Equipment/Monitors

Question 1

Hyperechoic structures appear bright because they produce _____ echoes
a. high amplitude
b. low amplitude
c. high frequency
d. low frequency

Answer 1

a. high amplitude

Hyperechoic structures like bone appear bright because the tissues have high amplitude and have high impedance

Question 2

Hypoechoic strucures include all of the following except…
a. skin
b. adipose
c. solid organs
d. bone

Answer 2

d. bone

Hypoechoic structures appear as a dark shade of grey because they produce weak (low amplitude) echoes (lower impedance). These structures include solid organs, skin, adipose, cartilage. Muscles tend to be but their surfaces often produce hyperechoic fascial lines

Question 3

Structures that do not produce any echo are called …
a. hypoechoic
b. anechoic
c. hyperechoic
d. transechoic

Answer 3

b. anechoic

Anechoic structures like vasculature, cysts and ascites appear black

Question 4

Peripheral nerves near the neuraxis tend to appear ___ while distal peripheral nerves tend to appear ____.
a. black; white
b. white; black
c. black; grey
d. grey; black

Answer 4

a. black; white

Nerves can appear different - either hypoechoic or hyperechoic depending on the region of the body they are located in. Nerves that are more distal tend to be enveloped in fascia and connective tissue that produce a greater degree of echogenicity. The black inside the white circle is the nerve itself

Question 5

All of the following are types of resolution except for…
a. axial
b. lateral
c. medial
d. elevational

Answer 5

c. medial

An ultrasound beam exists in 3D and affects resolution. Resolution is the ability to see two separate things as two distinct things

Question 6

The focal zone of the ultrasound waves is the region where the beam is the …
a. tallest
b. shortest
c. narrowest
d. widest

Answer 6

c. narrowest

Ultrasound waves leave the transducer and tend to converge before diverging beyond a certain point. the region between the transducer and the focal zone is the near zone.

Question 7

True of false: all of the sound waves leaving the ultrasound return to the transducer

Answer 7

False.

As sounds waves travel through the body, the strength naturally decreases and some of the waves never return to the transducer. These factors reduce image quality (called attenuation). Attenuation includes: scatter, absorption, reflection and refraction.

Question 8

A short axis view looks at a structure …
a. in cross section
b. along it’s length
c. at the widest point of the structure
d. at the narrowest point of the structure

Answer 8

a. in cross section

Long axis views on the other hand look at structures along their length

Question 9

Which term describes the following: The ability to differentiate structures that exist in the thickness of the ultrasound beam
a. axial resolution
b. beam depth
c. lateral resolution
d. elevational resolution

Answer 9

d. elevational resolution

Elevational resolution (aka beam thickness) is a fixed value determined by the transducer

Question 10

Which term best describes the following: the ability to differentiate a structure that exist along the length of the ultrasound beam
a. beam width
b. axial resoltuion
c. elevational resolution
d. beam thickness

Answer 10

b. axial resolution

Axial resolution (aka beam depth) is improved by using a higher frequency/shorter wavelength

Question 11

Where is image resolution the best?
a. near zone
b. focal zone
c. far zone
d. mid zone

Answer 11

b. focal zone

The three zones of the ultrasound beam are: focal, near and far zone. The focal zone is the zone where the beam is the narrowest and thinnest. Resolution in the near zone is also good. Resolution in the far sone is poor due to the distance between sound waves

Question 12

Which frequency (high or low) has better resolution?
a. high
b. low

Answer 12

a. high

Higher frequencies have shorter wavelengths produce the best resolution but they are not great at visualizing deep structures. Lower frequencies (longer wavelengths) allows you to see deeper structures but have poor resolution.

Question 13

What is the frequency range (MHz) of the low frequency transducer?
a. >10
b. 5-10
c. <5
d. 0.5-1

Answer 13

c. <5

High frequency: >10
Medium frequency: 5-10
Low frequency: <5

Question 14

Which transducer has a flat footprint and has piezoelectric crystals arranged in a parallel fashion?
a. linear array
b. curvilinear
c. phased array

Answer 14

a. linear array

The curvilinear transducer has a convex footprint with a similar arrangement of crystals. The phased array transducer is narrow and fans out with increasing depth.

Question 15

“B” in B mode stands for what?
b. base
b. blended
c. brightness
d. broad

Answer 15

c. brightness

B mode image stands for the brightness of pixels on the screen. B mode produces real time imaging and most bedside procedures utilize this mode.

Question 16

What does “M” in medium M mode stand for?
a. medium
d. moderate
c. motion
d. mechanics

Answer 16

c. motion

M mode is an alternative modality. This is like a time lapse photo that illustrates relative movement of the structures over time.

Question 17

What control option allows you adjust the strength of the echoes returning to the probe that will be displayed on the screen?
a. gain
b. depth
c. doppler
d. gray scale

Answer 17

a. gain

The gain can enhance or reduce the screen’s brightness but does not change the relative contrast of anatomy. Too much gain makes the screen too bright and too little gain makes teh screen very dark

Question 18

True or false: When the doppler function is utilized, the red flow is arterial and the blue flow is venous

Answer 18

False

Doppler measures the change in frequency of a sound wave when there’s motion between the source and the observer. If the source moves towards the observer, the wavelength gets shorter and the frequency (pitch) increases. This is called a positive doppler shift. If the source moves away from the observer, the wavelength gets longer and the frequency decrease (negative shift). The transducer is both the source as the sound waves and the observer. Red on the screen means the blood is moving towards the probe and blue means blood is moving away from the probe.

Question 19

When holding the probe to the skin in doppler mode, at what degree will it appear the flow of blood has stopped?
a. 120
b. 45
c. 90
d. 180

Answer 19

c. 90

When the probe is held perpendicular to the skin, the intensity of the doppler shift decreases. This is because the probe only shows color of things moving towards or away from it. The operator should angle the probe to pick up blood flow again

Question 20

What technique produces better image resolution by reducing the distance between the transducer and the target?
a. rotate
b. compress
c. slide
d. rock

Answer 20

b. compress

Rocking is moving the transducer from side to side to promote better contact between the patient and transducer. Sliding is moving the short axis of the transducer up and down at the same angle of incidence. Rotating is moving the transducer and a clockwise or counterclockwise motion in the same axis. Used to transition from a short axis to long axis view and vice versa.

Question 21

What artifact is described by the following: when a hyperechoic structure produces strong echoes giving the false impression there is nothing below the bone.
a. acoustic enhancement
b. shadow
c. reverberation
d. bayoneting

Answer 21

b. shadow

A shadow is produced deep to a hyperechoic structure (bone) because acoustic energy doesn’t penetrate through bone very well. Can be minimized by adjusting the scanning plane to find a better acoustic window.

Question 22

What is it called when an ultrasound wave accentuates the region below a fluid filled structure?
a. acoustic enhancement
b. impedance
c. shadow
d. mirror image

Answer 22

a. Fluid only minimally attenuates sound waves so the underlying tissue is accentuated. You can use this enhancement when trying to image a deep structure by placing a fluid filled structure between the probe and the structure.

Question 23

What is it called when a sound wave bounces between two strong parallel reflecting surfaces?
a. reverberation
b. mirror imaging
c. bayoneting
d. enhancement

Answer 23

a. reverberation

Reverberation is similar to mirror image artifact. You can see this when imaging the pleura or when using a wide bore needle that is highly attenuated.

Question 24

What is it called when a needle appears to bend during ultrasound imaging?
a. mirror imaging
b. reverberation
c. shadow
d. bayoneting

Answer 24

d. bayoneting

This is because the ultrasound machine assumes that sound travels through all soft tissue at 1540m/sec. It fails to account that every tissue has a different propagation velocity.

Question 25

The basic POCUS cardiac review consists of how many views?
a. 3
b. 4
c. 5
d. 6

Answer 25

c. 5

The five views are:
1. parasternal long axis
2. parasternal short axis
3. apical 4 chamber
4. subcostal 4 chamber
5. subcostal IVC

Question 26

To obtain a parasternal long axis view, one should rotate the transducer so that the orientation marker points towards the patient’s …
a. right shoulder
b. right hip
c. left shoulder
d. left hip

Answer 26

c. left shoulder

After obtaining the parasternal long axis view (orientation marker towards the patient’s right shoulder), one should rotate the probe 90 degrees clockwise and point the orientation marker towards to eh patient’s left shoulder.

Question 27

To obtain an apical 4 chamber view, the patient should be placed in left lateral decubitus and the the probe should be placed at ____.
a. mid axillary line 4th intercostal
b. subxiphoid
c. midclavicular line 2nd intercostal
d. point of maximal impulse

Answer 27

d. The point of maximal impulse is usually just inferolateral to the left nipple in men and under the inferolateral quadrant of a woman’s left breast.

Question 28

Where should the transducer be placed to obtain a subcostal 4 chamber view?
a. left subcostal margin
b. right subcostal margin
c. inferior to xiphoid
d. midclavicular line 5th intercostal

Answer 28

c. inferior to the xiphoid

The orientation marker should be pointed towards the patient’s left side. If excess gas in the bowel impedes the view, the liver can be used as an acoustic window.

Question 29

Which of the following ics NOT included in the subcostal IVC view?
a. IVC
b. RV
c. RA
d. liver

Answer 29

b. RV

The RV is not included in this view. The probe is placed inferior to the xiphoid. Here the volume status can be assessed by how much the IVC collapses

Question 30

On ultrasound image, what lines appear vertically beneath pleura?
a. A lines
b. B lines
c. C lines
d. Z lines

Answer 30

b. B lines

B lines are sometimes called “comet tails”. They can be a normal finding but may also suggest pathology of pulmonary edema