FAST Exam
What are the basic views for the FAST exam? A. Left upper quadrant, right upper quadrant, cardiac, pelvic B. Left upper quadrant, right upper quadrant, pleural, retroperitoneal, and cardiac C. Left upper quadrant, right upper quadrant, pleural, pelvic D. Right upper quadrant, cardiac, pleural, retroperitoneal, pelvic E. None of the above
A
The epicardial fat pad __________. A. can be mistaken for a pericardial effusion B. appears heteroechoic and moves with the heart C. is always visible in all cardiac views.
A and B
To optimize the subxiphoid cardiac view, __________. A. use the liver as an acoustic window B. be sure the patient's bed is flat
A and B
A pericardial fat pad __________. A. can be mistaken for a pericardial effusion B. is usually less than one centimeter in thickness C. does not typically surround the entire heart
A, B, C
To increase the accuracy of the FAST exam, __________. A. place the abdominal quadrant of interest in a dependent position B. insert a nasogastric tube C. perform the exam prior to Foley catheter insertion
A, B, C
To obtain an optimal left upper quadrant view of the splenorenal interface, __________. A. hold the ultrasound transducer in a coronal plane B. hold the ultrasound transducer slightly superior and posterior with respect to the position that was held for the right upper quadrant view C. avoid imaging the stomach
A, B, C
Which of the following choices may optimize the subxiphoid cardiac view? A. Ensure the patient's bed is flat. B. Use the liver as an acoustic window. C. Hold the ultrasound transducer flat against, and often nearly parallel, to the patient's abdomen. D. A and B E. A, B, and C
A, B, C
When visualizing the left upper quadrant, if the spleen and diaphragm have been visualized, but the kidney is not in its expected place, __________. A. fan the transducer slightly posteriorly B. fan the transducer slightly anteriorly C. rotate the transducer 90 degrees clockwise D. rotate the transducer 90 degrees counterclockwise E. None of the above
A, Correct. Imaging of the left upper quadrant view begins in a coronal plane at about the midaxillary line. When the spleen and diaphragm have been located, fan the transducer slightly posteriorly to bring the left kidney into view, without sliding the probe along the patient's skin. This brings the retroperitoneal space into the plane of view. Another way to imagine the movement is to pretend the probe is a flashlight and shine the flashlight slightly toward the spine.
When inspecting the thoracic cavity for a hemothorax, __________. A. a hemothorax will appear hyperechoic if the blood is clotted B. a hemothorax will appear anechoic if the hemorrhage is fresh C. sensitivity can be increased if the patient is put in reverse Trendelenberg position D. a small hemothorax may be difficult to distinguish from a sliver of intraperitoneal blood layering out under the diaphragm E. All of the above
All
When obtaining a parasternal long cardiac view, if the heart cannot be visualized, __________. A. slide the transducer directly over a rib interspace B. the patient may have subcutaneous emphysema, obscuring the view C. ensure the transducer is not positioned over the sternum D. attempt a subxiphoid view as an alternative E. All of the above
All
When obtaining a transverse pelvic view in the setting of trauma, if the bladder cannot be visualized, __________. A. the bladder may be empty due to recent voiding B. the bladder may be ruptured C. overlying subcutaneous emphysema may be limiting visualization D. the transducer may be overlying the pubic symphysis E. All of the above
All
Which of the following choices increases sensitivity of the FAST exam? A. Completing pelvic imaging prior to Foley catheter insertion B. Placing the abdominal quadrant of interest in a dependent position C. Slowly fanning the transducer during window imaging to detect subtle pockets of free fluid D. Performing serial FAST exams at varying stages of a patient's resuscitation E. All of the above
All
Which of the following statements regarding left upper quadrant FAST imaging is correct? A. Fluid in the stomach can be mistaken for free intraperitoneal fluid. B. Stomach fluid is often anechoic. C. Stomach fluid is encapsulated and does not fill the splenorenal interspace. D. All of the above
All
Which of the following choices may help obtain an optimal right upper quadrant view of the hepatorenal interface? A. Hold the ultrasound transducer slightly inferior and anterior with respect to the position that was held for the left upper quadrant view. B. Hold the ultrasound transducer in a coronal plane. C. Avoid placing the transducer directly over ribs. D. When using an abdominal curved-array transducer, rotate the transducer slightly counterclockwise (5 to 10 degrees) from the coronal plane to position the transducer between ribs. E. All of the above
All the above
In which of these anatomic spaces can free fluid be reliably detected with a FAST exam? A. Pericardial, retroperitoneal, peritoneal, and pleural space B. Pericardial, retroperitoneal, and pleural space C. Pericardial, peritoneal, and pleural space D. Retroperitoneal, peritoneal, and pleural space E. None of the above
C. Correct. The FAST exam is used to evaluate a patient's pericardial, peritoneal, and pleural space for free fluid. Hemorrhage within the retroperitoneal space can rarely be detected with a FAST exam.
What are the indications for performing a FAST exam? A. Blunt or penetrating trauma to the abdomen or chest B. Abdominal pain, vaginal bleeding, or hemodynamic instability in a pregnant patient C. Unexplained hypotension in any patient D. All of the above E. None of the above
D
Which of the following best characterizes perinephric fat? A. Perinephric fat has a uniform anechoic appearance. B. Perinephric fat is an extremely rare sonographic finding. C. Perinephric fat has a uniform hyperechoic appearance. D. Perinephric fat displays mixed echogenicity.
D
When obtaining a sagittal pelvic view, if the bladder cannot be visualized, __________. A. rock the transducer deeper into the pelvis B. fan the transducer slightly anteriorly C. rotate the transducer 90 degrees clockwise D. rotate the transducer 90 degrees counterclockwise E. None of the above
D; Rotate the transducer 90 degrees counterclockwise
True or false: A high-frequency linear transducer is the ideal transducer selection for performing a FAST examination.
FALSE Want low frequency
The parasternal long cardiac view is always obtainable and is the preferred cardiac view. A. True B. False
False
True or False: FAST examination is more accurate than CT imaging for detecting retroperitoneal pathology. A. True B. False
False
True or False: Fast is more accurate than lavage A. True B. False
False
True or False: The recto-uterine space is also referred to as the anterior cul-de-sac. A. True B. False
False
What are the basic views for the FAST exam?
RUQ LUQ Cardiac Pelvis
On the sagittal pelvic view, free fluid can be found collecting in the __________. A. vesicouterine space (anterior cul-de-sac) B. rectouterine space (posterior cul-de-sac or pouch of Douglas) C. on the left side of the ultrasound screen
all the above
The left upper quadrant FAST view requires the ultrasound transducer to be held in a __________ plane. A. Sagittal B. Transverse C. Coronal D. Oblique E. Horizontal
corneal
The right upper quadrant FAST view requires the ultrasound transducer to be held in a __________ plane.
coronal
The right upper quadrant FAST view requires the ultrasound transducer to be held in a __________ plane. A. Sagittal B. Transverse C. Coronal D. Oblique E. Horizontal NEXT QUESTION
coronal
There is no benefit in repeating a FAST exam following initiation of resuscitation (e.g., within 10 minutes of the initial FAST exam), because it is rare to have new findings appear. A. True B. False `
false
True or False: The parasternal long (PSL) cardiac view is always easier to obtain than the subxiphoid cardiac view.
false
When visualizing the left upper quadrant, if the spleen and diaphragm have been visualized, but the stomach is visualized instead of the kidney, __________.
fan the transducer significantly posteriorly
True or False: In a supine patient, the hepatorenal interface, or Morison's pouch, is one of the most dependent points within the peritoneal cavity. A. True B. False
true
True or False: When inspecting the thoracic cavity for a hemothorax, the artifact that suggests the presence of a normally inflated lung is called mirror artifact.
true
True or false: The hepatorenal interface, or Morison's pouch, is the most dependent point within the peritoneal cavity in a supine patient.
true
True or false: the acronym FAST stands for focused assessment with sonography in trauma. A. True B. False
true