Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPAP > EM: Block 1 > Flashcards

EM: Block 1 Flashcards

1
Q

What is the simple way to describe Dx US and what’s an example?

US signals assume a ? speed during travel through mediums

A

Pulse-echo principle- Sonar

Relative propagation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is relative distance determined by US?

How are sound waves formed by the US?

A

Time elapsed for echo to return after hitting object

Electric current passes through transducer crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Piezoelectric effect

US calculations are made based on the assumption sound waves travels at the same speed through all tissues which is ? fast

A

Pressure-Electricity: generates constant high frequency, longitudinal, mechanical sound to be measured

1540m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Depth

How does this correlate to what is seen on the screen?

A

Time for returning echo relative to transducer distance

Louder echo= brighter pixels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define Sound Waves

Define US

? units are used for Dx purposes

A

Repeated mechanical pressure wave through medium

Sound w/ frequency >20K Hz

2-15M cycles/sec (2-15MHz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define Amplitude

This unit is AKA ?

This unit correlates to ?

A

Peak wave pressure (height)

Loudness

Intensity of returning Echo
Loud= large amplitude
Soft= small amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define Period

Define Frequency

A

Time required for one complete cycle

Number of times wave is repeated per second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

US spend 99% of their time conducting ? function

Define Pulse

A

Listening
1% of time generating waves

Period of wave generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the relation to transducer frequency and image quality and when are they used

A

Higher= Inc resolution, dec tissue penetration
Linear: superficial structures/procedural guidance- vascular access, ocular US

Lower= dec resolution, inc penetration
Curved/Linear probe- bone Fxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define Velocity

What is the relation to this part of US and imaging

A

Speed of sound wave
Closer= better propagation

Travels faster in bone than soft tissue
Less dense molecules (gas) slows sound (vacuum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define Wavelength

What is the equation to determine this

A

Distance traveled/second

WL= propogation speed/frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does attenuation begin/end

What factors can affect it

A

Pulse generation through round trip path until returns, recorded as echo
Lack of- fluid, bright

Wavelength
Number of interfaces
Degree of homo/heterogeneity
Medium 
Tissue type/density
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

US travels best w/ the least ? such as through ?

This explains why ? procedure is done for OB

A

Attenuation
Homogenous fluid filled

Transabdominal US of uterus/ovaries w/ filled bladder, creates acoustic window to posterior anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Attenuation occurs MC by ?

A

Reflection- wave redirected back to source; foundation of US

Scattering- beam hits interface smaller/irregular than bean

Absorption- acoustic to thermal energy (therapeutic US)

Refraction- redirection of sound wave when crossing medium boundaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

US should evaluate anatomy at _* to maximize structure reflection

Therapeutic US uses ? principle of US

A

90*

Absorption, not used for Dx US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the different modes on US and what are they used for

A

Curvilinear, LF probe:
B: brightness, converts amplitude of returning echo to 2D image
Used by most of EM

Phase Array probe-
M: motion, simultaneous B-mode and the waveform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is used to view/assess fetal heart rate w/ US in the ER

Define Doppler

A

M-mode, less energy than Doppler

Interpretation of frequency shifts (train noises)
Towards= high frequency
Away from= low frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Doppler displays ? two pieces of info

What does Color Doppler use to produce images

A

Flow direction
Velocity

Pulse-Echo principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define Power Doppler

Define Echogenecity

A

Amplitude/strength of motion, better for slow flow/low volume states (torsion)

Amplitude of signal reflected from structure compared to amplitude reflected from surrounding structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define Hyperechoic

Define Hypoechoic

A

More echogenic/inc amplitude (brightness)

Less echogenic/less amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the leading cause of MisDx w/ US

What can be the benefit of this cause of mis-Dx

A

Image artifacts

Some artifacts= pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 4 causes of artifacts

Define Shadowing

A

Attenuation/refraction
From w/in PT
Operator error
External sources

Sound hits highly reflective surface, returned w/ little energy w/out continuing to deeper structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clean Shadows can be caused by ?

Dirty Shadows can be caused by ?

A

Ribs Gallstones Calcified structures

Acoustic mismatch at tissue/air interface, normally bowel gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What causes posterior acoustic enhancement

This phenomenon can be used to confirm presence of fluids where?

A

Sound waves passing through low attenuation, increased energy= inc echogenecity posterior w/ less attenuation

Joints
Tissue necrosis
Anesthetics after injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The presence of ? is the enemy to US

Why?

A

Gas

Difference in density disperses sound waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Define Reverberation artifacts

Why are these bad?

A

Sound bounces of two highly reflective objects causing brigh arcs in equidistant intervals

Obliterates B-mode image distally (lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Define Mirror Artifacts

Why are these bad?

A

Objects appearing on both sides of a strong reflector; diaphragm during FAST
NO pathology

Duplication of structures leading to incorrect interpretation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Define Side Lobes

Acoustic power is AKA ? and relates to the ? produced by transducers

A

Lower intensity beams originating at angles to primary beam, results in false info (oblique line/acoustic echo)
TVUS

Output- amplitude produced by transducer
Wave amplitude- determine brightness/quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Increasing acoustic power results in ?

Acoustic power is directly related to ?

A

Higher amplitude, stronger return echoes that increase contrast between light/dark areas

Intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Define ALARA

Define Gain

A

As Low As Reasonably Achievable

Control to adjust brightness w/ acoustic power

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Difference between Power and Gain

A

P: changes brightness by changing strength of sound entering body

G: inc amplification of signals after echoes have returned to transducer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Define Time Gain Compensation

What is the most frequently used knob on US

A

Adjustment of brightness at different depths; near/far fields

Depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the two reasons to adjust depth

When is the zoom function most useful

A

Greater depth= smaller structures, fit more on display
Inc depth= longer listening to collect data

Measuring small structures-
Need to magnify one section to focus on deeper structures, w/out changing number of pixels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define Cine Loop

Define Footprint

A

Last several seconds of image saved for re-review

Area that sound waves leave and return to transducer; larger better for deeper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Low frequency curved transducers have a ? footprint and are used for ?

High frequency curved transducers are used for ?

Linear array transducers are used for ?

A

Large
Deep: thorax abdomen bladder

Endocavitary scans (vag/rectal)

Superficial structures w/ high frequency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are phases array transducers used for?

What are the land marks for internal jugular access?

A

Echos, small footprint= easy intercostal imaging

SCM and Clavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the land marks for femoral access?

What are complications from US line placement

A

Inguinal ligament
Femoral artery

Arterial/vessel puncture
Bleeding
PTx
Hemothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What two vessels are preferred for peripheral access

What type of transducer is used?

A

Basilic/Cephalic

Linear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is a screening test to eval abdominal trauma instead of an EFAST

What has a better specificity and thus, the DxTest of choice in trauma centers

A

Dx Peritoneal Lavage

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the disadvantages of doing a FAST

A

Operator dependent

Interpreting difficulties if obese/gaseous PT

Inability to differentiate hemorrhage from ascites

Can’t eval retroperitoneum as well as CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the indications to do a FAST exam

FAST can identify what 3 parts about found fluids

A 
Blunt/penetrating trauma
Undifferentiated HTON
Subacute torso trauma
Trauma w/ pregnancy
Pediatric trauma

Presence Amount Location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

FAST exams are particularly helpful in what blunt trauma scenarios

A

Hemodynamically unstable

Unreliable PE due to intoxication, distracting injury, CNS injury

Unexplained HOTN and equivocal PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When are FASTs conducted for penetrating trauma

What are the 5 eFAST windows

A

Uncertain immediate surgery
Multiple wounds
Uncertain trajectory into pericardium, lower chest or epigastrium

RUQ LUQ Cardiac Pelvis Chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

?mL of fluid in abdomen/chest is needed for visual identification w/ US

How much is needed in the for visualization on CXR?

A

250mL/20mL

50-100 in upright chest
175 in supine chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the most beneficial assessment for a PTs w/ penetrating torso trauma and HOTN?

What are the classic PE findings for this exam?

A

Cardiac FAST

Distended neck veins
HOTN
Muffled heart tones

46
Q

How is the pneumothorax exam conducted

What is the MC normal sign when looking for PTx?

A

High freq linear probe on 2nd intercostal space, MCL x 4-5 respiration cycles

Lung sliding- excludes PTx

47
Q

When is the transducer dot NOT pointing to the L

Define Seashore Sign

Define Stratosphere Sign

A

Cardiac- to PTs head/L hip
Parasternal long axis

+ lung sliding

Barcode sign- no lung sliding

48
Q

What is the alternating point between Seashore and Stratosphere sign

If clinician can see ? and ?, PTx can be confidently excluded

A

Lung point sign- when lung contacts parietal pleura w/ inspiration

Lung sliding
B lines

49
Q

If clinician sees ?, suspicion of PTx exists and is increased if ? is seen

What does the lung points sign indicate

A

No lung sliding or B lines
A-lines

100% specific for PTX and correlates to radiographic size

50
Q

RUQ view

LUQ view

A

Phased array, marker to head

Phased array, marker to head/knuckles to bed

51
Q

Subxyphoid view

Alternate cardiac view

A

Phased array, marker to PTs right

Phased array, marker to PTs L hip

52
Q

Bladder views

Lung views

A

Transverse: marker to R
Sagittal: marker to head

Linear probe, marker to head

53
Q

What is the gold standard for Dx of cardiac abnormalities

What are the primary indications for conducting a focused cardiac US

A

Echocardiography

Cardiac arrest
Massive PEs
Volume statue/fluid response
Pericardial effusion/tamponade
LV structure/function
Unexplained HOTN
Guide emergency pacing
54
Q

PTs presenting w/ ? get cardiac US

What views is the most useful for POC cardiac US and why?

A

Chest pain
Dyspnea
Trauma
Syncope

Subcostal 4 chamber view, No interference w/ thoracostomy, CPR, subclavian line insertions or intubations

55
Q

What are four ways to increase poor quality images from subcostal 4 chamber views

A

US gel

Shallow angle to chest wall

Move transducer to R to use L liver lobe as a window

Move off xiphoid/over intercostal space to image PT w/ barrel chest/large AP diameter

56
Q

When using sub-xiphoid view, where are the chambers being seen

What is on top of all of these landmarks

A

Top L: RV
Bottom L: RA
Top R: LV
Bottom L: LA

Liver

57
Q

How is the parasternal long axis view obtained

If done correctly, what structures will be on the right side of the images?

A

Align US plane w/ long axis of LV
Transducer perpendicular to chest wall L to sternum w/ indicator to L hip

AV/MV
Proximal aorta/LA

58
Q

How is the parasternal short view obtained

What are the 3 views obtained

A

Rotate transducer 90* clockwise from parasternal long view position

Aortic valve- mercedes sign
Mitral valve- fish mouth view
Papillary muscles

59
Q

What are the 4 views obtained with the apical 4 chamber view

What type of view is the apical view?

When is this view preferred?

A

Base Mitral Apex Papillary

Coronal- 4 chambers on one plane

Assessing LV function and size

60
Q

When using the IVC view, what finding is consistent w/ low right sided filling pressures

Where is the transducer indicator pointing during this view

A

Collapses >50%

PTs head

61
Q

Screening PoC US are done on PTs >50y/o w/ pain or ? Sxs?

Elective Tx of AAAs is suggested when they’re what size

A

Groin Flank Abdomen Back
Dizziness/Syncope
Unexplained HOTN
Cardiac arrest

5.5cm or larger

62
Q

What is the triad for ruptured AAA

A

Pain Palpable mass HOTN

Pain is most consistently found

Palpating mass- unreliable

HOTN- not always found in ruptures

63
Q

Most AAAs rupture in ? direction causing ? effect

What is the max external diameter considered normal?

A

Retroperitoneum
Transient tamponade

<3cm

64
Q

When the celiac artery branches off of the aorta, what is the sign

What is the sign called when passing the SMA

A

Seagull sign

Mantle sign

65
Q

What probe is used when assessing for AAAs

What is the MC reason structures wouldn’t be seen

A

Curvilinear probe

Gas

66
Q

How is an AAA scan conducted

What are the 3 measurements taken

A

Transverse view- from prox (Celiac/SMA) to distal (bifurcation)

Prox: level to Celiac/SMA
Mid: between xyphoid and bifurcation
Distal: umbilicus, above bifurcation

67
Q

What is done during the sagittal view of the AAA exam

AAA US Summary

A

Video only, no measurements

Curvilinear- prox to dist
Transverse: marker to PT R, Measure 3- prox, mid, dist
Saggital: marker to PT head

68
Q

When is an US of the eye warranted

What is the normal measurement of the optic nerve

A

HA/AMS
Acute vision changes
Trauma
Inc ICP

3mm

69
Q

How do you differentiate retinal or vitreous detachment

A

Retinal- attached posterior, vertical flow

Vitreous- not attached at disc, horizontal flow

70
Q

What causes a “comet-tail” artifact when doing an eye US?

Ocular Summary

A

Doppler w/ metal debris

LInear transducer w/ 2 orthogonal planes:
Transverse- marker to PT R
Sagittal: marker to PTs head
Measure ONSD at 3mm from retina, N=<5mm
>5mm= Inc ICP (+20mmHg)
71
Q

Where are most DVTs Dx

What is the gold standard imaging test for Dx DVTs?

A

Proximal veins of LE

US of prox LE

72
Q

Most algorithms for Dx DVTs use ? combos of info

Flow Chart

A

Clinical suspicion
D-dimer
Compression US

DCT Deck- Slide 7

73
Q

Where do we start the US assessment for DVTs?

What structure is the compression assessed at?

A

Junction of great saphenous/ common femoral

Inguinal ligament

74
Q

Where is the popliteal vein located?

Where does the popliteal vein trifurcate?

A

Adjacent/superficial to popliteal artery, mid fossa
Pop-on-top

Distal popliteal fossa

75
Q

DVT summary

A

Linear transducer
Curvilinear if obese w/ marker to PT R
Supine, frog leg w/ 30* reverse trandelenberg
Scan prox femoral/popliteal veins, compress q1cm x 10cm

76
Q

US are more sensitive than CXR for Dx of ? Fxs

How do foreign bodies that have been retained for >24hrs appear on US?

What can be done to improve ability to find/visualize foreign bodies

A

Rib

Halo from edema/pus

Local anesthetic adjacent to foreign body

77
Q

If an abscess is seen on US but has color flow, what does that mean?

What appearance doe cellulitis have on US?

A

Necrotic lymph node

Cobblestoning

78
Q

Define Anisotropy

What type of foot print is seen at the top of the screen for a HF transducer?

What type of foot print is seen if a LF probe is used?

A

Not 90* causing tendon to appear dark/torn when not

Flat across

Curved shape into screen

79
Q

2D imaging can be AKA ? or ?

Where is Morrison’s pouch and what is it AKA?

What is the name of the fascia that surrounds the pouch?

A

B-mode
Gray Scale imagines

Between Liver/Kidney
Hepatorenal recess

Gerota’s fascia- anterior
(Zuckers on posterior)

80
Q

The intensity of US beam, or the amount of energy, determines the ? of the US

How do images appear if the near or far fields are over/under gained?

A

Bioeffects

Near, top half is darker if under gained:
Far field, lower half is darker and under gained

81
Q

Sector size of the linear transducer is identical to ?

Phased array transducer is sometimes AKA ?

A

Footprint of the transducer

Cardiac probe

82
Q

When attempting peripheral IV access, normally ? vein is used

What does E-FAST stand for

A

Basilic vein

Extended Focused Assessment w/ Sonography in Trauma

83
Q

If PT has Neg-FAST exam and are not stable, what is the next step?

It is important to capture the pole of ? on ? side

A

Repeat/continue assessment

R sided, inferior kidney pole

84
Q

What structure makes visualization of fluids appear first on LUQ view

Where would this be seen

A

Splenocolic ligament

Sub-diaphragm

85
Q

Free fluid in abdomen is usually going to pool on ? side

What valve leaflet is being assessed during the PSL view

A

L side

Anterior leaflet of Mitral valve

86
Q

? bladder view is more sensitive

What probe is used for the abdominal and pneumothorax scans

A

Saggital

R/L/Pelvic- phased array
Pneumo- linear

87
Q

What are the parts of a Sky Ocean Beach sign

What part is lost during a PTx

A

Sky- soft tissue
Ocean- hyper echoic pleura
Beach- motion artifacts

Beach

88
Q

Subxyphoid view transducer and position

A

Phased array, PTs R

Alt: PSL, phased array, PTs L hip

89
Q

Bladder view transducer and position

A

Phased array
Transverse: PTs R
Sagital: PTs head

90
Q

Lung view transducer and position

A

Linear probe, PTs head

91
Q

What is the best view to ID mod/large pericardial effusion

What is the best view to ID gross cardiac activity/stand still

A

Subcostal

Subcostal or Parasternal

92
Q

What is the best view to assess heart chamber size

What view is best for assessing 2d EF

A

Apical 4 chamber

Subcostal PSL or Apical

93
Q

What view is the best for measuring E-point septal separation to estimate EF

What view is best for evaluating gross valve motions

A

PSL

Parasternal long or short

94
Q

What view is best for assessing volume status by IVC size/collapsability

A

Subcostal sagittal view

95
Q

What is the name of the sign seen in the PSA view

A

Mercedes sign of aortic valve

96
Q

Where is the indicator pointing during the apical 4 chamber view

Where is the proximal IVC located?

A

PT R hip

Subcostal midline saggital view: posterior to liver into RA

97
Q

Where is the transducer pointing during the IVC view

All cardiac US views use ? probe

A

PTs head

Phased array

98
Q

Sub-Xyphoid View

A

PTs R:
RV
RA LV
LA

99
Q

PSL View

A

PTs L Hip:
RV
LV Ao
LA

100
Q

PSS View

A

PTs R hip:

Mercedes Fish Papillary

101
Q

4AC View

A

PTs R Hip at PMI:
RV LV
RA LA

102
Q

What was the rule about seeing a vein that crosses over in the abdomen

One time AAA screenings are done for men between ? age that have tobacco Hx

A

Above SMA= splenic
Between SMA/Aorta= L renal going to IVC

65-75y/o

103
Q

? is most mis-Dx as AAA

Type of artifact

A

Kidney stone

Shadow Edge Artifact Gas Reverberation Acoustic enhancement Mirroring Side lobes

104
Q

Septal thickness measured w/

MSK probe

What is NOT seen on PSS view

A

PSL

Linear

???

105
Q

How do you adjust for PAE

Sector size larger than transducer

A

Gain

Curvillinear

106
Q

Plot end point separation
Parasternal separation

On abdominal exam, IVC takes on ? appearance

A

M mode

Tear dropped

107
Q

Sagittal view of aorta, what is the sequence of structures branching off

How can you decrease optic echoes that are creating difficulty Dx borders of optic nerve sheath

A

Celiac artery
SMA

Dec gain due to PAE

108
Q

How could a subtle lens dislocation be accentuated on US?

A

Consensual pupillary constriction

109
Q

Well’s Score

A

S/Sxs of DCT- 3
PE most likely Dx- 3

Tachy- 1.5
Immobile/Post-op x 4wks- 1.5
Prior DVT/PE- 1.5

Hemoptysis- 1
Ca/Tx x 6mon- 1

Low <2 High>6
Unlikely 0-4
Likely 5 or +

110
Q

How do you know if you’re looking at PTs R or L leg on US during DVT scan

A

R: GSV runs medial to CFV

Arteries to L side of screen

IPAP (212 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions