Echo/Pocus

Question 1

If you suspect pneumonia in a patient, what might you see on TTE?

Answer 1

Dynamic air bronchogram

Question 2

What does “spine sign” indicate?

Answer 2

Effusion/ PNA or PTX

Question 3

How many B-lines are normal?

Answer 3

3 or less

Question 4

What does lung pulse tell you?

Answer 4

It is normal = lung sliding with heart rate

Question 5

What does lung point tell you?

Answer 5

PTX - it is the visceral pleura kissing the parietal pleura

Question 6

What do TAPSE less than 17 indicate?

Answer 6

RV dysfunction

Question 7

How could you calculate stroke volume on TTE?

Answer 7

Use pulse wave Doppler to calculate VTI using the area of LVOT and multiply by the heart rate

Question 8

What is fractional area of change?

Answer 8

TEE measurement of RV and LV dysfunction

Preload dependent

Question 9

What are the absolute contraindications to placing a TEE?

Answer 9

Zenker’s
Active GI bleed
Esophageal tumors or stricture

Question 10

What TEE views would you use for assessing for wall motion abnormalities?

Answer 10

Mid esophageal 5 chamber view
Mid esophageal 4 chamber view
Transgastric mid-short axis view

Question 11

What view would you want to assess for saddle pulmonary embolism?

Answer 11

Mid esophageal ascending aortic short axis

Question 12

At what degree is the mid-esophageal four chamber at?

Answer 12

0 degrees

Question 13

How do you get a mid esophageal 2 chamber view?

Answer 13

By rotating the omniplane by 90 degrees from the mid esophageal 4 chamber

Question 14

Where is the anterolateral wall of the LV in the mid esophageal 2 chamber?

Answer 14

On the right of the screen

Question 15

Where is the inferior wall of the LV on midesophageal 2 C?

Answer 15

Left side

Question 16

What can be seen with midesophageal long axis view?

Answer 16

Can see the LA, MV, LV, aortic root and LVOT+ sliver of RV
Aortic valve is in long axis
USED TO CALCULATE LVOT Cross sectional area and thus AVA and CO
Can see SAM in this view

Question 17

At what degree is the midesophageal long axis at?

Answer 17

120-160

Question 18

What is the midesophageal ascending aortic short axis view good for?

Answer 18

Positioning a PAC in the main PA

Question 19

What can be seen on the midesophageal ascending aortic short axis view?

Answer 19

SVC
Aorta
Right and main PA

Question 20

What omniplane angle is a midesophageal ascending aortic short axis at?

Answer 20

0-60 degrees

20-30 cm depth

Question 21

What omniplane angle is a midesophageal ascending aortic long axis at?

Answer 21

100-150

30-40 cm depth

Question 22

What is the midesophageal aortic valve short axis used for?

Answer 22

Assessing AI and AS

Question 23

What can be seen on the midesophageal aortic valve Sax view?

Answer 23

RA, RVOT, tricuspid and pulmonic valve
Aortic valve in short axis
LA

Question 24

What is the midesophageal RVOT useful for?

Answer 24

Placing PA Cathetr since path from RA to RV to Pa can be viewed in continuity

Question 25

At what degree and depth is the midesophageal RVOT view?

Answer 25

60-90 degrees | 30-40 cm

Question 26

At what degree and depth is the midesophageal aortic valve short axis view?

Answer 26

30-60 degrees | 30-40 cm

Question 27

What degree and depth is the midesophageal bicaval view at?

Answer 27

120 degrees 30-40 cm Twist clockwise from midesophageal 4C

Question 28

What is the bicaval view used for?

Answer 28

Central line placement | Detection of PFO or ASD

Question 29

Where is the IVC on the bicaval view?

Answer 29

Left side of the screen

Question 30

How do you get a transgastric midpapillary view?

Answer 30

Advance probe to 50 cm | Ante flex the probe to 90 degrees

Question 31

Where is the posteromedial papillary muscle on a transgastric midpapillary view?

Answer 31

On the back Side of the heart

Question 32

Where is the anterolateral papillary muscle in the transgastric view?

Answer 32

At the 5 o'clock position

Question 33

What is the descending aortic view used for?

Answer 33

Look for aortic dissection

Question 34

What is McConnel's sign?

Answer 34

Preservation of apical contractility | Seen in embolism

Question 35

What can be seen on TEE with air embolism?

Answer 35

Bowing of interatrial and inter ventricular septums to the left McConnel's signs Severely hypo kinetic RV Enlarged right atrium and ventricle

Question 36

What view do you want to use for air embolism?

Answer 36

Midesophageal 4C

Question 37

In what views would you see pericardial effusions?

Answer 37

Transgastric midpapillary view Midesophageal 4 Midesophageal 2C Midesophageal aortic LAX

Question 38

What is lung point

Answer 38

Specific sign of pneumothorax

Question 39

What is lung pulse?

Answer 39

Sign of main stem or atelectasis | In conjunction with heartbeat

Question 40

What does the presence of 3 or more B lines mean?

Answer 40

Pulmonary edema

Question 41

What are A lines?

Answer 41

Normal reverberations of lung tissue Should still see in PTX

Question 42

What does spine sign mean

Answer 42

Usually pulmonary effusion

Question 43

What is the FAST exam?

Answer 43

Four views to assess for fluid accumulation Subxiphoid: tamponade RUQ: hepatorenal recess LUQ: perisplenic Superior pubic symphysis: retrovesicular pouch