E Med Exam 2 US Clinical correlation/key topics

Glomus tumor (under the nail of the thumb)

14 year old female patient with pain in the thumb during compression of the nail. What is the dx?

Pericardial effusion (final dx is pericarditis with secondary diagnoses of lupus, pneumonia and sepsis)

22-year-old male arrived at the Emergency Department around midnight, complaining of chest pain and shortness of breath. It was his second visit to the ED in as many weeks; just 14 days earlier, he had come in with a respiratory infection, which was treated with antibiotics. The patient's malaise and fatigue had continued, however. He presented the second time in severe distress. He had no nausea, vomiting or fever, but in addition to the chest pain and dyspnea, he had a rash on his extremities. Because his symptoms were worsening, with increasing dyspnea, tachycardia and a rise in blood pressure to 172/102, we decided to perform a bedside ultrasound. What is the likely dx?

Acute ureteral colic

26 year old woman presents complaining of vague left-sided back and lower abdominal pain. She reports that the pain is "kinda" the same as her prior kidney stone. Senior resident "unimpressed" by her pain, diagnoses her with MSK strain. UA neg for pregnancy or blood. A student intern decides to circumvent the senior resident and performs a renal ultrasound. What is the likely dx?

Morrisons pouch

30 y/o pedestrian struck by a car, hemodynamically unstable, and tachycardic. FAST performed after primary survey revealed free fluid in all four abdominal views of the FAST exam. There is free fluid in ____ ___ of the RUQ view. This is the MOST sensitive view to detect free fluid in trauma.

Retrocalcaneal bursitis and Achilles' tendon tendinosis

30 year old athlete with persistent heel pain on the right side. What is the dx?

Ovarian vein thrombophlebitis (with thrombus extending in the inferior vena cava)

31 year old female 2 weeks post Caesarian section. Now presents with pain in the right lower abdomen, fever and slightly raised infection parameters. What does she present with? The

Medial meniscal cyst and meniscal tear

37 year old female patient with a palpable mass on the anterior medial aspect of the knee. What is the dx?

Supxiphoid view, pericardial effusion

37 year-old female presents with dyspnea and tachycardia. CXR shows cardiomegaly. Bedside echo is performed. What cardiac view is this? What is the pathology?

Full thickness tear of the long head of biceps tendon with retraction

74 year old male felt a sudden painfull snap in the upper arm during a game of tennis. What is the dx?

Juxtaductal coarctation of the aorta

8 year old boy with abdominal pain and vomiting was referred for ultrasound of the abdomen. What is the likely dx?

Pericardial effusion (circumferential)

93 year old female with history of hypertension, stage IV CKD, and dementia, presents to the ED brought by family for altered mental status and shortness of breath. She was found to by tachypneic and hypoxic on room air. What abnormality do you see?

Pyogenic liver abscess

A 10-year-old male, previously healthy, presented with right upper quadrant pain for 2 weeks without other symptoms. Initially, the pain was present only at night, and the patient described the initial pain as though "someone punched him." Pain progressed and became worse over the ensuing week. The patient denied fever, nausea, vomiting, diarrhea, constipation, hematemesis, or hematochezia. On questioning, the patient denies any fatigue, chills, diaphoresis, anorexia, or shortness of breath. He has had no change in his urine output. He also denies any hematuria or back pain. He has not reported any rash. Of note, the patient does live on a farm and drinks well-water. He also bathes in the well water. He has had no recent travel, sick contacts, or strange food consumption. The patient and his family have not appreciated any jaundice. His temp was 38.1 degrees Celsius. The patient had positive bowel sounds. Abdomen was soft, nondistended, mildly tender to palpation over the right upper quadrant with guarding. Liver border appreciated at the costal margin on deep palpation. WBC was 14.1 with 72% neutrophils. CRP was 9.5 and ESR was 40. What is the likely dx?

These ultrasound images demonstrates limited flow into the right testicle suggestive of testicular torsion. Manual detorsion was performed at the bedside using the "open-the-book" maneuver with subsequent ultrasound demonstrating return of flow to the right testicle. Urology was consulted, and the patient was scheduled for an outpatient orchiopexy.

A 13-year-old male presents to the emergency department with right testicular pain for one-hour duration. The pain began while having a bowel movement. He had no nausea or vomiting. His exam is notable for a high riding right testicle and tenderness to palpation over the right testicle. Vitals: T: 97.8, HR: 106, BP: 135/79, RR: 16, Sat: 96% on RA A bedside ultrasound of the testicles is performed. What do you see?

Incision and drainage. The patient presents with lateralizing pharyngitis symptoms associated with fever and trismus concerning for peritonsillar abscess (PTA). The ultrasound clip demonstrates a well circumscribed, hypoechoic fluid collection abutting the left tonsil confirming this diagnosis

A 22 year old male presents to the emergency department with a sore throat for 1 week. The pain is predominately on the left side and is associated with difficulty opening his mouth and fever. He was placed on amoxicillin 3 days ago but notes that his symptoms have progressed. He appears uncomfortable. Vitals: T 101.4 HR 105 BP 132/81 RR 14 O2 98% on RA A bedside ultrasound is performed, what is the next best step in management?

Hydronephrosis

A 23 y/o female is post op emergency hysterectomy post uterine rupture with rising creatinine in surgical ICU. POCUS revealed right sided mild grade 1 ______ with appreciable dilated Major calyces and renal pelvis. Initial concern is for obstructive process or ureter injury.

Start with transabdominal scan

A 24 year-old female arrives with early pregnancy and pelvic cramping. She has never had an ultrasound to confirm IUP. Below is a transvaginal ultrasound (TVUS) image of a pregnancy. What would you do differently with regard to imaging this pregnant female?

Pericholecystic fluid, long

A 25 y/o female PMH HIV presents with non bloody, non bilious vomiting for ONE day associated with upper abdominal pain. POCUS revealed gallbladder wall thickening and pericholecystic fluid, but no gallstones or sonographic Murphys sign. The pt received symptomatic treatment and a surgical evaluation. The pt ultimately improved and was determined to not have cholecystitis. The pt was discharged home after her symptoms resolved and she was able to tolerate PO. What is the likely dx? What axis is this?

The ultrasound demonstrates a large amount of free fluid between the spleen and the diaphragm. There is also a sliver of echogenic material above the capsule of the spleen suggestive of clotted blood. Morison's pouch (not shown) was also noted to be significantly positive for free fluid. Given the patient's unstable vitals and the clinical history, this was concerning for a ruptured ectopic pregnancy. OB was consulted immediately and the patient was taken to the OR. The diagnosis of ruptured ectopic pregnancy was confirmed during laparotomy. The patient did well.

A 25 year old female presents to the emergency department with acute abdominal pain and a syncopal episode. She notes a positive home urine pregnancy test 1 week ago. She appears mildly uncomfortable with a tender abdomen. A bedside ultrasound is performed, a clip is shown below. What are the findings of the ultrasound clip and what is your diagnosis? Vitals: T 98.7 HR 120 BP 95/72 RR 20 O2 98% on RA

Lemierre's syndrome

A 26 y/o with no PMH had left molar extracted 10 days prior, and now presents with four days of subjective fever, malaise, and increasing pain to L neck, tachypneic and hypoxic and was intubated with central line placed. The POCUS scanned through the jugular vein to reveal a clot. CT angiogram showed left internal jugular vein thrombosis with low attenuation of the L temporal lobe that is concerning for parenchymal abscess. What is this syndrome?

Bar code sign (pneumothorax)

A 28 /yo male presents to the ED stating he was kicked in the chest. He went home to try to relax and smoke some weed but now has SOB and with pleuritic chest pain after smoking. POCUS demonstrates decreased lung slide on the left. What sign is this?

Testicular rupture

A 29 y/o male presents with scrotal pain upon awakening after a night of heavy drinking. He could not recall any trauma. PE revealed a tender, swollen, and ecchymotic scrotum. POCUS demonstrates hematocele, as well as disruption of the tunica albuginea, contour abnormality of the testis, and heterogenous echotexture of testicular parenchyma. These THREE findings collectively are highly sensitive and specific for ______ ______ and warrant URGENT surgical exploration.

Using ultrasound as an adjunct to your exam, you are able to tell the consultant that there is a normal appearing, reactive pupil and that the extra-ocular movements of the eye are intact. The consultant is appreciative over the phone and is happy to come in and see the patient whom after evaluation is discharged home with close outpatient follow up.

A 30 year old male presents to the emergency department after blunt trauma to the face from an altercation. He notes he was punched several times in the face but did not pass out. His exam is notable for significant right periorbital ecchymosis and edema with inability to open his eye. You are unable to perform a direct eye exam given the significant periorbital swelling. A CT maxillofacial is performed which shows an isolated right inferior orbital wall fracture. Vitals: T 98.6 HR 85 BP 142/81 RR 14 O2 98% on RA Prior to ENT consultation, a bedside ultrasound of the orbits is performed. In spite of being unable to open the eye, what can you tell your consultant regarding your exam?

Biliary colic,

A 31 y/o male presents to the ED reporting of acute onset of abdominal pain immediately after eating a meal. He was well appearing and afebrile. PE is notable for reproducible tenderness to palpation of his upper abdomen. POCUS long axis view is obtained to right of epigastrium which is notable for hyperechoic material within the lumen of the gallbladder producing a posterior shadowing. The dx is _____ _____ and the pt was able to be discharged with scheduled outpatient elective surgery.

Hydrocele

A 31 y/o sexually active male with no previous medical history presents to the ED with testicular pain. POC US demonstrates a septated __________.

The ultrasound image demonstrates a simple cyst located in the cortex of the kidney. The cyst can be described as anechoic, homogenous, with thin and smooth walls, and would be a type I lesion according to the Bosniak classification system (image below). There is no evidence to suggest obstructing hydronephrosis. The Bosniak classification for renal cysts was developed in the 1980s as an attempt to standardize the description and management of complex renal lesions. Based on classification of the renal lesion, the likelihood of malignancy can also be predicted. While the Bosniak classification was initially described and validated with CT imaging, newer data suggests that ultrasound may be sufficient to follow renal cysts that are minimally complex (Bosniak I & II).

A 32 year old healthy female with no past medical history presents to the emergency department with left sided flank pain x 2 days. Vitals: T 98.6 HR 72 BP 126/82 RR 12 O2 98% on RA A bedside ultrasound of the left kidney is performed, what is the next best step in management?

These ultrasound images show an apical 4 chamber and parasternal short view of the heart, as well as a right lower extremity DVT. The apical 4 chamber demonstrates right ventricular dilation with bowing of the septum into the left ventricle. The parasternal short illustrates "D sign" with right ventricular dilation and bowing/flattening of the interventricular septum leading to decreased left ventricular systolic function. Both views indicate right heart strain in the setting of likely pulmonary embolism. The right lower extremity showed a noncompressible right femoral vein, indicating DVT. TPA was prepared and ready to give incase patient had worsening hemodynamic instability. She was fortuantley able to tolerate further imaging without HD compromise; CT angio confirmed the diagnosis of pulmonary embolism in bilateral main pulmonary arteries extending into all 5 lobes. Half dose TPA was administered and the patient was admitted to the ICU.

A 32 year-old woman with history of pleurisy and systemic lupus erythematosus presented to the emergency department with three weeks of shortness of breath and pleuritic chest pain, acutely worse one day prior to arrival. She flew into San Diego three days prior to her hospital presentation. She became dyspneic when walking from her hotel bed to the bathroom. On review of systems, she did endorse 3 weeks of right lower leg cramping. She denied fever/chills, cough, back pain, or history of blood clots. She was tachypneic and speaking in short phrases upon arrival. Vitals: T: 98.3, HR: 130, BP: 142/88, RR: 24, SpO2 97% on RA A bedside ultrasound ECHO and lower extremity scan was preformed. What do you see?

Pleural effusion

A 33yo male presents to the ED with c/o chest pain for 3 months. He is dyspneic but otherwise has normal VS. He states that he was told that "something was wrong with my left lung." The probe is oriented in a coronal plane along the left posterior axillary line.. what is the diagnosis?

These ultrasound images show an apical 4 view of the heart. There is a hyperechoic mass in the right atrium that does not shadow, suggestive of a line thrombosis. A CT angio confirmed the diagnosis, showing a large clot adhered to the distal tip of the catheter.

A 35 year old woman with sickle cell disease presented to the emergency department with localized swelling and pain near her port site. The pain started two days prior to arrival, when she was at an infusion center and her port was found to be inaccessible by the staff. She stated that the staff were unable to draw back any blood. She denied shortness of breath, chest pain, fever, or any other skin changes aside from the swelling. Vitals: T: 97.8, HR: 64, BP: 144/80, RR: 16, Sat: 96% on RA A bedside ultrasound ECHO was preformed to evaluate the distal tip of the port. What do you see?

There is evidence of severe aortic regurgitation and aortic root dilation (~6 cm) on this parasternal long axis view. In a patient without any previous cardiac history with new aortic regurgitation this is concerning for acute aortic dissection. Cardiac surgery was consulted immediately and the patient was taken straight to CT scan for confirmation of type A aortic dissection. The patient was in the OR within 1 hour and had an excellent outcome.

A 40 year old male presented with 3 days of progressive dyspnea on exertion. He notes he was in a normal state of health prior to this and played basketball daily without issue but now he can no longer walk across the room without becoming winded. He has no chest pain, a normal chest x-ray and an ECG demonstrating sinus tachycardia Vitals: HR 109 BP 110/72 RR 22 O2 96

Right patellar fracture

A 43 year old man presented after trauma to right knee. An ultrasound of the right knee was performed. What is the dx?

The ultrasound clips demonstrate hypoechoic material in the orbits bilaterally, swirling around with subtle eye movement. This is consistent with bilateral vitreous hemorrhage. The diagnosis was discussed with the patient and he was referred to ophthalmology clinic for dilated eye exam in 24 hours.

A 45 year old male with poorly controlled DM presents with bilateral vision loss. His right eye vision acutely worsened 3 days ago with the sensation of a curtain moving back and forth across his visual field. Today his left eye vision acutely worsened with flashes and floaters occurring. He denies any trauma, headache, or new medications. Vitals: T 98.6 HR 90 BP 149/87 RR 16 O2 98% on RA A bedside ultrasound of the orbits is performed, what is the next best step in management?

Pneumothorax, barcode sign

A 47 y/o male with a sudden onset of right sided chest pain that woke him from sleep. He had decreased breath sounds on the right side. POCUS shows decreased lung slide with normal lung slide in left lung. What is the dx and what is the sign that presents when putting the US in M Mode?

Spine, pleural effusion

A 47 y/o woman presents to the ED with gradual onset of severe right sided chest pain, pleuritic, associated with tachycardia but normal BP. She was mildly tachypneic but not hypoxic, unable to lie down as that exacerbated her pain. This US shows the pts RUQ and right lung base. The ______ sign is seen along with a RIGHT _____ ____ and a circumscribed mass 8 x 6 cm with likely compressive Atelectasis and a mass effect of the right hemidiaphragm.

PE

A 47 year old male presents after having a "panic attack" shortly after being discharged from the hospital. While the nurses were talking to him in the car, he loses pulses. The staff begins CPR in the parking lot and wheels the patient into the ED resuscitation bay. He was resuscitated according to ACLS algorithm. An ECHO performed at a rhythm check is shown below. What is the likely dx?

Type A aortic dissection

A 50 y/o mandarin speaking man complains of vague central chest pain. You pursue a routine cardiac workup which is fairly normal. Upon discharging him, the nurse tells you his systolic BP is now in the 80s. You perform a RUSH exam, and echo demonstrates a widened aortic outflow tract suggesting a ______ ____ ______ ______. You also see a pericardial effusions ith right ventricular diastolic collapse. A CT surgeon needs to be in house for this case!!!!

Insertion of foley catheter. The clip above demonstrates severe hydronephrosis of the patient's transplanted kidney. A foley was inserted in the emergency department with immediate output of 1.5 L of clear urine. The patient was found to be in renal failure secondary to his urinary outlet obstruction. He was admitted to transplant surgery and his renal function improved over the next day; he was discharged home with a leg bag and urology follow up. Below is a repeat ultrasound of his transplanted kidney after drainage of his bladder:

A 52 year old male with a h/o kidney transplant presents to the emergency department with pain over his transplanted kidney site (right pelvic region). He also notes increased weakness, nausea and a significant decrease in urine output. He denies any fever. He states he is compliant with his anti-rejection medications. Vitals: T 99.0 HR 105 BP 165/91 RR 18 O2 98% on RA A bedside ultrasound is performed, what is the next best step in management?

Tension hemothorax

A 55yo F with h/o recurrent ovarian CA, PE, pleural effusions and ascites, presents with cough, SOB, and CP. VS: 131/79, 155, 99.1 20, 94% on 2L/NC. Point-of-care hemoglobin is 6. A bedside cardiac and pleural exam is performed. What is the likely presentation?

hydronephrosis

A 58-year-old female with a history of kidney stones presents with acute onset of right-sided 8/10 flank pain and NB/NB vomiting 3 hours ago. Over the past 10 days she has experienced mild dysuria, intermittent hematuria, and right-sided flank "aching" that radiates to her ipsilateral labium. Her LMP was 5 years ago. She admits to chills but denies fever or a history of STIs. What does she present with?

Ureterovesical junction nephrolithiasis

A 59 y/o man presents with his first episode of severe LLQ pain and vomiting. The differentials were diverticulitis vs nephro/urolithiasis. POCUS was performed obtaining images of the left and right kidneys, bladder and aorta. This image shows a 7 mm stone with shadowing at the L UVJ. What is the dx?

Pulmonary embolism

A 65 year old female presents with shortness of breath after a return flight from the Gold Coast of Australia to the United States. Vitals: HR 107 BP 110/80 RR 22 O2 95 What is the likely presentation?

Retinal detachment

A 66 y/o Female PMH DM with sudden onset of flashes of light and floaters followed by progressively worse blurred vision in her right eye. She has a history of cataracts surgery as well as DM retinopathy. POCUS of affected eye shows a prominent hyper-echo is linear density floating freely above the posterior fundus as shown. What is the dx?

No, the patient's IVC is small and collapsing almost 75% with normal respiratory variation. This predicts a fluid-responsive state. The patient was given another liter of lactated ringers, his blood pressure improved to 108/69, and his lactate cleared. You start maintenance IV fluids, call the hospitalist back, and the patient is admitted upstairs and does well.

A 67 year old male with a PMHx of DM presents with a chief complaint of cough and generalized weakness. Vitals: T 102.4 HR 127 BP 77/58 RR 24 O2 88% on RA You place the patient on O2 via nasal cannula and activate the sepsis protocol. He is empirically treated with broad spectrum antibiotics and IVFs are started. The chest x-ray shows multifocal pneumonia and you call hospital medicine to admit the patient. "What's the blood pressure now," the hospitalist asks. You glance at the monitor and murmur back, "92/63, but he looks pretty good." The hospitalist asks you to insert a central line, start vasopressors, and contact the ICU. Instead, you wheel the ultrasound machine into his room, and ultrasound his IVC. Does this patient require a central line and vasopressors?

Acute chest syndrome

A 7 y/o with HbSS presents with coughing with left sided chest pain and 1 day of fever. Lungs are without crackles and good air entry bilaterally. A consolidative process is seen with a hypoechoic region with posterior enhancement greater than 1 cm in an area where normal A lines should be present. This is highly suggestive of ____ _____ ____ given the clinical features.

Ganglion cyst (in the flexor digitorum longus tendon)

A 7-month-old male baby presented with a hard mass in the left hand just proximal and ventral to the left 2nd metacarpo-phalangeal joint. An ultrasound was performed. What is the dx?

Tarso-metatarsal joint arthritis (of tuberculous origin)

A 73 year old woman with history of bilateral calf vein thrombosis, secondary varix, infected calf ulcers and iron deficiency anemia, was admitted to the hospital for pain and partial functional compromise of the legs. She described a 2 year history of gradually increasing calf pain, left greater than right. One month before admission, the patient noted the presence of an ill defined, reddish area, edema and a painful mass in the lower third of the left calf. Local examination showed in the distal third of the left calf a tender pseudotumoral lesion, with hyperpigmentation of the neighboring skin. The patient was referred for a soft tissue ultrasound examination of the calf. What is the dx?

Rib fracture

A ____ ______ is seen here as a disruption in the hyperechoic line or bony cortex. Also there is an associated hyperechoic hematoma formation

Posterior fat pad

A _____ _____ ___ aka SAIL SIGN, is one of the common findings that is looked for after a traumatic elbow injury that can indicate an underlying fracture.

Morrisons pouch

A blunt trauma pts with a POSITIVE FAST exam. The liver can be seen floating in free fluid with the kidney posteriorly. The fluid is in the ________ _______.

Retinal detachment

A hyperechoic linear density is seen arising from the location of the fundus, indicating ______ ________.

Cysts

A middle aged adult female presents to the ED with abdominal pain. The pt reported history of PKD. Beside renal US revealed multiple renal ______ in both the cortex and medullary areas of the kidneys which is consistent with her history. Stones and hydronephrosis would be difficult to detect in the setting of PKD.

Diverticuli

A middle aged male presents with lower abdominal pain and difficulty urinating. He also reported incomplete bladder emptying. POCUS demonstrated multiple bladder _______ that were subsequently confirmed on CT pelvis.

The image above is of Morrison's pouch, demonstrating significant free fluid within the peritoneal cavity. Given the recent TURBT and lack of urinary output from the patient's foley catheter, this suggests that the fluid identified is consistent with urine secondary to intraperitoneal bladder perforation. This was later confirmed by CT cystogram and shortly after the patient was taken to the operating room for definitive repair.

A middle aged male s/p TURBT (transurethral resection of bladder tumor) 1 day ago presented with lower abdominal pain and no urine output from his foley catheter. A bladder scan was performed which was ~ 50 cc. What's the dx? Vitals: T 98.7 HR 110 BP 117/70 RR 18 O2 98% on RA

Arterial embolus

A middle aged woman presented to the ER as a stroke code. She complained of paresthesias in her right arm and had decreased sensation to light touch. It was noted that this arm was colder than the left, so after she returned from head CT, POCUS was performed of her brachial artery. There is a non compressible hyperechoic structure inside the brachialartery, consistent with the clinical pic of a ______ _______. Due to the urgency of stroke treatment, this image was obtained after the stroke team had administered tenecteplase.

Fat stranding

A non compressible appendix with appendicolith is seen with surrounding ______ ______ posterior to a decompressed cecum.

Miliary tuberculosis

A pt in rural Uganda presents with weight loss, night sweaters and cough. Utilizing the high frequency linear transducer, the pts thoracic pleura and superficial lung were evaluated. The US demonstrated multiple focal sub pleural lesions with tripartite B lines consistent with ________ _________.

Clot

A pt presents after a high speed MVC. The pt had a past medical history of A fib and was anticoagulated. The pt was agitated, calmly, and noting SOB. The initial E fast was negative. The pt was incubated with propofol for CT imaging. 15 min post intubation the pt became hemdyanmically unstable and Bradycardic followed by cardiac arrest. An apical FOUR chamber view was obtained during pulse check showing dense ______ in RV/RA with minimal cardiac activity.

Biliary sludge

A pt presents to the ER with recurrent abdominal pain. This image demonstrates a large amount of ______ _____ within a normal sized gallbladder. Biliary colic from intermittent obstruction was suspected.

Contusion

A pt presents with a history of blunt chest trauma. Lung US reveals a focal area of B lines as well as a hypoechoic wedge shaped subpleural consolidation. These findings are consistent with a pulmonary __________.

Interventricular septum, D

A pt presents with acute onset of undifferentiated SOB. POCUS was used to narrow the differential. Para sternal short axis demonstrated flattening of the ______ _____ which pushes the left ventricle into the shape of the letter ______.

Pneumonia, pleural shred sign

A pt presents with fever and purulent discharge from tracheostomy site. On this US, there is a discontinuity of a thickened pleura and B lines. These findings are consistent with dx of ____________. What sign is this?

Dynamic air bronchograms

A pt presents with no cough, no crackles and only subtle changes on CXR but in seconds he was diagnosed with Pneumoniae. This US shows ______ ____ _______ in pneumoniae.

Penile urethral calculus

A pt presents with penile pain and blood in urine. POCUS demonstrates a calculus obstructing the distal urethra. What is the dx?

Perinephric hematoma

A pt presents with sudden, severe right flank pain. There was no history of trauma and no gross hematuria. The pts pain was difficult to control with analgesics and bedside US reveals apparent spontaneous _____ ________.

Ganglion cyst

A pt struck his wrist severe days ago, and noted a deformity. There is a clear cystic structure with no Doppler flow diving between the bones and involving the synovium which represents a ______ ________

Olive sandwich sign

A small round hepatic artery (in cross section) is sandwiched between the long axis views of the CBD superiorly and portal vein inferiorly. The IVC is seen in long axis deep to the portal vein. What sign is this?

Lung point, pneumothorax

A trauma code to the waiting room: a 21 y/o male was stabbed to the left chest in the mid axillary line. Pt was thrown in a wheelchair and pushed to the resuscitation room and POCUS was performed revealing this image. There is a lung sliding which disappears revealing an area without lung slide. Moving up to one rib space to the apex, there is no lung slide at all. This junction of slide/no slide is the _____ _____ and its pathognomonic for __________. It represents the exact point where the air begins to separate the parietal from visceral pleura aka the junction of where we normally see the ANTS MARCHING or the SHIMMERING aka the lung slide. This is highly specific.

Pneumothorax

A young man presents to the ED with multiple thoracic stab wounds. POCUS quickly identifies absent lung sliding as well as a lung point. These findings are highly sensitive and specific for the diagnosis of ___________.

Patellar tendon rupture

AB is a 35 y/o male who presents with swelling and pain inferior to his knee following hearing a POP when he jumped playing basketball. Pt was unable to extend his leg and a X-ray demonstrated a high riding patella. Longitudinal US showed a hyperechoic tendon that is NOT continuous between the patella and tibia, with an anechoic area of hemorrhage consistent with a _____ ______ ______.

Subscapularis tendinopathy

AB is a 49 y/o woman presents with anterior left shoulder pain. US reveals severe _______ ____________ with calcification and several small tears.

Suprapatellar bursitis

AB is a 59 y/o male who presents complaints of knee pain for over a week and swelling. He presents with _____ ______ from repetitive trauma of playing on the floor with his young grandchildren.

Small Bowel Obstruction (SBO)

AB is a 60 y/o female who presents with 3 days of vomiting, suprapubic distension and left groin pain. POCUS shows distended bowel loops, to and fro motion of hyperechoic bowel contents and extra luminal free fluid. NG was passed for decompression and surgical admission was arranged. CT confirmed the findings. What is the likely dx?

Small bowel obstruction (pt has dilated bowel loops and findings of back and forth peristalsis)

AB is a 69yo F who presents with 24 hours of epigastric abdominal pain. History of a TAH for fibroids and a laparoscopic cholecystectomy. She complained of 10/10 abdominal pain. She did have a small bowel movement on the day of admission, but no longer can recall the last time she had flatus. Diffuse, moderate abdominal pain without guarding or rebound. BP markedly elevated, but VS otherwise normal. Her pain goes away with an oral dose of an anti-hypertensive. However, on re-exam, she has further paroxysms of pain and undergoes a bedside ultrasound. What is the dx?

Diaphragmatic contraction

AC is a 64 y/o female with a history of chronic Hep C, end stage liver disease, and pulmonary HTN. She presents to the ED complaining of increasing dyspnea and abdominal distension over the last 10 days. POCUS of the right upper quadrant showed large anechoic fluid collections in the pleural space and intra abdominal cavity with a spine sign visible and with distinct flopping of the diaphragm over the caudal tip of the cirrhotic liver with each respiratory cycle. A great view of ______ ________ in a pt with dyspnea.

Phase array

All views for US use the _____ ______ probe.

Although the quality of images is lacking due to the urgency of the situation and the patient's body habitus, the first image (RUQ) does not show obvious free fluid. The following images (suprapubic and LUQ) clearly show free fluid in the abdomen. An emergent evacuation of the patient to a level 1 Trauma service was requested. Patient was transfused with two units of O blood. Due to his history of hemophilia A, the patient was also given factor VIII to 100% repletion. The patient was taken to the OR at the level 1 trauma center where he was found to have a greater omental bleed and was successfully treated with clot evacuation and laceration repair. He was placed on a factor VIII drip postop.

An 80 year old man presents to a rural emergency room at 3am with abdominal pain. His past medical history is significant for mild hemophilia A. Six hours prior to arrival, he was driving a golf cart when he struck a pole and the steering wheel hit his stomach. He initially had no symptoms but began to have abdominal pain while trying to sleep. He also became nauseated and vomited once. He eventually called EMS and was brought to the ER. On arrival, his vitals are as follows. Vitals: T: 90.7, HR: 108, BP: 74/48, RR: 28, SpO2 98 on 4L He is alert, oriented and his only complaint is abdominal pain. A FAST exam was done. What do you see? What are your next steps?

Pneumobilia

An 81 y/o male presents to the ED with abdominal pain, and has a history of recurrent cholangitis. US imaging of the RUQ reveals presence of __________.

Supraspinatus tendon tear (full thickness tear)

An 85-year-old woman presents with pain in her right shoulder. An ultrasound of the right shoulder was performed. What is the dx?

Pulmonary edema

An acutely dyspnoeic pt presents with V tachy and has no response to initial chemical cardioversion. Lung POCUS shows widespread bilateral confluent b lines indicating acute ______ _______. His unstable tachycardia was terminated using synchronized electrical cardioversion.

Osteosarcoma of the femur

An adult male presents with a palpable mass in the anterior lower thigh. Ultrasound was performed to characterize the mass.. what is the dx?

malignant pleural effusion

An elderly gentleman was called as a respiratory code while walking to the clinic without his home oxygen. Initially the pt was tachycardic, tachypneic and hypoxic to mid 80s on Room air. However he was normotensive in mild respiratory distress that resolved with 3 L of O2 by nasal cannula. There are multiple loculated pleural effusions in the left lung base that is adjacent to compressive Atelectasis vs cardiaca activity. The effusion was later drained, found to be a ______ _____ _______ with a subsequent biopsy showing a non small cell CA int he left upper lobe and SCC in the right upper lobe.

Tuboovarian abscess (TOA)

Angela is a 33-year-old woman that returned to our emergency department with back pain radiating from her left flank to her left anterior thigh. On her first visit there were no significant findings on her physical examination. She had normal vital signs and was afebrile. A urinalysis and urine pregnancy test were negative, and she was sent home with a non-steriodal pain medication and told to follow up with her primary care physician. She returned ten days later complaining of the same pain without any relief. She had a hard time moving around and getting up to walk made it worse. VITAL SIGNS HR = 74, BP = 125/73, RR = 14, T = 98.0 STUDIES AND EXAM A urine pregnancy test and urinalysis done in triage were normal. Her physical exam was remarkable for no tenderness in her flank. There was some very mild tenderness on the anterior aspect of her left thigh, but no swelling or mass. She had good femoral, popliteal, and dorsal pedal pulses in this extremity. There was no other abnormality of the left leg. Her cardiovascular and pulmonary exams were normal. Her abdomen was slightly tender in the left lower quadrant with no peritoneal signs. We thought her pain is related to either radicular nerve pain from vertebral disc disease or vascular disease such as a DVT. However, we decide to perform a pelvic exam and transvaginal ultrasound just to be sure we are not missing something. THE PELVIC Her speculum exam was remarkable for cervical discharge. During the transvaginal ultrasound examination she complained of a lot of tenderness. What is the Likely dx?

Reflection, absorption

Attenuation occurs most commonly by: ________, scattering, _______ and refraction

Buckle fracture, radial fracture

BM is a 8 y/o male who presents with tenderness over his right distal radius with mild swelling. He apparently fell off the monkey bars. POCUS reveals a discontinuity in the hyperechoic cortex of the child's distal radius with minimal displacement. This is suggestive of a _____ ____ or a minimally displaced distal _____ ______.

Sagittal

Blunt trauma pt with positive fast exam. Free fluid can be seen posteriorly and laterally to the bladder in this ________ view.

Appendicitis (with perforation/free fluid)

CA is a 18yo male who presents with 3 days of lower abdominal pain. Vital signs normal except for a pulse of 101. Has supra-pubic and right lower quadrant pain. He is guarding. What is your diagnosis?

Rib fracture

CE is a 42 y/o male with polysubstance abuse, who presents with left sided rib pain after a traumatic blow. CXR was equivocal. The pt was asked to point to where it hurt, and the linear transducer revealed a displaced _____ _____. He complained of significant pain even after the resident gave 2 Percocet and was unwilling to leave the ED. After a intercostal nerve block, that relieved the pts pain and he went home.

CHOLELITHIASIS (with dilated CBD, and intrahepatic ductal dilatation)

CE is a 64 year old female who presents with crampy upper abdominal pain and nausea/vomiting. Similar episodes in the past. What is the clinical dx?

Hyperechoic, posterior, reverberation

Common materials such as wood, glass, metal, plastic, and gravel will generally appear _______ with variable amounts of ________ acoustic shadowing and associated artifacts that are material and shape dependent. Linear metallic foreign bodies will typically display a ________ artifact with bright regularly spaced parallel lines seen distal to the actual object.

Jellyfish sign

Consolidated lung floating in anechoic fluid (pleural effusion). What sign is this?

Pulmonary contusion

EM is a 26 y/o female in a MVA with hypotension and hypoxia. There is normal lung with A lines that can be briefly seen until the sonographer moves the probe superiorly to reveal an area of B lines adjacent to A line. In the setting of trauma, this US finding is consistent with _______ _______.

Ureterocele

EM is a 28 y/o female with no significant medically history, presenting to the ED for dysuria. POCUS demonstrated a ________ seen projecting into the bladder.

diverticulum

ES is a 61 y/o male who presents to the ED for eval of hematuria. POCUS demonstrates a ________ extending from the anterior bladder surface.

gallbladder sludge

Echogenic material can be seen within this gallbladder but there are no stones. It is NOT bright white and furthermore there isn't any shadowing. What is the likely dx?

Sternal fracture

Ellie is a 9 yr old female who presents with chest pain after a fall out of a bouncy house at her neighborhood block party. She has notable bony tenderness to the anterior chest wall over the sternum. POCUS revealed normal lung slide, but on evaluation of the sternum, a fracture was noted. On this US, there is cortical disruption with surrounding trace hyperechoic hematoma formation. What is the likely dx?

Left

For vascular access US, the indicator should be to the _____ of the person performing the procedure.

Nonreducible inguinal hernia (containing the right ovary)

Four weeks old girl with a palpable mass in the right groin. What is the dx?

pericholecystic fluid

Free fluid can be appreciated around this gallbladder. This is called _____ _____. However, there are no stones, nor gallbladder wall thickening and the sonographic Murphys is negative.

Cardiac tamponade (in stabbed pt)

Hematoma and relatively hypoechoic blood can be seen around the heart. What is the dx?

Higher, enhanced, lower, tissue penetration

Higher frequencies result in _____ resolution and ______ image quality. Lower frequencies result in ______ resolution and have better ______ _______.

Ruptured AAA

I am a triad of abdominal/back/flank pain, palpable abdominal mass and hypotension. Pain is the most consistent part, and hypotension is not always present. What am I?

Hypoechoic

In 2 dimensional imaging, what structures appear LESS echogenic?

Hyperechoic

In 2 dimensional imaging, what structures are more echogenic than the surrounding anatomy?

Isoechoic, anechoic

In 2 dimensional imaging, what structures has the same echogenecity as the surrounding structures? What refers to the absence of echoes?

Normal

Is this US normal or abnormal of the eye?

High

Is this US picture high or lower frequency?

Low

Is this US picture high or lower frequency?

Low

Is this US picture low or high frequency?

20

It is estimated that a US can detect an minimum of _____ mL of pleural fluid.

Quadriceps tendon rupture

JM is a 42 y/o male who presents with bilateral knee pain and the inability to extend his knees after injuring the knee while carrying heavy plywood boards. POCUS confirmed the dx of bilateral ______ _____ _______.

Rectus abdominis hematoma

LD is a 41 y/o male who presents to the ED with a painful right sided abdominal mass. ON exam the area of swelling was TTP and initially was suspected to be a hernia. The pt had engaged in strenuous exercise the day before. Using the abdominal probe, a bedside US demonstrated hyperechoic 4.9 x 4.7 cm hematoma within the right lower rectus muscle with active extravasation. This pt underwent successful interventional radiology embolization and had unremarkable hospital course. What is the dx?

Infant Skull Fracture

LD is a 8 month old who feel from a 4 ft high crib that was unwitnessed. On exam a small hematoma is present over the right parietal skull, and appears tender. POCUS reveals a discontinuity in the hyperechoic cortex of the infant skull that is underneath the hematoma. This discontinuity is different from the image of a suture line within the same pts skull. What is the dx?

Pleural effusion

LD is a 80 y/o male with a history of Alzheimer's with a recent accelerated decline and experienced a fall from his bed. Though the only visible trauma involved a laceration above the right eye and globally diminished breath sounds were noted. A Prehospital eFAST exam was performed. This US shows a large right sided _______ ________ with visible spine sign.

Artificial lens

LE is a 62 y/o woman who presents with a longstanding history of severe cataracts that is presenting after 5 mos s/p cataract extraction with intraocular lens placement (CEIOL). US demonstrates a linear echogenic structure that is posterior to the iris with reverbation artifact in place of normal lenticular structure (native lens) consistent with _____ ______.

Plantar fasciitis

LE is an 85 y/o female who cant bear weight on her left foot. Pt was usually ambulatory with no known trauma. There is left side thickened plantar fascia on symptomatic side (greater than 4.5 cm) and a hypoechoic fascia compared to a normal R side. What is the likely dx?

Retinal detachment (with vitreous hemorrhage)

LS is a 35 y/o male with acute, atraumatic, painless, complete vision loss in the right eye x 3 days, with an eye exam showing opacitification of the right pupil and no light/dark perception. OCULAR POCUS revealed a complete _____ ______ with a classic funnel shape. This funnel shape is caused by strong attachments of the retina to the optic nerve posteriorly and to the ora serrata anteriorly.

Effusion, tamponade, embolism

List the primary indications for focused cardiac US: Cardiac arrest Pericardial _____ and ______ Massive pulmonary ________ left ventricular structure and function Volume status and fluid responsiveness Unexplained hypotension Guidance of emergency cardiac pacing

Free wall, cavity, intraventricular septum

List the structures that can be visualized from the parasternal long axis view from anterior to posterior on the monitor: Right ventricular _____ _____ Right ventricular _______ _________ __________ Left ventricular _____ Posterior left ventricular free wall.

Hemopericardium

Massive _______ with coagulating blood and tamponade in a pediatric trauma pt. The pt went straight to the OR based on this image!!!

HOCM

Natasha is 20-year-old student studying communications at the local university. Over the past year she has also been working out hard to "get in shape". She felt that she gained too much weight from all the studying, so she changed her diet and starting running. On one hot day she was running around the campus at school and fainted. EMS brought her to our emergency department. On arrival she said she still felt a bit dizzy, but denied any specific chest pain, shortness or breath, or pain associated with trauma. She had no past medical problems and had never fainted before. Her last menstrual period was six weeks prior, but she often had irregular periods because she was using Norplant. VITAL SIGNS HR = 78, BP = 110/70, RR = 14 Her physical exam including cardiovascular, pulmonary, gastrointestinal, and neurologic examinations were unremarkable. Orthostatic vital signs were normal. STUDIES Her ECG showed a normal sinus rhythm. Her CXR was normal. Her urine pregnancy test was negative. Her hemoglobin was 14.1 gm/dL. Her TSH, glucose, and serum electrolytes were normal. So JUST TO MAKE SURE nothing was missed, a cardiac ultrasound was performed. What is the likely dx?

retinal detachment

Not many clinicians would think to use ultrasound to image the eye. However, an eyeball is basically a bag of water. And this makes it a perfect organ to image with ultrasound. In fact, ultrasound can help you with a lot of ocular emergencies that in the past have been very difficult to diagnose, in addition to convincing the on-call ophthalmologist to come in and manage the patient. HISTORY AND PHYSICAL EXAM Bob is watching TV when he starts to see flashes of light. The problem is they are not coming from the TV, but rather they seem to be in his right eye. His visual acuity is 20/30 in the left eye, and 20/200 in the right eye. You decide to use ultrasound to help you figure out the cause of his sudden loss of vision. What is the likely dx?

Abscess

Orbital cellulitis evolving into _______ in a diabetic pt. Multiple pus collections are visible on the medial side.

Inferno

Pt presents with a history of glandular problems as per the family, presents to urgent care with CONFUSION, slurred speech, tremors and fever. TSH was sent out. The pt was started on treatment for THYROID STORM after color flow over an enlarged thyroid demonstrated the ______ sign.

DVT

Pt presents with pain and swelling of the entire left lower extremity. A Three point POCUS carries a sensitivity of 95% and specificity of 96% for detecting a _______ when performed by ER physicians.

Bifurcation

Pt presents with pain and swelling of the entire left lower extremity. The POCUS should be performed 1-2 cm distal to the ________ of the common femoral for a complete study.

Sialadenitis has

Pt presents with painless left sided facial swelling and no dental issues. There is left submandibular gland swelling with ductal dilation and hyperechoic density in the far field representing sialolith and surrounding inflammation ___________.

Lens dislocation

Pt presents with severe maxillofacial trauma of unclear etiology. OCULAR POCUS demonstrates a biconvex structure with a hyperechoic rim consistent with traumatic ______ _______.

Vitreous hemorrhage

SM is a 48 y/o male with coronary artery disease who is on ASA/clopidogrel. He presents with 4 days of decreased vision in his right eye. POCUS demonstrates swirling, amorphous echogenicities known as the WASHING MACHINE sign. If the eye remains still, the blood will settle with gravity. Fundoscopic eval by ophthalmology confirmed the dx of _____ ______.

Linear, longitudinal

SM is a 54 y/o male with a 20+ year history of tobacco and ETOH abuse and newly diagnosed SCC presenting with productive cough and cachexia, found to have multifocal pneumonia likely due to aspiration. A mid axillary US of the right lung using a _______ 13-6 MHz probe in a ________ plane demonstrating hepatization of the lung and focal consolidation adjacent to normal lung parenchyma.

Patellar tendon rupture

SM is a 55 y/o male who presents with right knee swelling after getting his foot stuck under a pallet and falling backwards. He was found to have a patella Alta and right _____ ____ ______.

Right, 34d, 4th

The imaging plane for the parasternal short axis view is towards the _____ hip and should be obtained in the left _____ or _____ ICS just left of the sternum.

Base, mitral, papillary, apex

The parasternal short axis view shows: ____ of the heart Level of the _____ valve Level of the _______ muscles The _______

Pixel, 1540, 2, 15

The piezoelectric effect is voltage—> crystals are deformed —> pressure wave—> crystals—> electric current and machine translates into a ________. Velocity is the SPEED of the wave and is ______ m/s in soft tissue. US for diagnostic purposes range from ___ to ____ MHz.

1540

The speed of wave is ______ m/s

Curvilinear, cirrhotic liver

This RUQ view obtained with a _______ probe reveals a _____ _____ (reduced dimensions with irregular edges and an overall heterogenous echo texture) surrounded by significant ascites within Morrison's pouch.

Cellulitis

This US Picture is __________.

Abscess

This US demonstrates a well circumscribed fluid collection in the soft tissue consistent with an ________.

Hydrocele

This US demonstrates fluid filling the scrotal sac with multiple thin septations with a complex _________. In the setting of epididymitis, a pyocele should be considered.

Long, Achilles' tendon

This US pic is a _____ axis sonogrma of the _______ _______.

Long, proximal femoral shaft

This US picture is a _____ axis sonogram of a ____ _____ ____ in a pt with a fracture.

Tibial shaft

This US picture is a long axis sonogram of a _____ _____ fracture.

Sternal body

This US picture is a long axis sonogram of a ______ ______ fracture.

Achilles rupture, long axis

This US shows a full thickness tear of the right _____ ______ after a skateboarding accident. What view is this?

Longitudinal, appendix, appendicolith

This image demonstrates a ________ view of an _______ that appears enlarged with edematous walls, containing a shadowing ___________.

No, posterior vitreous hemorrhage detachment

This is a 60 year old female with history of DM, HTN and GERD who presented with a two day history of right eye pain. She stated that she woke up with the pain, had an increase in floaters and blurry vision. She denied trauma to her affected eye. VA was 20/25 right eye and 20/50 left eye. EOMI were intact. A right eye ultrasound was obtained. Does this pt have increased IOP? What is her ocular US finding?

Use M mode (correctly) for fetal HR

This is a TVUS image of an early pregnancy of a woman who comes to the ED complaining of lower pelvic pain. Fetal heart rate is calculated using M mode (FHR 98). What is wrong with this image?

Right femoral vessels, transverse, linear array

This is a US of what? What view? And what transducer?

Longitudinal, Baker's cyst

This is a _________ view of a ruptured ______ ________. When performing a DVT scan, always look out for incidental findings that may explain the pts presentation.

Subcutaneous edema

This is a classic appearance of ______ _____ (cobblestoning) which in the appropriate clincal setting would be consistent with cellulitis.

Seagull sign

This is called what sign?

Long, fracture

This picture is a _____ axis sonogram of a rib _______.

Long

This picture is a _____ axis sonogram of the biceps tendon.

Short

This picture is a _____ axis sonogram of the biceps tendon.

Long, rib

This picture is a _______ axis sonogram of a ______.

Cholecystitis, obstructing stone

This view demonstrates _______ with ______ _______. Other signs of this condition is pericholecystic fluid, gallbladder wall thickening, CBD dilatation and positive sonographic Murphys sign.

20,000

Ultrasound is a SOUND having a frequency greater than how many Hz?

US

WHat imaging modality is more sensitive for diagnosing rib fractures than CXR?

echocardiography

WHat is the gold standard for the diagnosis of many cardiac abnormalities?

Gain

WHat is the primary control clinicians use to adjust brightness?

Time Gain Compensation (TGC)

What allows the clinician to adjust the brightness of the image at different depths?

B lines, curved probe

What are vertical artifacts that move with respiration from the pleural surface? And they are obtained with what kind of probe?

acoustic enhancement

What artifact is used to confirm the presence of areas suspected to be fluid filled such as hemorrhage, joint effusions, and tissue necrosis or abscess and can be used to see the spread of anesthetic as it is injected?

Long axis

What axis is this view of gallbladder?

Freeze

What button holds an image on the display?

Zoom

What function magnifies one section of the display?

Clean shadows

What image artifact is caused by ribs, gallstones, and other calcified structures?

Mirror artifacts

What image artifact is when objects appear on both sides of a strong reflector?

Dirty shadows

What image artifacts is a result from acoustic mismatch at tissue air interfaces and are MOST commonly caused by bowel gas?

Side lobes

What image artifacts may originate at angles to the primary beam and are generally of little consequence?

Edge artifact

What is a change in the sound beam direction that results when there is an oblique incidence of the sound beam as it crosses a boundary of tissue with different propagation or strikes a curved structure?

Artifacts

What is any echo info that does NOT correspond to accurate anatomical info?

Adenomyomatosis

What is generally a benign condition that is characterized by diffuse thickening of the gallbladder wall and intramural diverticula? (On US it creates a comet tail artifact originating from distinct locations on the gallbladder wall)

Gas

What is often the ENEMY of US?

Achilles rupture, long axis

What is the DX based on US picture? What axis is this?

Depth

What is the MOST frequently used button or knob on any US machine?

Echogenicity

What is the amplitude of the signals reflected from a given structure compared to the amplitude of the signals from surrounding structures?

Wavelength

What is the distance the wave travels in a single cycle?

Aortic aneurysm

What is the dx based on US?

aortic aneurysm

What is the dx based on US?

Achilles rupture, short axis

What is the dx based on the US picture? What axis is this?

Distal radius fracture

What is the dx?

Lens dislocation

What is the dx?

Retinal detachment

What is the dx?

Retinal detachment has

What is the dx?

Vitreous hemorrhage

What is the dx?

vitreous detachment (

What is the dx?

Retinal detachment

What is the dx? (Look at US)

Vitreous hemorrhage

What is the dx? (Look at US)

US of proximal lower extremities

What is the gold standard imaging test for diagnosing DVT?

Aortic dissection

What is the likely dx based on US?

Cholecystitis

What is the likely dx?

Amplitude, frequency

What is the peak pressure of the wave AKA the loudness of the wave? What is the number of times per second the wave is repeated?

Pulse

What is the period where the US generates ultrasound waves?

Twinkle artifact

What is the phenomenon that may aid in the detection of nephrolithiasis and can be seen on color Doppler ultrasounds when applied to stationary high echogenic objects therefore generating a false sense of movement on color Doppler?

Refraction

What is the redirection of part of the sound wave as it crosses a boundary of mediums possessing different propagation speeds?

Reflection

What is the redirection of the part of sound wave back to its source?

Velocity of sound

What is the speed of waves?

Hypercoagulability, venous stasis, vessel injury

What is virchow's triad?

B mode

What mode converts amplitude of the returning echo into a grayscale image?

M mode

What mode permits a simultaneous display of the 2D B mode image and a characteristic waveform?

Scattering

What occurs when the US beam encounters an interface that is smaller than the sound beam or irregular shape?

Absorption

What occurs when the energy of the sound wave is contained within the tissue?

Acoustic shadowing

What occurs when the sound encounters a highly reflective surface?

Acoustic power

What on the US relates to the amplitude of sound waves produced by the transducer?

Distal aorta

What part of the aorta is this?

Proximal aorta

What part of the aorta is this?

Spine sign

What positive sign is a clear view of several thoracic vertebrae through the pleural effusion?

Curved Linear Array

What probe is being used in this US?

Curved linear

What probe is being used in this US?

phased array

What probe is being used in this US?

Hydropoint

What shows a air/fluid interface which is suggestive for hemato/hydro/pyo pneumothorax?

Dove in pleural field

What sign is this?

Whirlpool sign

What sign is this?

Shred sign

What sign represents the distinction between the consolidated lung and the aerated lung and is seen on this US?

Phased array

What transducer has a flat footprint and are often sued in echo as the small foot print allows for easy intercostal imaging and the small flat transducer makes excellent skin contact with minimal pressure?

Linear array

What transducer is generally used to view superficial structures and are therefore constructed to produce higher frequencies?

Popliteal vein

What vein is located adjacent and superficial to the popliteal artery in the mid popliteal fossa?

Inferior vena cava view

What view allows evaluation of the proximal IVC during expiration and inspiration?

Transverse

What view for examining aorta scans the aorta from proximal to distal (where the aorta bifurcates into iliac arteries)?

Sagittal view

What view for scanning for AAA has the probe marker to the pts head?

Transverse view

What view for scanning for AAA has the probe marker to the pts right?

Apical 4 chamber view

What view is a CORONAL view of the heart that visualizes ALL FOUR chambers in one plane?

Apical 4 chamber view

What view is advantageous for assessing LEFT ventricular function as well as relative chamber sizes?

Parasternal long axis view

What view is obtained by aligning the US plane with the long axis of the left ventricle, and the transducer should be PERPENDICULAR to the chest wall at the 3rd or 4th IC immediately to the left of the sternum with the transducer indicator directed toward the LEFT HIP?

Subcostal view

What view is this US?

Sagittal

What view is this of the aorta?

Transverse

What view is this of the aorta?

Parasternal long axis view

What view is this on the US picture?

Apical 4 chamber view

What view is this?

IVC view

What view is this?

Parasternal short axis

What view is this?

Transverse view (of the aorta)

What view is this?

Subcostal views, no

What views are often the most useful for point of care cardiac ultrasound? Does scanning from this view interfere in resuscitative measures like thoracostomy, CPR, subclavian line insertion or endotracheal intubation?

Lung curtain

When a pt takes a deep breath, the dirty shadowing of a normal air filled lung comes over the liver like a curtain. This is called what?

3, transverse

When evaluating for a AAA, record ____ aorta measurements in a _____ view at the proximal, mid and distal. Measure the outer wall to outer wall in AP diameter.

Curvilinear, supine, bowel gas

When examining for a AAA, used a ______ probe, examine pts in the _____ position and maybe place them in the right or left decubital positions if there is excess bowel gas. What is the most common cause for inability to view the abdominal aorta?

Right, head

When examining the eye with the transverse view, the probe marker should be to the pts ______. In sagittal view, the probe marker should be to the pts _______.

Cholelithiasis (not impacted)

When looking at the US, you see 2 large hyperechoic stones that can be appreciated in the gallbladder. What is the dx?

3

When measuring the optic nerve for increased ICP, the measurement should take place _____ mm behind the globe.

Peritonsillar abscess (PTA)

You encounter an 19yo woman with a "Hot Potato" voice and an angry ENT physician on-call. Click on the button below to see how you can make this case "easy" for you and the patient. What is the likely dx?

B lines, pulmonary edema

______ _____ are vertical artifacts that move with respiration from the pleural surface. They represent increased WATER in an area of the lung. This represents ______ ________.