What's on the ARDMS Abdomen Exam? (2026 Breakdown)

The ARDMS Abdomen (AB) exam covers a lot of ground: solid organs, the biliary tree, kidneys, vessels, the GI tract, superficial structures and procedures. Knowing what's on it, and which facts come up again and again, makes your study time far more efficient. Below is a topic-by-topic breakdown, the high-yield normal values and pathology to know cold, and a study plan built around abdomen sonography ARDMS practice tests.

Abdomen exam basics

• Format: about 165 questions in 3 hours, according to ARDMS. Expect hotspot (image) questions, where you identify a structure or finding on an image, along with standard multiple choice.
• Scoring: reported on a 300–700 scale; 555 passes.
• Where: ARDMS exams are administered by Inteleos/ARDMS and taken at Pearson VUE test centers.
• Credential: Passing Abdomen plus the SPI earns the RDMS credential with the Abdomen specialty.

ARDMS publishes an official content outline that lists the domains and how heavily each is weighted. We don't reproduce percentages here because they can change. Download the current outline from ardms.org and use it to decide where to spend the most time.

Topic areas to study

Patient care and safety

Expect questions on patient identification, communication, infection control, sterile technique, positioning, preparation (for example, fasting before a gallbladder exam), recognizing emergencies, ALARA and ergonomics. These are easy points if you review them; don't skip them.

Liver

Know lobar and segmental anatomy, the ligaments and fissures, and the relationship of the hepatic and portal veins. Review diffuse disease (fatty infiltration, hepatitis, cirrhosis), focal lesions (cysts, hemangioma, focal nodular hyperplasia, adenoma, hepatocellular carcinoma, metastases, abscess) and the sonographic signs of portal hypertension.

Biliary system

Gallbladder and bile duct anatomy and variants, gallstones, sludge, acute and chronic cholecystitis, adenomyomatosis, polyps, gallbladder carcinoma, biliary dilatation and choledocholithiasis.

Pancreas

Anatomy and vascular landmarks (splenic vein posterior to the pancreas, SMA and SMV), echogenicity changes with age, acute and chronic pancreatitis, pseudocysts, and pancreatic masses.

Spleen

Size, accessory spleen, splenomegaly and its causes, infarct, trauma, cysts and masses.

Urinary tract and adrenals

Kidney anatomy and congenital variants (duplex collecting system, horseshoe kidney, ectopia, column of Bertin), hydronephrosis, stones, cysts (simple vs. complex), polycystic kidney disease, solid masses, medical renal disease, transplant evaluation, bladder, and adrenal anatomy and masses.

Abdominal vasculature and retroperitoneum

Aorta and branches, IVC and tributaries, portal venous system, renal and mesenteric vessels, normal Doppler waveforms, aneurysm, dissection, stenosis, thrombosis, TIPS evaluation, retroperitoneal lymph nodes and fluid collections.

GI tract, peritoneum and abdominal wall

Bowel wall layers, appendicitis, pyloric stenosis, intussusception, ascites, abscess, hernias and other abdominal wall masses.

Superficial structures

The Abdomen exam reaches beyond the abdomen. Review the thyroid and parathyroid glands, neck (including lymph nodes), and scrotum and testes: normal anatomy, nodules, inflammation, torsion and masses.

Procedures and contrast

Ultrasound-guided biopsy, paracentesis, thoracentesis and drainage, the time-out and sterile field, and the basics of ultrasound contrast agents.

High-yield normal values

These are commonly used reference values. Your program or lab may use slightly different cutoffs, so learn the typical numbers and the reasoning behind them.

Structure	Commonly cited normal
Gallbladder wall	≤3 mm
Common bile duct	~6 mm (can be larger with age and after cholecystectomy)
Pancreatic duct	≤3 mm
Spleen length	~12–13 cm
Abdominal aorta	<3 cm diameter
Adult kidney length	~10–12 cm
Main portal vein	≤13 mm, with hepatopetal (toward the liver) flow
Pyloric muscle (infant)	<3 mm thickness
Appendix	≤6 mm, compressible

A few notes on the ones that trip students up:

• Common bile duct: about 6 mm is a common upper limit, but the duct can be mildly larger in older patients and is often larger after cholecystectomy. Read the question stem for age and surgical history.
• Aorta: a diameter of 3 cm or more is generally considered aneurysmal.
• Portal vein: reversed (hepatofugal) flow is a classic sign of portal hypertension.

High-yield pathology by organ

Liver

• Fatty liver: increased echogenicity, poor visualization of deeper structures and vessel walls.
• Acute hepatitis: may show a "starry sky" pattern from bright portal triads against a darker liver.
• Cirrhosis: nodular surface, coarse echotexture, caudate lobe enlargement, and signs of portal hypertension (splenomegaly, ascites, varices).
• Hemangioma: classically a well-defined, homogeneous, hyperechoic lesion.

Biliary

• Gallstones: echogenic, mobile, with posterior acoustic shadowing. A contracted gallbladder full of stones can give the wall-echo-shadow (WES) sign.
• Acute cholecystitis: stones, wall thickening, pericholecystic fluid and a positive sonographic Murphy sign.
• Adenomyomatosis: comet-tail artifact from the gallbladder wall.

Pancreas

• Acute pancreatitis: enlarged, hypoechoic gland, possible peripancreatic fluid.
• Chronic pancreatitis: calcifications, a dilated or irregular duct, atrophy.
• Pancreatic head mass: can obstruct both the CBD and pancreatic duct (double duct sign), sometimes with a palpable, enlarged, nontender gallbladder (Courvoisier gallbladder).

Spleen

• Splenomegaly: look for associated portal hypertension or hematologic causes.
• Infarct: classically a wedge-shaped, hypoechoic peripheral area.

Kidneys and adrenals

• Hydronephrosis: dilated, connected calyces and renal pelvis; look for the cause (stone, mass, obstruction).
• Simple cyst: anechoic, thin-walled, with posterior acoustic enhancement.
• Angiomyolipoma: a well-defined, highly echogenic renal mass.
• Renal cell carcinoma: solid renal mass; evaluate the renal vein and IVC for tumor extension.
• Autosomal dominant polycystic kidney disease: bilateral enlarged kidneys with multiple cysts; check the liver for cysts too.
• Medical renal disease: increased cortical echogenicity, often with small kidneys in chronic disease.

Vasculature

• Abdominal aortic aneurysm: measure outer wall to outer wall; note any thrombus.
• Dissection: an intimal flap with flow in true and false lumens.
• Normal waveforms: know which vessels are normally low-resistance (such as the renal and hepatic arteries) versus high-resistance (such as the fasting SMA and the aorta below the renal arteries), and how the SMA changes after a meal.

GI tract

• Appendicitis: noncompressible, dilated appendix, possible appendicolith and surrounding inflammatory change.
• Pyloric stenosis: thickened, elongated pyloric muscle with delayed gastric emptying.
• Intussusception: "target" or "donut" appearance in transverse view.

Superficial structures

• Thyroid: know features that raise concern in a nodule (such as microcalcifications, taller-than-wide shape and irregular margins) and the appearance of thyroiditis.
• Scrotum: testicular torsion shows absent or decreased flow on the affected side; epididymitis typically shows increased flow.

A 6-week abdomen study plan

Week	Focus
1	Baseline practice test, patient care and safety, liver
2	Biliary system and pancreas
3	Spleen, urinary tract and adrenals
4	Abdominal vasculature, retroperitoneum and Doppler waveforms
5	GI tract, peritoneum, abdominal wall, superficial structures, procedures
6	Full-length mock exams, targeted review of weak categories

Each week, combine short reading sessions with plenty of practice questions, and review every explanation, including on questions you got right. Hotspot questions reward image recognition, so look at lots of images of both normal anatomy and pathology.

Practice with SonoPass Abdomen

SonoPass includes 340 original Abdomen practice questions and 2 full-length Abdomen mock exams of 170 questions in 3 hours, slightly longer than the real exam's ~165 questions, so you build a little extra stamina. Mocks include a question grid, flagging, a review screen and auto-submit when time runs out.

Every question has a detailed explanation and a hint. Use Study Mode to drill one category at a time (biliary or vasculature, for example), run a Quick 10 session in about 5 minutes, and review with the Abdomen flashcard study guide. Your progress screen tracks accuracy, streak and weak categories, and the exam-date countdown keeps your timeline honest. It all syncs across iPhone, Android and sonopass.com.

Start free with one Quick 10 a day. SonoPass Pro unlocks every question and mock for $9.99/month or $49.99 one-time for Pro Lifetime at the launch price (it goes up after launch).

Haven't taken the SPI yet? Start with how to pass the ARDMS SPI exam on your first try, and when your date gets close, read our ARDMS exam day tips.