Emergency Ultrasonography

Post-Test

1. Velocity of propagation is better in water than in air
2. Higher frequency increases velocity
3. The equation is: Velocity= Frequency X Wavelength
4. Frequency is the number of cycles per second
5. All of the above are correct

1. Ultrasound images (what you see) are based on the depth and direction of the returning echoes
2. Depth is determined by the time elapsed between the signal and the received echo
3. The returning intensity is proportional to the grayscale assignment on the screen (increased intensity=white, decreased=black)
4. A and B
5. All of the above

1. The loss of signal energy as it passes through tissue
2. The resistance to the propagation of sound
3. The ability of the sound waves to discriminate between two different objects
4. Anechoic signal caused by failure of the ultrasound beam to pass through an object
5. None of the above

1. The gain amplifies the returning echoes from all parts of the screen
2. Returning echoes, by nature, are weaker than ultrasound pulses
3. Distant structures tend to appear less echogenic
4. A and B
5. All of the above

1. Represents time on the horizontal axis
2. Produces red color with flow towards the probe, and blue color with flow away from the probe
3. Depicts the motion or deflection of the tissue relative to the transducer
4. A and C
5. All of the above

1. Is initially anechoic
2. Appears “pointy”
3. Appears “rounded”
4. Is difficult to distinguish from ascites
5. A, B, and D
6. All of the above

1. Is more sensitive in obese patients
2. Is used to identify free intraperitoneal or pericardial fluid in the setting of trauma
3. Is sensitive for intra-abdominal organ injury
4. Free fluid is most commonly found in the left upper quadrant
5. A and B
6. All of the above

1. __
2. __
3. __
4. __

1. Perinephric fat is typically hyperechoic, and does not shift with movement
2. Duodenal fluid, the gallbladder, and the IVC are all mimics for free fluid
3. Perinephric fat tends to be even thickness
4. Pleural fluid may present as an anechoic stripe above the diaphragm
5. All of the above

1. The phrenicocolic ligament restricts the flow of free fluid to the LUQ
2. Blood preferentially flows between the left paracolic gutter to the LUQ
3. The LUQ view is typically found more anterior and inferior as compared to the RUQ view
4. The LUQ is the most easily visualized of the FAST views
5. All of the above

1. Seminal vesicles may be incorrectly identified as free fluid
2. Gain artifact is a major issue in this view
3. The probe should be angled to just below (caudal to) the prostate or vaginal stripe
4. The probe should be placed in a periumbilical location
5. A and B
6. All of the above

1. RV or RA collapse may occur in an otherwise normal patient
2. A little pericardial fluid may be completely normal
3. Scans may be enhanced by obesity and pneumoperitoneum
4. Imaging typically worsens when the patient takes a deep breath
5. None of the above

1. Between two rib shadows, there is a notable echogenic line composed of the visceral and parietal pleura
2. The transducer is placed longitudinally (pointed cranially) in the midclavicular line
3. The transducer is moved inferiorly in a systematic fashion
4. A and C
5. All of the above
6. None of the above

1. Viscus perforation
2. Bowel wall contusion
3. Pancreatic trauma
4. Renal pedicle injuries
5. Retroperitoneal hemorrhage
6. All of the above

1. Typically occur in the ovaries
2. The B-hCG always rises less than 50% every 2 days
3. If a patient has a B-hCG of <500, then an ultrasound is not helpful to evaluate for ectopic
4. The incidence of heterotopic pregnancy is around 1 in 400
5. None of the above

1. Thin-walled
2. Anechoic
3. Spherical
4. No loculations
5. All of the above

1. Fetal pole
2. Double decidual sign
3. Fetal heart tones
4. Yolk sac
5. Thickened endometrium

1. Is approximately 2cm as it enters the abdomen and then gradually increases in size distally
2. Gives off, in the following order, the celiac trunk, the superior mesenteric artery, the inferior gastric artery, the inferior mesenteric artery, and the renal arteries
3. Bifurcates into the common iliac arteries at approximately the level of the umbilicus (L4 level)
4. B and C
5. All of the above

1. Are defined as an abnormal focal dilation of the vessel wall that measures greater than 5cm
2. Expand at an average rate of 2-3 cm per year
3. When ruptured, tend to do so intraperitoneally
4. An intervention is often recommended if the aneurysm grows more than 1 cm per year or it is bigger than 5.5 cm
5. None of the above

1. Has been reported to be nearly 100% sensitive for detecting AAA, assuming the study is adequate
2. Has a high sensitivity for detecting extraluminal blood from a ruptured AAA
3. Usually incorporates a 2.5-5 MHz curved array probe
4. A and C
5. All of the above

1. Fascial planes are hyperechoic
2. Muscle has a characteristic striated appearance
3. Lymph nodes have echogenic centers with hypoechoic rims
4. A and B
5. All of the above

1. The transverse approach is typically easier to learn
2. A disadvantage of the longitudinal approach is that you must scan back and forth to locate the needle tip as you advance
3. The one person technique is preferable in a busy ED
4. A and C
5. All of the above

1. Pulsatile
2. Collapsible
3. Thin-walled
4. All of the above
5. None of the above

1. The linear probe is typically used
2. The patient is maintained (if possible) in Trendelenburg
3. Augmentation, spontaneity, and respiratory variation are documented for an Emergency Ultrasound DVT exam
4. A and B
5. None of the above

1. A contracted gallbladder is common in acute cholecystitis
2. Normal gallbladder wall thickness is < 7mm
3. The most common cause of gallbladder wall thickening is acute cholecystitis
4. Ultrasound has a high sensitivity for detecting common bile duct stones
5. None of the above

1. Rule out renal tumors
2. Evaluate for painless hematuria
3. Search for an etiology of acute renal failure
4. Evaluate patients with a clinical suspicion of ureteral colic
5. Look for urinary retention
6. C, D and E
7. All of the above

1. Your views may be improved by angling the probe indicator posteriorly in the orientation of the ribs
2. Perinephric fat is commonly seen between the kidney and the adjacent liver or spleen
3. The normal ureter is not visualized
4. Bladder volume may be estimated by taking 3 dimensions (in centimeters), and multiplying them together (X times Y times Z) for a volume in milliliters
5. The left kidney is often more difficult to visualize due to a smaller sonographic window
6. A and D
7. All of the above

1. Calyceal dilation is reflected as hyperechoic areas in the renal sinus
2. Ureteral stones are commonly visualized in the mid-ureter
3. Color flow may be placed over the kidney to differentiate vascular structures versus hydronephrosis
4. B and C
5. None of the above

1. ________ narrows the US beam at the depth of interest.
2. ________ adjusts the number of centimeters to the bottom of the screen.
3. ________ expands the area of interest on the viewing screan.
4. ________ improves resolution.
5. ________ augments the ultrasound signal on the viewing screen.

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