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ARDMS AB-Abdomen Exam - Topic 3 Question 6 Discussion

Which technique would best assist the sonographer to verify the finding in this image obtained from the right upper quadrant?
D) Assess for sonographic Murphy sign
A) Use compound imaging
B) Change the patient's position
C) Ask patient to perform Valsalva

ARDMS AB-Abdomen Exam - Topic 3 Question 6 Discussion

Actual exam question for ARDMS's AB-Abdomen exam
Question #: 6
Topic #: 3
[All AB-Abdomen Questions]

Which technique would best assist the sonographer to verify the finding in this image obtained from the right upper quadrant?

Show Suggested Answer Hide Answer
Suggested Answer: D

The image demonstrates a gallbladder with a possible echogenic focus (likely a gallstone) and posterior acoustic shadowing. This is suggestive of cholelithiasis. To differentiate uncomplicated gallstones from acute cholecystitis, the most effective technique is to assess for a positive sonographic Murphy sign.

A positive sonographic Murphy sign refers to the presence of focal tenderness over the gallbladder when it is directly palpated with the ultrasound transducer. It is a strong indicator of acute cholecystitis when combined with other features such as gallbladder wall thickening, pericholecystic fluid, and gallstones.

Sonographic Murphy sign --- key points:

Assessed during real-time scanning

Localized tenderness when pressure is applied over the gallbladder

Highly sensitive for acute cholecystitis (especially in the presence of stones)

Differentiation from other options:

A . Use compound imaging: Improves image quality by reducing artifacts but does not verify tenderness or confirm acute inflammation.

B . Change the patient's position: Helpful to confirm mobility of gallstones, but not diagnostic of inflammation.

C . Ask patient to perform Valsalva: Used primarily in vascular studies (e.g., assessing for varicocele or venous reflux), not relevant here.


Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic Ultrasound. 5th Edition. Elsevier, 2018. Chapter: Gallbladder and Biliary System, pp. 148--152.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum, 2020.

Radiopaedia.org. Sonographic Murphy sign: https://radiopaedia.org/articles/sonographic-murphy-sign

by Tiara at Nov 19, 2025, 05:06 AM

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Janine
3 months ago
C seems less relevant here. Valsalva is for different scenarios.
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Twanna
3 months ago
I feel like A could enhance the image quality, but not as effective.
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Shaun
3 months ago
Option B could help too. Changing position might reveal more.
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Audria
4 months ago
I agree, D makes sense. It directly assesses gallbladder issues.
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Ben
4 months ago
I think option D is the best. Murphy sign is crucial.
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Lai
4 months ago
Valsalva could be useful too, but not sure it's the best option.
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Roxane
5 months ago
I thought compound imaging was the go-to for this?
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Werner
5 months ago
Wait, can changing the position really help that much?
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Antonio
5 months ago
Totally agree, D makes the most sense!
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Chandra
5 months ago
I think D is the best choice here.
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Marcelle
5 months ago
C) Ask patient to perform Valsalva is a good technique to try as well. Gotta love those fancy maneuvers!
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Tanja
5 months ago
D) Assess for sonographic Murphy sign is the correct answer. That's a classic sign for right upper quadrant pathology.
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Terrilyn
6 months ago
B) Change the patient's position is the best option to verify the finding in this image.
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Omer
6 months ago
Compound imaging sounds familiar, but I feel like it might not directly help with verifying the findings in this specific case.
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Pedro
6 months ago
Changing the patient's position might give us a better view, but I can't recall if it's the best option here.
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Dalene
6 months ago
I remember practicing questions about the sonographic Murphy sign; it seems like a solid choice for verifying findings in the right upper quadrant.
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Lyla
6 months ago
I think using the Valsalva maneuver could help, but I'm not entirely sure how effective it is in this scenario.
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Bonita
6 months ago
This is a tricky one, but I'm feeling confident. I'll start by assessing for the sonographic Murphy sign, then consider changing the patient's position if needed. Gotta cover all the bases!
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Noah
7 months ago
I'm a little confused by the options here. Does compound imaging mean using multiple transducer positions? I'll need to review that technique before deciding.
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Nickolas
7 months ago
The sonographic Murphy sign seems like the most direct way to check for the issue shown in the image. I'll focus on that approach.
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Gary
7 months ago
True, but D is more specific for this case.
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Elsa
8 months ago
Okay, I think I've got this. Changing the patient's position could help get a better view of the area in question. And the Valsalva maneuver might reveal something interesting too.
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Jennie
8 months ago
Hmm, I'm not sure about this one. I'll need to think through the different imaging techniques and how they could help verify the finding.
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Evette
3 months ago
Compound imaging could also clarify the findings. So many options!
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Herman
3 months ago
I’m leaning towards the Valsalva maneuver. It might highlight some issues.
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Tasia
3 months ago
Yeah, that might give a better view of the area.
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Cletus
7 months ago
I think changing the patient's position could help.
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Angelica
7 months ago
What about assessing for the Murphy sign? That could be useful too.
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