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Echo > Focused/ED/Miscellaneous > Flashcards

Focused/ED/Miscellaneous Flashcards

1
Q

Focused Cardiac Ultrasound (FCU)

List 4 goals of a focused cardiac ultrasound.

A
  • identify reduced LV systolic function
  • determine volume status measured by RAP (more accurate & feasible than physical examination)
  • identify marked RV enlargement
  • identify significant pericardial effusion
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2
Q

Image recording is not mandatory for handheld ultrasound.

True or False ?

A

True

Image recording is not mandatory

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3
Q

Initial evaluation when there is a reasonable suspicion of valvular heart disease scores a 1 on the AUC.

True or False ?

A

False

*indication #34: initial evaluation when there is a reasonable suspicion of valvular heart disease (AUC score = 9)

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4
Q

Sustained or nonsustained atrial fibrillation, SVT, or VT scores a 9 on the AUC.

True or False ?

A

True

*note:

SVT - Supraventricular tachycardia begins in the upper portion of the heart, usually the atria

VT - Ventricular tachycardia begins in the heart’s lower chambers, the ventricles

Because VTs occur in the ventricles, they make the heart extremely inefficient and are more serious than SVTs.

The symptoms of VTs are usually more severe, and have a much greater tendency to be fatal.

While SVTs are not usually life-threatening, they can cause both emotional and physical problems. It is cause for concern if a patient experiences frequent SVTs or if the episodes are lengthy.

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5
Q

List at least 4 things suitable for a handheld ultrasound system.

A

LV systolic dysfunction

  • LA enlargement
  • LVH
  • aortic root aneurysm
  • AV calcification
  • MVP/MS
  • pulmonary edema
  • pleural effusion
  • pneumothorax

LV aneurysm

pericardial effusion

isolated RV enlargement

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6
Q

The last structural change that can be detected in atherosclerosis is an increase in IMT.

True or False ?

A

False

*The first structural change that can be detected in atherosclerosis is an increase in IMT

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7
Q

A __________________ with level 2 or 3 training performs a limited cardiac echocardiogram.

A

sonographer

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8
Q

FoCUS is done by ＿＿＿＿＿

A

physician with FCU training

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9
Q

“Appropriate Use Criteria” was developed as a result of the over use of echocardiograms.

True and False ?

A

True

*rational approach to prevent unnecessary use of TTE

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10
Q

Atherosclerosis most often develops gradually and slowly, starting from childhood and proceeding into adulthood with varying velocity and susceptibility to complications.

True or False ?

A

True

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11
Q

A limited Echocardiogram has a formal report meeting ________ standards and has a billing code ________.

A

IAC

93308

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12
Q

A handheld ultrasound exam is usually less than ___ minutes.

A

5

*physician performs imaging during physical examination. Procedure needs short, specific explanation to patient

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13
Q

Most Common Indications for TTE in a Clinical Setting is:

A

Indication #1: Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event (AUC score = 9)

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14
Q

Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event AUC score = 9).

True or False?

A

True

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15
Q

Coronary Flow Imaging has a reported specificity of 90%.

True or False ?

A

True

  • Coronary flow imaging has a potential for noninvasive assessment of significant stenosis during routine echocardiography.*
  • Indications are reported that there is a 90% specificity*
  • *note: specificity -* the percentage of people who test negative for a specific disease among a group of people who do not have the disease
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16
Q

_______________ is an important atherosclerotic risk marker.

A

Intima-media thickness (IMT) is an important atherosclerotic risk marker.

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17
Q

Coronary flow imaging has no potential for noninvasive assessment of significant stenosis during routine echocardiography.

True or False ?

A

False

It has a potential for noninvasive assessment

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18
Q

Significant stenosis in the LAD is usually located in the ____ segment of the artery

A

proximal

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19
Q

A FCU as full function: M-mode, 2D, color Doppler, spectral Doppler, TDI, contrast, and is ECG - gated.

True or False?

A

False

FCU - 2D minimum

limited echo - Full function (M-mode, 2D, color Doppler, spectral Doppler, TDI, contrast), ECG-gated

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20
Q

Significant stenosis in the LAD is usually located in the proximal segment of the artery.

True or False?

A

True

21
Q

Based on the AUC, routine surveillance (< 1 year) of heart failure (systolic or diastolic) when there is no change in clinical status or cardiac examination would be considered ok.

True or False?

A

False

Indication # 74:** Routine surveillance (< 1 year) of heart failure (systolic or diastolic) when there is no change in clinical status or cardiac examination (**AUC score = 2)

22
Q

List 4 risk factors for carotid intima media thickness.

1.

2.

3.

4.

A

aging

HLD

HTN

smoking

DM

obesity

sedentary lifestyle

23
Q

A hand held Ultrasound system is the new stethoscope for a physiscian.

True or False?

A

True

  • Physician with a stethoscope – former
  • Physician with Hand held ultrasound
24
Q

List 4 limitations of FCU.

1.

2.

3.

4.

A
  1. transducer quality/selection
  2. devices used to image: smaller screens, fewer imaging modes, less image processing
  3. lack of ECG gating
  4. typically not quantitative
  5. imaging protocols from limited windows
  6. limited experience of user - obtaining images/interpreting images
25
Q

A focused cardiac ultrasound does not have a defined scope of practice and can be performed anywhere, anytime.

True or False?

A

False

FCU: location of imaging - defined scope of practice

*Scope of practice is broadly defined as healthcare services that a physician or other healthcare practitioner is authorized to perform. Responsibilities are based on education, training, experience, and demonstrated clinical competency.

26
Q

Intima-media thickness values of more than ___ (ESC) or over the 75th percentile (ASE) should be considered abnormal.

A
  • Intima-media thickness values of more than 0.9 mm (ESC) or over the 75th percentile (ASE) should be considered abnormal.*
  • *note: ESC - The European Society of Cardiology*
27
Q

A ____________ with FCU training typically is the person performing a FCU.

A

physician

FCU acquisition: Physician with FCU training

FCU interpretation: Physician with FCU training defined, limited scope

28
Q

When the need for clinical evaluation is emergent or urgent and echocardiography is not immediately available, FCU may be used. List 4 pathologies that might be assessed in the ED or at the seen of trauma.

A

hemodynamic instability or shock

chest trauma

clinical suspicion of pericardial tamponade

cardiac arrest

acute heart failure

29
Q

What is FOCUS ?

A

Focused cardiac ultrasound (FOCUS) refers to the use of ultrasound to evaluate cardiac pathophysiology at the point of care, by providers actively managing a patient.

*limited exam

30
Q

Limited Echocardiogram vs. Focused Cardiac US

  • image protocol?
  • equipment (function)?
  • measurement?
  • acquisition by?
  • interpretation by?
  • image storage?
  • documentation?
  • billing?
A
31
Q

Hand Held Ultrasound

functions (4)

A

Basic 2D imaging – measurements

Color Doppler – lesions

High Frequency – atherosclerosis

Assess diastolic filling patterns

32
Q

Hand Held Ultrasound Technique

patient position?

gel application?

risk?

study interpretation?

documentation?

A
  • Patient is supine or in semi-Fowler position*
  • Minimize gel reapplications, preferably use only a single dollop*
  • Device drop, misplacement, and contamination risks*
  • Study interpreted on the spot, while imaging*
  • Document subjective findings, preferably as a component of physical examination*
  • Recharge device battery every 1-2 days*
33
Q

Applications of Focused Cardiac Ultrasound

A
34
Q

Most Common Indications for TTE in a Clinical Setting

Indication #2: Prior testing that is concerning for heart disease or structural abnormality, including but not limited to chest X-ray, baseline scout images for stress echocardiogram, ECG, or cardiac biomarkers (AUC score ?)

A

9

35
Q

Most Common Indications for TTE in a Clinical Setting

Indication #9: Syncope when there are no other signs of cardiovascular disease (AUC score = ? )

A

7

36
Q

Most Common Indications for TTE in a Clinical Setting

Indication #58: Suspected cardiovascular source of embolus (AUC score = ?)

A

9

37
Q

Most Common Indications for TTE in a Clinical Setting

Indication #71: Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or

cardiac exam without a clear precipitating change in medication or diet (AUC score = ? )

A

8

38
Q

Most Common Indications for TTE in a Clinical Setting

Indication #73: Re-evaluation of known HF (systolic or diastolic) to guide therapy (AUC score = ? )

A

9

39
Q

Most Common Indications for TTE in a Clinical Setting

Indication #1: Symptoms or conditions potentially related to a cardiac etiology, including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic event (AUC score = ?)

A

9

40
Q

Most Common Indications for TTE in a Clinical Setting

Indication #5: Sustained or nonsustained atrial fibrillation, SVT, or VT (AUC score = ?)

A

9

41
Q

Most Common Indications for TTE in a Clinical Setting

Indication #34: Initial evaluation when there is a reasonable suspicion of valvular heart disease (AUC score = ?)

A

9

42
Q

“Rarely Appropriate” indications for TTE

A
43
Q
  • Intima-media thickness is an important atherosclerotic risk marker. However, this increase is not synonymous with subclinical atherosclerosis, but is related to it. Indeed, increase in IMT is also the result of nonatherosclerotic processes.*
  • T or F ?*
A

T

44
Q

The ______________is a measure used to diagnose the extent of carotid atherosclerotic vascular disease. The test measures the thickness of the inner two layers of the carotid artery—the intima and media—and alerts physicians to any thickening when patients are still asymptomatic.

A

carotid intima-media thickness test (CIMT)

45
Q

Coronary Flow Imaging

A
46
Q

PoCUS is the test of choice in the ED for… (2)

A

cardiac arrest and emergency triage

47
Q

UAPE stands for?

A

ultrasound augmented physical examination

48
Q
A

Echo (35 decks)

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