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Apex- Ultrasound Flashcards

1
Q

How fast does ultrasound propagate through soft tissue?

A. 343m/sec
B. 1540m/sec
C. 3051m/sec
D. 4892 m/sec

A

B. 1540m/sec

WHO FUCKING CARES

air = 343m/sec
bone = 3k-5km/sec

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2
Q

Higher frequencies produce (shorter/longer) wavelengths

Lower frequencies produce (shorter/longer) wavelengths

A

higher frequencies = shorter wavelengths

lower frequencies = longer wavelengths

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3
Q

Match compression and rarefacation with

high pressure vs low pressure

A

high pressure = compression
lower pressure = rarefaction

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4
Q

T/F: frequency is a measure of pitch

how is it expressed

A

true

in Hertz (Hz) or cycles per second

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5
Q

what represents a sounds loudness and is measured in decibels

A

amplitude

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6
Q

What is sound?

A

a pressure wave that travels in a longitudinal wave.

A sound wave is created when a vibrating object sets the molecules of a medium into motion

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7
Q

Which concept BEST explains why lead zirconate titanate is commonly used in ultrasound transducers?

A. Echolocation
B. Doppler Effect
C. Snell’s law
D. Piezoelectric effect

A

D. Piezoelectric effect

To produce an image, the ultrasound transducer utilizes a piezoelectric material that can transduce electrical energy into a mechanical (sound) energy and vice versa.

Echolocation describes the use of sounds and echos to determine where objects are located in space

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8
Q

how does the ultrasound machine produce a visual image?

A

by using a piezoelectric material that transduces electrical energy to mechanical (sound) energy.

by applying electric current to a piezoelectric material, it will vibrate and emit sound waves; conversely, if you subject that material to sound waves (ie mechanical stress), that material will generate an electrical potential

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9
Q

what is a common piezoelectric material commonly used in ultrasound transducers?

A

lead zirconate titanate

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10
Q

What is the primary determinant of the vertical placement of each illuminated pixel on the u/s monitor?

A. Time delay
B. Resolution
C. Acoustic impedance
D. Doppler effect

A

A. Time delay

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11
Q

What determines the vertial placement of each dot on the screen?

A

how long it takes for the echo to return to the transducer (time delay)

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12
Q

What determines the horizontal placdement of each dot on the screen?

A

the particular crystal that receives the returning echo

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13
Q

Match each term with its BEST descriptor: hyperechoic, hypoechoic, anechoic

-produces high amplitude echos
appear as dark shades of grey
does not produce echos

A

produces high amplitude echos → hyperechoic
appear as dark shades of grey → hypoechoic
does not produce echos → anechoic

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14
Q

T/F: hyperechoic structures appear **bright **and produce strong, **high-amplitude echoes. **

A

True

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15
Q

How do vascular structures appear in short axis vs long axis

A

short axis = black/anechoic circles
long axis = black/anechoic tubes

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16
Q

How does bone appear on u/s

do these have a high or low impedence?

A

hyperechoic - white

strong/high amplitude echos produced

high (3k-5k)

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17
Q

4 examples of hypoechoic structures

do they produce high/low amplitude echoes
do they have high/low impedence

A

solid organs (liver)
skin
apidose
cartlidge

lower amplitude
lower impedence

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18
Q

How does muscle appear on u/s

A

hypoechoic with hyperechoic fasical lines

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19
Q

3 examples of anechoic structures

A

Vascular structures
Cysts
Ascities

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20
Q

what should a distended, non-compressible vein raise suspicion for?

A

DVT

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21
Q

T/F: nerves can appear anechoic or hyperechoic depending on the region of the body

A

True

-peripheral nerves near the neuraxis tend to apppear anechoic (traffic lights)
-distal peripheral nerves are hyperechoic (white) with a characteriestic honeycomb appearance

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22
Q

are peripheral nerves that are distal or near the neuraxis the ones that are hyperechoic with a honeycomb appearance

A

distal peripheral

peripheral near the neuraxis are anechoic

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23
Q

t/f: peripheral nerves are collapsible but non-pulsatile

A

false- they are not collapsible or pulsatile

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24
Q

T/F: the best method to differentiate a tendon from an erve is by scanning distal from the muscle towards the joint

A

false - scan proximal from the joint towards the muscle

tendons become flat and disappear as they connect to muscle ; they also appear “rope-like” at joints where they connect to bone

nerves are continuous and will not change size as you scan

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25
T/F: nerves are continous and will not change in size as you scan
True ## Footnote tendons become flat and disappear as they connect to muscle ; they also appear "rope-like" at joints where they connect to bone
26
What process describes a sound wave that bounces off a tissue boundary that has a different acoustic impedance? a. Absorption B. Reflection C. Scatter D. Refraction
B. Reflection ## Footnote Absorption occurs as u/s waves are lost to body as heat Scatter occurs when u/s wave encounters an object smaller than the wave Refraction = bending of the ultrasound wave that encounters a tissue boundary at an oblique angle
27
****T/F: **Resolution** is the ability to see two seperate things as two seperate things
True
28
T/F: the focal zone is the region where the beam is the narrowest
True
29
What is the Frensel zone vs Fraunhofer zone?
Frensel zone = near zone (region b/t transducer and focal zone) Fraunhofer zone = far zone (region beyond the focal zone ## Footnote Fraunhofer = longer = further out
30
Short axis vs long access and how they look at structures
short axis - looks at a structure in cross-section long axis - looks at a structure along its length
31
Match terms: Axial, lateral, elevational -beam thickness -beam depth -beam width
-beam thickness : elevational -beam depth : axial -beam width : lateral
32
order the structures that produce the degree of attenuation they provide from greatest to least : soft tissue, bone, fluid
Bone (greatest) - furtherst , weakest image Soft tissue Fluid
33
Is attenuation a greater threat to higher frequency sound waves or lower?
higher
34
Applying gel b/t transducer and pts skin reduces: A. Absorption B. Reflection C. Scatter D. Refraction
B. Reflection
35
T/F: **Scatter** explains why fluid- filled structures appear anechoic
True ## Footnote Scatter occurs when the u/s wave encounters an object smaller than the wave >this causes the echoes to scatter in all directions, so the signal never returns to the transducer
36
What describes the bending of an ultrasound wave that encounters a tissue boundary at an oblique angle? | What law?
Refraction | Snell's law ## Footnote a formula used to calculate the refraction of light when passing b/t two media with different refraactive indices
37
Match the following : Axial, Elevation, Lateral The ability to differentiate structures that are: -side-by-side in the x-axis -in the same plane of the ultrasound beam in the y-axis -are in the thicness of hte ultrasound beam in the z-axis
**Lateral** → side-by-side in the** x-axis (horizontal)** **Axial** → in the same plane of the ultrasound beam in the **y-axis (vertical)** **Elevation **→ are in the thicness of hte ultrasound beam in the **z-axis (depth)**
38
Which type of transducer produces the BEST image resolution? A. High frequency B. Medium frequency C. Low frequency D. Ultra-low frequency
A. High frequency ## Footnote Low frequencies = longer wavelengths - allow us to see deeper but we sacrifice resolution high frequency = shoter weavelengths - cant see as far but have better resolution
39
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Axillary block
> 10 | High frequency ## Footnote shorter wavelengths high resolution linear array transducer
40
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Lumbar plexsus
< 5 Hz | low frequency ## Footnote longwer wavelengths, deepr structures , lower resolution
41
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Ankle block
> 10 Hz | high frequency ## Footnote shorter wavelengths higher resolution
42
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Sciatic block
5-10 Hz | medium frequency ## Footnote ~ 3-6 cm below skin Sciatic, popliteal, infraclavicular and deepr blood vessels
43
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : TAP block
> 10 Hz | high frequency ## Footnote short wavelengths linear transducer
44
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Popliteal bock
5-10 Hz | medium frequency ## Footnote Sciatic, popliteal, sciatic deep blood vessels
45
Transducer selection: > 10Hz, 5-10Hz, <5 Hz : Gluteal sciatic block
< 5 Hz | low frequency ## Footnote lumbar plexus, celiac ganglion, neuraxial, gluteal ciatic
46
3 things to use medium frequency transducers for ## Footnote 4 things for low frequency
medium: infraclavicular popliteal sciatic ## Footnote lumbar plexus celiac ganglion neuraxial block gluteal sciatic
47
which transducers are good for deep blood vessels vs superficial blood vessels high, medium, or low frequency
deep - medium superficial- high frequency
48
would you use a high or lower frequency transducer for pts with a higher BMI
low frequency ## Footnote long wavelengths to get thru all that extra fat
49
Which setting on the u/s machine is used to adjust the strength of the returning echoes displayed on the screen? A. Depth B. Attenuation C. Gain D. M-mode
C. Gain
50
T/F: "depth" determines how deep you can see into the body
true
51
What does "B" in "B-mode" stand for?
brightness of the pixels on the screen ## Footnote produces real-time image and most u/s's use this modality
52
What does "M" in M-Mode stand for?
Movement ## Footnote alternate modality time-lapse mode - illustrates the realtavie movement of the structures over time
53
T/F: most bedside u/s machines use M-Mode
False -B-Mode ## Footnote B = brightness - real time image M = Motion = time lapse
54
What's the isssue here
too much gain
55
Issue? How to fix it
not enough gain - increase the gain
56
T/F: the beam width is the narrowest and thinnest in the focal zone
True
57
What mode is frequentl yused in echocardiography - B or M
M-mode ## Footnote prodives useful information about valvular integrity, ventricular function, wall thickenss, chamber s ize, and aortic root diameter
58
3 circumstances where M-mode is useful
1. echocardiography 2. ptx 3. evaluating fluid responsiveness
59
Accoridng to the Doppler effect, what changes occur when the sound source moves closer to a person listening to that sound? (select 2) 1. Wavelength becomes shorter 2. Pitch increases 3. Doppler shift becomes negative 4. Frequency decreases
Wavelength becomes shorter and pitch increases ## Footnote the doppler effect describes the change in the perceived frequency of a sound wave when theres relative motion b/t the sounds source and an observer if the source moves towards an observer, then the wavelength gets shorter in this direction and the frequency appears to increase - this is refferred to as a postive doppler shift
60
Regarding the angle of insonation, -the shift is the (greatest/zero) when the US beam is (parrallel/perpindicular) to flow
- greatest when parrallel - zero when perpendicular
61
T/F: Red and Blue on U/s represent arterial and venous blood
False ## Footnote color represents the degree of doppler shift describes direction of blood flow relative to the transducer -if flow is moving twoards transducer = red -flow is moving away from transducer = blue
62
When might carotid flow appear blue on u/s?
color depicts direction of blood flow so if blood is moving away from the transducer (if transducer is angled caudad toward the head, blood from the heart is going up and away from transducer) it will appear blue; where blood returning from the brain via the IJ will be flowing towards the transducer and appear red
63
If the source moves towards the observer, the wavelength gets (shorter/longer) and the frequency/pitch (increases/decreases) | (positive/negative) doppler shift
towards = shorter and increased pitch | postive doppler shift
64
if source moves away from the observer, wavelenth gets (shorter/longer) and the frequency/pitch (increases/decreases) | (positive/negatie) doppler shift
away = longer, decreased pitch | negative doppler shift
65
Red and blue colors tell you what | shorrt and sweet
degree of doppler shift
66
According to the standard convention, the orientation marker on the u/s probe should point towards the patient's: (select 2): -Head -Feet -Left -Right
Right in the Head ## Footnote Orientation marker pointing toward patients right = short-axis (cross section) Orientation marker pointing towards pts head = long axis (longitudinal section)
67
which is "in-plane" vs "out- of - plane"
first = in-plane (long-axis) second = out-of-plane (short axis)
68
Match the following terms: - Standard convention/Short axis image - Standard convention/Long axis image - Cardiolgy convention/Short axis image - Cardiology convention/Long axis image With: -Marker points towards patients left -Marker points towards patients right -Marker points towards patients head (2)
- Standard convention/Short axis image → towards pts right - Standard convention/Long axis image → towards pts head - Cardiolgy convention/Short axis image → towards pts left - Cardiology convention/Long axis image → towards pts head
69
What describes the angle at which ultrasound waves encounter a structure? | What angle will produce the highest quality image?
Angle of incidence | 90 degrees (perpendicular) ## Footnote *diff from doppler
70
Which technique improves image resolution by reducing the distance b/t the transducer and the anatomical target? A. Compression B. Tilt C. Slide D. Rotate
A. Compression
71
label from left to right, top to bottom
- tilting - rocking - sliding - compression - rotating
72
D. Reverbation ## Footnote occurs when a sound wave bounces b/t 2 strong parallel reflecting surfaces -you could observe this while imaging the pleura or when using a highly attenuating wide-bore nedle (shown in the image)
73
what kind of artifact
bayoneting ## Footnote -occurs as needle passes thru adjacent tissues of different acoustic impedence
74
During a cardiac POCUS exam, what structures are visible on a parasternal short-axis view of the heart? (select 2) -RV -Aorta -LV -Pericardium
LV and pericardium ## Footnote POCUS = Point of Care Ultrasound
75
What are the 3 standard imaging windows for the cardiac POCUS
## Footnote Parasternal, Apical, Subcostal
76
label ## Footnote how should hte pt be positoned? transducer placement markerorientation
## Footnote left lat decub or supine phased-array tarnsducer just left of the sternum at the 3rd or 4th intercostal space orient marker twoards pts right shoulder
77
## Footnote how to establish this view
## Footnote get a PLAX view (left lat debup or supine) & rotate trandsucer 90 dgrees clockwise so orientation maker points towards pts left shoulder
78
label ## Footnote position and orientation of marker
## Footnote left lat decub, transducer on the PMI -orient transucer to pts left side with beam pointing towards right shoulder
79
label ## Footnote transducer placement: orientation:
## Footnote inferior to xiphoid process marker towards pts left side *might have to apply a good amount of pressure - discomfort -have pt bend knees up to relax abd
80
label ## Footnote how to get ur view
## Footnote from a subcostal 4-chamber view (inferior to xiphoid), rotate transducer 90 degrees and tilt the beam in a posterior diretion
81
label this parasternal long axis us image
RV LV → Aorta Pericardium → LA Descendig aorta
82
label parasternal short axis image
RV→Intraventricular septum →LV
83
label this subcostal 4 chamber image
top = liver bottom up going left to right RA → RV LA →LV
84
label subcostal ivc image
RA → Liver → IVC
85
What's dat
Gastric antrum ## Footnote lowest part of the stomach -used to determine if pt has a full stomach
86
label
87
When assessing for a full stomach with POCUS, what positon should the patient be in?
Right lateral decub ## Footnote allows air to rise to the top of the stomach and gravity to move the gastric coentents in the direction of the pylorus to fill the atrum.
88
performing gastric u/s in the suprine psoition will likely (over/under) estimate the volume of gastric contents
underestimate
89
gastric u/s -what kind of transducer -where is it placed at -where should the orientation indicator be pointing?
-curvilinear midline below xiphoid process pointing celphelad
90
Empy stomach, clear fluids or particulate matter
Empty stomach = bulls eye | anechoic border isn't fluid, its the muscularis propriae
91
clear liquids = anechoic ## Footnote contents will make antrum look round and distended
92
T/F: if hte patient drank milk or full liquids, they will appear anechoic | how will solid food appear?
false - hyperechoic | bright particulate matter in tha ntrum
93
What does the absence of lung sliding suggest? (2)
PTX or endobronchial intubation
94
Lung A lines vs B lines - which are horiztonal and which are vertical ## Footnote what do they indicate?
A- horizontal B- vertical ## Footnote A- from reverberation artifact bc pleura is a strong reflector B- normal or pulmonary edema
95
What best describes the color of the interneal jugular vein
positive doppler shift ## Footnote -the angle of isonation relative to the IJ flow is less than 90 degrees, appearing on the screen as a red color, repreenting a postive doppler shift
96
Low frequency → spinal block Medium → Sciatic High → interscalene
97
Anechoic → Cyst Hypoechoic → Liver Hyperechoic→ Thyroid cartilage
98
What is the BEST way to minimize the influence of shadow artifact? A. Increase the gain B. apply color doppler C. increase the depth of the focal zone D. adjust the acoustic window
D. Adjust the acoustic window
99
on which ultrasound view would you expect to see the bat sign? A. GAstric B. Subcostal IVC C. Lung D. Parasternal long-axis
C. Lung ## Footnote pattern of the 2 ribs (wings)and the pleural line (body)

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