which lab values correlate with pathologies (elevated bilirubin with obstruction, elevated BUN/creatinine with renal disease).
5. Don't Neglect Doppler Assessment
Vascular evaluation is integrated throughout the exam. Know normal flow direction, velocities, and waveforms for portal vein, hepatic artery, hepatic veins, and renal arteries.
6. Practice Time Management
With 170 questions in 180 minutes, you have about 63 seconds per question. Practice with timed exams to build your pacing. Don't spend too long on any single question.
FAQs
How many questions are on the Abdomen exam?
The Abdomen exam contains approximately 165 multiple-choice questions.
What is the passing score for the Abdomen exam?
You need a scaled score of 555 or higher (on a 300-700 scale) to pass the Abdomen exam.
How long is the Abdomen exam?
You have 3 hours (180 minutes) to complete the exam, which allows approximately 63 seconds per question.
What is the Abdomen exam pass rate?
The current first-time pass rate is approximately 73%.
How much does the Abdomen exam cost?
The examination fee is $275 (as of 2026).
How many times can I take the Abdomen exam?
You can attempt the Abdomen exam up to 3 times within a 12-month period with a mandatory 60-day waiting period between attempts.
Do I need to pass the SPI exam before taking the Abdomen exam?
You can take the exams in either order, but you must pass both the SPI and Abdomen exams to earn your RDMS credential. Many candidates take the SPI first while physics is fresh from school.
What content domains are covered on the Abdomen exam?
The exam covers four domains: Domain 1: Anatomy, Perfusion, and Function (30%), Domain 2: Pathology, Vascular Abnormalities, Trauma, and Postoperative Anatomy (42%), Domain 3: Abdominal Physics (8%), and Domain 4: Clinical Care, Practice, and Quality Assurance (20%).
How do I know if I'm ready for the Abdomen exam?
Aim for 80-85% accuracy on practice exams under timed conditions (170 questions in 3 hours) before scheduling your test.
Related ARDMS Exam Guides
Explore other ARDMS certification exam guides to continue your journey.
SPI Exam Guide
Required for RDMS/RDCS/RVT | 110 questions
OB/GYN Exam Guide
RDMS (OB/GYN) | 165 questions
Adult Echocardiography Exam Guide
RDCS (AE) | 165 questions
Vascular Technology Exam Guide
RVT | 165 questions
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This guide is updated regularly to reflect the latest ARDMS Abdomen exam information. Last reviewed: January 2026.