sonosim lungs
Lung parenchyma is composed of which of the following? A. Bronchial airways B. Capillaries C. Epithelial alveolar cells D. All of the above E. A and C only
D. All of the above
Which of the following is seen in this lung ultrasound image? A. A-line artifact B. Rib shadowing C. Reverberation artifact D. All of the above E. None of the above flip the card to see the picture but cover the answer with your hand
D. All of the above
Which of the following statements regarding the cardiopulmonary vasculature is correct? A. The pulmonary veins return blood to the left atrium of the heart. B. The pulmonary arteries deliver deoxygenated blood to the lungs. C. Gas exchange occurs at the level of the pulmonary capillaries. D. All of the above E. A and C only
D. All of the above
Which of the following statements regarding the use of M-mode imaging during lung sonography is correct? A. M-mode imaging documents motion over time. B. M-mode imaging is a useful adjunct to help identify and document pleural lung sliding. C. The Seashore sign is the expected pattern in normal patients. D. All of the above E. A and C only
D. All of the above
Which of the following statements regarding transducer selection and machine settings for pulmonary imaging is correct? A. Low- and high-frequency transducers both have roles in lung sonography. B. A high-frequency linear transducer is ideally suited for imaging pleural sliding. C. A low-frequency transducer can be used to visualize B-line artifacts. D. All of the above E. None of the above
D. All of the above
Which of the following will result in the absence of lung sliding during lung ultrasonography? A. Cessation of breathing (no respirations) B. Significant gas accumulation between the visceral and parietal pleurae C. Tight adherence of the visceral and parietal pleurae D. All of the above E. A and C only
D. All of the above
The arrow in this image points at which of the following structures? A. Rib B. Lung parenchyma C. Lung pleura D. Intercostal muscle E. Internal mammary artery flip the card to see the picture but cover the answer with your hand
A. Rib
Which of the following statements regarding lung sonography is correct? A. Ribs have a hyperechoic bony cortex that casts an acoustic shadow. B. The visceral and parietal pleurae are typically seen as two distinct, adjacent, hyperechoic lines. C. Lung parenchyma is clearly visualized with lung sonography. D. All of the above E. None of the above
A. Ribs have a hyperechoic bony cortex that casts an acoustic shadow. Correct. The lungs are most commonly imaged in a window that visualizes the ribs and intercostal space. The ribs have hyperechoic cortexes and cast shadows deep to them because ultrasound waves are reflected by bone. Deep to the skin, subcutaneous fat, and intercostal musculature lies the pleura. Ultrasound is not sufficiently sensitive to discriminate between the parietal and visceral pleurae. As a result, the interface of the parietal and visceral pleurae appears as a single hyperechoic line just deep to the ribs.
A-line artifacts are hyperechoic, horizontal lines that appear at regular intervals deep to the pleural line and are a type of reverberation artifact. A. True B. False
A. True
This arrow is pointing at the right mainstem bronchus. A. True B. False flip the card to see the picture but cover the answer with your hand
A. True
Thoracic cavity expansion results in generation of negative intrathoracic pressure, which draws atmospheric air in through the mouth and nose into the lungs. A. True B. False
A. True Correct. Inhalation relies upon active expansion of the thoracic cavity. Thoracic cavity expansion is driven via the diaphragm, external intercostal muscles, and several accessory muscles. Diaphragmatic excursion generates a majority of inspiratory force. Thoracic cavity expansion results in generation of negative intrathoracic pressure, which draws atmospheric air in through the mouth and nose into the lungs. Exhalation is largely a passive process, driven by the elastic recoil of the lungs, following relaxation of respiratory muscles.
In this sagittal image of the right lung, which of the following correctly identifies the oblique, or major, fissure? A. Arrow 1 B. Arrow 2 C. Arrow 3 D. All of the above E. A and C only flip the card to see the picture but cover theflip the card to see the picture but cover the answer with your hand answer with your hand
B. Arrow 2 Correct. This is a sagittal image of the right side of the chest, showing the right major (oblique) and minor (transverse) fissures as faint, thin white lines and how they separate the right lung into the right upper, middle, and lower lobes.
B-line artifact always indicates the presence of lung pathology. A. True B. False
B. False
Which of the following statements regarding transducer selection and machine settings for pulmonary imaging is correct? A. A high-frequency linear transducer is poorly suited for pneumothorax screening. B. Lung sonography often starts with initially positioning the transducer in a longitudinal plane and using ribs as anatomic landmarks. C. Lung sonography is best performed by acquiring one single lung image along each lung base. D. Machine settings should be activated to filter out lung imaging artifacts. E. None of the above
B. Lung sonography often starts with initially positioning the transducer in a longitudinal plane and using ribs as anatomic landmarks.
Which of the following statements regarding this pulmonary sonographic image is correct? A. The vertical, hyperechoic lines represent A-lines. B. The image-artifact pattern seen in this image is commonly seen in normal lungs. C. This image artifact is indicative of fluid accumulation within the alveolar-interstitial interspace. D. None of the above E. A and B flip the card to see the picture but cover the answer with your hand
C. This image artifact is indicative of fluid accumulation within the alveolar-interstitial interspace.
The arrow in this axial CT image of the chest points to __________. A. the oblique (major) fissure B. the middle lobe of the right lung C. the upper lobe of the left lung D. the lower lobe of the left lung E. None of the above flip the card to see the picture but cover theflip the card to see the picture but cover the answer with your hand answer with your hand
C. the upper lobe of the left lung
Which of the following is correct regarding air movement during inspiration? A. The air first enters the mainstem bronchi from the trachea. B. From the mainstem bronchi, air passes directly into lobar bronchi. C. From the lobar bronchi, the air travels down successively smaller airways, finally reaching the alveolar unit. D. All of the above E. None of the above
D. All of the above Correct. Gas travels in and out of the lungs through a series of progressively smaller airway passages, known as bronchi. Air enters through the trachea, which bifurcates into the right and left mainstem bronchi, each of which is dedicated to its respective lung. The mainstem bronchi branch into lobar bronchi, which are dedicated to their specific lung lobe. Subsequently, air travels through successively smaller bronchioles. Ultimately, air reaches the terminal bronchiole with an associated alveolar unit.
The alveolar unit __________. A. is the location of gas exchange in the lung B. contains the terminal bronchiole C. contains capillaries D. All of the above E. A and C only
D. All of the above Correct. The exchange of carbon dioxide and oxygen occurs at the level of the alveoli. The alveolar unit contains the structures needed for gas exchange and includes connective alveolar tissue, single-layer epithelial cells, capillaries, and terminal bronchioles.
Within each hemithorax, the lung is bordered by __________. A. the diaphragm B. the chest wall C. the mediastinum D. All of the above E. None of the above
D. All of the above Correct. The lung occupies the pleural cavity delineated by the chest wall externally, the mediastinum medially, and the diaphragm inferiorly. Superiorly, the lung tapers into a dome shape that extends to the medial third of the clavicle. The lung is encased by the visceral pleura. The chest wall, mediastinum, and diaphragm are lined by the parietal pleura. The visceral and parietal pleurae are in direct contact in all of these areas.
How do the right and left lung differ from each other? A. The right lung is typically slightly larger than the left lung. B. The right lung contains a middle lobe, whereas the left lung does not. C. The left lung contains the lingula, whereas the right lung does not. D. All of the above E. None of the above
D. All of the above Correct. The right lung is typically slightly larger than the left, due to the presence of the heart in the left hemithorax. Each lung consists of lobes, which can be thought of as separate blocks of parenchymal tissue. The right lung has a superior, middle, and inferior lobe, separated by oblique and horizontal fissures. The left lung has superior and inferior lobes separated by an oblique fissure, and contains the lingula (a small projection of the inferior aspect of the upper lobe).
Which of the following is true regarding the lung's fissures? A. The right major (oblique) fissure divides the inferior lobe from the rest of the right lung. B. The left major (oblique) fissure divides the superior and inferior lobes of the left lung. C. The right minor (horizontal) fissure separates the superior and middle lobes of the right lung. D. All of the above E. None of the above
D. All of the above Correct. The right major (oblique) fissure divides the inferior lobe from the remainder of the lung. The right lung is divided into three lobes, the upper, middle, and lower lobes, by the oblique and horizontal fissures. The horizontal fissure of the right lung, also called the transverse fissure, separates the upper and middle lobes. The left lung does not have a horizontal fissure or middle lobe. It only has a major fissure dividing the superior from inferior lobe.
The arrow in this axial CT image of the lower chest points to __________. A. Lung parenchyma B. Right kidney C. Spleen D. Liver E. None of the above flip the card to see the picture but cover theflip the card to see the picture but cover the answer with your hand answer with your hand
D. Liver
Which of the following statements regarding lung-imaging artifacts is correct? A. The lung pulse indicates the presence of a pneumothorax. B. The sliding-lung sign indicates the presence of a pneumothorax. C. The absence of lung sliding confirms the presence of a pneumothorax. D. Lung sliding is typically absent in the presence of a pneumothorax. E. A-line artifact is characterized by vertical, anechoic lines on the ultrasound screen.
D. Lung sliding is typically absent in the presence of a pneumothorax.
Which of the following is seen in this sagittal slice CT image of the chest? A. Right lung B. Oblique (major) fissure C. Lingula D. Left lung E. A and B flip the card to see the picture but cover theflip the card to see the picture but cover the answer with your hand answer with your hand
E. A and B
The space between the parietal and visceral pleurae __________. A. is a potential space B. often contains a trace amount of physiologic fluid C. normally measures approximately one centimeter in diameter during all phases of respiration D. All of the above E. A and B only
E. A and B only
Which of the following statements regarding lung sonography is correct? A. Ribs are highly echogenic and reflect sound waves. B. Gas-filled lungs scatter sound waves and limit sonographic visualization of lung tissue. C. The pleura is uniformly seen as two distinct echogenic lines, reflecting the visceral and parietal layers. D. All of the above E. A and B only
E. A and B only
How do lung sliding and lung pulse differ from each other? A. Lung pulse is timed to the patient's heart rate. B. Lung pulse may be seen during breath holding, whereas lung sliding will not. C. Lung pulse and lung sliding describe the same phenomena. D. All of the above E. A and B only
E. A and B only Correct. Lung pulse and lung sliding represent separate processes. They are not synonymous. A lung pulse is defined by the absence of lung sliding and the perception of cardiac pulsation at the pleural line. A lung pulse is characterized by very limited to-and-fro movement, often described as a shimmering appearance. Importantly, the rate of movement matches the heart rate, rather than the respiratory rate. With breath holding, there will be no lung sliding, but a lung pulse may still occasionally be observed.
Lung sliding __________. A. is a normal finding B. is the sonographic image of the visceral and parietal pleurae moving past one another C. is a pathologic finding D. All of the above E. A and B only
E. A and B only Correct. Lung sliding refers to the sonographic appearance of the pleural line during respiration. Lung sliding results from the visceral and parietal pleural layers moving past each other during the respiratory cycle. These two move past each other during inhalation and exhalation, seen on ultrasound as lung sliding. Lung sliding is a normal finding. Note that during breath holding, no lung sliding will be observed.
In the normal patient, __________. A. both pleural layers abut one another in all areas surrounding the lung B. the pleural layers slide past each other during respiration C. the pleural layers are separated by at least one centimeter throughout the respiratory cycle D. All of the above E. A and B only
E. A and B only Correct. The pleural space between the visceral and parietal layers is a potential space. The pleural space contains a trace amount of normal physiologic fluid that is produced by the mesothelium. This fluid works as a lubricant to facilitate sliding of the pleural surfaces during respiration. Under normal conditions, the lung, both pleural layers, and chest wall touch each other and move together as a unit.
Which of the following correctly characterizes the pleura? A. The parietal pleura is adherent to the inner chest wall. B. The visceral pleura is richly innervated with pain fibers and is quite pain sensitive. C. The visceral pleura is the fibrous layer that adheres to the lung parenchyma. D. All of the above E. A and C only
E. A and C only Correct. The parietal pleura is the very thin, pain-sensitive fibrous layer that is adherent to the inner aspect of the chest wall. Immediately deep to the parietal pleura lies the insensate visceral pleura, the very thin fibrous layer that is adherent to the lung parenchyma.
Which of the following structures comprise the chest wall? A. Visceral pleura B. Ribs C. External intercostal muscles D. All of the above E. B and C only
E. B and C only
B-lines __________. A. are hyperechoic, horizontal lines that occur at regular intervals deep to the pleura B. can indicate fluid in the alveolar-interstitial space C. may represent a normal finding D. All of the above E. B and C only
E. B and C only Correct. A-line artifact, or A-lines, are hyperechoic, horizontal lines that appear at regular intervals deep to the pleural line. This repetitive artifact, known as reverberation artifact, results in echoes of the pleural line represented at progressively deeper regular intervals on the ultrasound display. B-lines are hyperechoic, vertical lines that arise at the pleural line, move with respiration, erase the normal A-line pattern, and extend downwards off the screen without fading. While the occasional B-line can be found in healthy lungs, the presence of multiple B-lines (typically more than three within an intercostal space) indicates fluid in the alveolar-interstitial space and is seen in patients with a variety of pathologic lung conditions.
Which of the following statements regarding pulmonary blood flow is correct? A. The pulmonary artery contains highly oxygenated blood, delivering it to the left atrium from the lungs. B. Following gas exchange between the alveoli and capillaries, blood travels to the pulmonary venous system. C. Pulmonary veins deliver blood to the heart's left atrium. D. All of the above E. B and C only
E. B and C only Correct. In contrast to other arteries in the body, the pulmonary artery delivers deoxygenated blood. The pulmonary artery receives blood from the heart's right ventricle and delivers it to the left and right pulmonary arteries, which progressively branch into smaller and smaller vessels, ending in the capillaries of the alveolar unit. At this point, gas exchange between the alveolus and capillary occurs, and blood then travels to the pulmonary venous system. This venous oxygenated blood travels from the microscopic venules through progressively enlarging vessels, eventually arriving at the pulmonary veins, which deliver blood to the heart's left atrium.
The arrow in this lung ultrasound image identifies which of the following structures? A. Rib B. Lung bronchus C. Reverberation artifact D. Intercostal muscle E. Lung pleura
E. Lung pleura
