NBE CCE Exam Review Flashcards
Prep for the NBE exam. Note that this tool is meant to help with the rote memorization aspect of ultrasonography and is not meant to replace the knowledge and skills that come from dedicated study of the foundations, concepts, and practical application of CCUS. - David Wang
1
Q
TAPSE cutoff?
A
c. Lateral TV
c. M-mode
c. Cutoff: > 16 normal
2
Q
IVC collapsibility with spontaneous breathing:
RAP < 5 mmHg: IVC < […cm] & > 50% collapsibility with sniff
A
RAP < 5 mmHg: IVC < 2.1 cm & > 50% collapsibility with sniff
3
Q
IVC collapsibility with spontaneous breathing:
What is RAP if IVC > 2.1 cm & less than 50% collapsibility with sniff
A
RAP >15 mmHg
4
Q
IVC collapsibility with spontaneous breathing:
What is RAP if IVC > 2.1 cm & > 55% collapsibility, OR IVC < 2.1 cm & < 55% collapsibility
A
RAP 8 mmHg
5
Q
PE:
60/60 sign?
A
- *a. RVSP <60 mmHg
b. PA acceleration time < 60 sec**
The 60/60 sign in echocardiography refers to the coexistence of a truncated right ventricular outflow tract acceleration time (AT <60 ms) with a pulmonary arterial systolic pressure (PASP) of less than 60 mmHg (but more than 30 mmHg). In the presence of right ventricular failure, it is consistent with an acute elevation in afterload, commonly due to an acute pulmonary embolism.
6
Q
McConnell’s sign: coexistence of akinesia of the […region]
A
McConell’s sign (for PE): coexistence of akinesia of the mid-free right ventricular wall with preserved apical contractility
7
Q
RV hypertrophy: what cutoff in thickness?
A
> 5mm
8
Q
Best view for Rv hypertrophy:
A
Subcostal 4 chamber
9
Q
Pulm HTN/ RVSP / PAP calc:
PA mean is calculated with what measurement at pulmonic valve?
A
velocity at the beginning of the PR signal, aka early diastole (using cw doppler across PV)
https://youtu.be/XXFTnz8ys3k
10
Q
Pulm HTN/ RVSP / PAP calc:
PAD is calculated with what measurement at the pulmonic valve?
A
velocity at the end of the PR signal
https://www.youtube.com/watch?v=XXFTnz8ys3k&ab_channel=LukeHoward
11
Q
Pulm HTN/ RVSP / PAP calc:
PAD equation using pulmonic valve?
A
4 * (VED)2 + RAP
12
Q
How to calculate mean PAP using RVOT?
A
Mean PAP= 90 – (0.62 x RVOT AT in msec)
AT = acceleration time, measured via pulsed-wave doppler
https://www.youtube.com/watch?v=vbTQyep26qY&ab_channel=LukeHoward
13
Q
PV diastolic gradient equation?
A
PV diastolic gradient: PAD - RAP
14
Q
AS severity:
Aortic jet velocity (m/s): cutoff for mild?
A
2.6-2.9
15
Q
AS severity:
Aortic jet velocity (m/s): cutoff for severe?
A
> 4.0
16
Q
AS severity:
Mean gradient (mmHg): cutoff for severe?
A
> 40 by ESC guidelines
> 50 by AHA/ACC
(probably reasonable to assume on the test that they won’t pick something in between so only need to know one of these)
17
Q
AS severity:
Mean gradient (mmHg): cutoff for mild?
A
< 20 by ESC guidelines
< 30 by AHA/ACC
(probably reasonable to assume on the test that they won’t pick something in between so only need to know one of these)
18
Q
AS severity:
AVA (cm2): cutoff for mild?
A
> 1.5
19
Q
AS severity:
AVA (cm2): cutoff for severe?
A
< 1.0
20
Q
AS severity:
Indexed AVA (cm2): cutoff for mild?
A
> 0.85
21
Q
AS severity:
Indexed AVA (cm2): cutoff for severe?
A
< 0.6
22
Q
AS severity:
Velocity ratio: cutoff for mild?
A
> 0.50
23
Q
AS severity:
Velocity ratio: cutoff for severe?
A
< 0.25
24
Q
AS severity:
Which measurement is adjusted for BMI?
A
AVA, hence the indexed AVA.
NB: the validiy of indexed AVA is somewhat controverisal in the literature from what I read
25
TTE PSAX view:
name the AV leaflets
Right, left, noncoronary
26
AV:
Which is better for morphologic evaluation, TTE or TEE?
TEE
27
AV:
Which is better for flow evaluation, TTE or TEE?
TTE
28
AS:
## Footnote
AVR is reasonable for asymptomatic patients with **aortic velocity ≥ [...m/s]**) and low surgical risk
AVR is reasonable for asymptomatic patients with very severe AS (stage C1, **aortic velocity ≥5.0 m/s)** and low surgical risk
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
29
AS:
## Footnote
AVR is reasonable for asymptomatic patients with **aortic velocity ≥ [...m/s]**) and low surgical risk
AVR is reasonable for asymptomatic patients with very severe AS (stage C1, **aortic velocity ≥5.0 m/s)** and low surgical risk
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
30
AS:
## Footnote
AVR is recommended for symptomatic patients with **[...severity of AS]** who have symptoms by history or on exercise testing
AVR is recommended for symptomatic patients with **severe** high-gradient AS who have symptoms by history or on exercise testing (stage D1)
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
31
AS:
## Footnote
AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF under what condition?
AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF (stage D2) with a **low-dose dobutamine stress study** that shows severe AS flow or gradient: an aortic velocity ≥4.0 m/s (or mean pressure gradient ≥40 mm Hg) with a valve area ≤1.0 cm2 at any dobutamine dose
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
32
AS:
## Footnote
AVR is reasonable in symptomatic patients who have low-flow/low-gradient severe AS who are normotensive and have an LVEF ≥50% under what condition?
AVR is reasonable in symptomatic patients who have low-flow/low-gradient severe AS (stage D3) who are normotensive and have an LVEF ≥50% if clinical, hemodynamic, and anatomic **data support valve obstruction as the most likely cause of symptoms**
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
33
AS:
## Footnote
AVR is indicated for patients with **[...severity]** AS when undergoing other cardiac surgery
AVR is indicated for patients with **severe** AS when undergoing other cardiac surgery
NB: "reasonable" to replace if you have moderate AS and undergo cardiac surgery, but not "indicated"
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
34
AS:
How to calculate velocity ratio?
**velocity ratio = VLVOT / VAV**
Some debate on if we should use peak velocity or VTI, so both can be used?
This is also known as velocity index, or dimensionless index (note I am not 100% sure about this please correct me if I'm wrong)
35
AS:
how to calculate indexed AVA?
AVA / BSA
36
AS:
AVR may be considered for asymptomatic patients with **[...severity of AS]** and rapid disease progression and low surgical risk
AVR may be considered for asymptomatic patients with **severe AS** (stage C1) and rapid disease progression and low surgical risk
37
AI severity:
Central jet width compared to LVOT: cutoff for mild?
\< 25%
38
AI severity:
Central jet width of LVOT: cutoff for severe?
\>= 65%
39
AI severity:
pressure half time (ms): cutoff for mild?
\> 500 ms
40
AI severity:
vena contracta (cm2): cutoff for severe?
\> 0.6 cm2
41
AI severity:
vena contracta (cm2): cutoff for mild?
\< 0.3
42
AI severity:
Jet depth: cutoff for severe?
head of papillary muscle
43
AI severity:
Jet depth: cutoff for moderate?
tip of anterior MV leaflet
44
AI:
is dehiscence of AV prosthesis alone an idication for valve replacement?
No
45
AI severity:
Flow reversal indicates severe AI when and where?
**holodiastolic flow reversal in descending aorta**
46
AI severity:
Which of the following is reliable in eccentric jets?
* Vena Contracta
* Jet width/LVOT diameter
* Regurgitant flow and regurgitant fraction
* Flow reversal in aorta
* Area of jet in Short axis
* Adequate CW
* LV size
Yes:
**• Vena Contracta- if clearly defined**
**• Regurgitant flow and regurgitant fraction**
**• Flow reversal in aorta**
**• LV size –always look at the scale!**
Less reliable indicators of severity:
* Jet width/LVOT diameter
* Area of jet in Short axis
* Adequate CW jet recording may be difficult- “bidirectional”
47
AI:
AVR is reasonable for asymptomatic patients with severe AR with normal LV systolic function (LVEF ≥50%) but with severe LV dilation **[...criteria]**
AVR is reasonable for asymptomatic patients with severe AR with normal LV systolic function (LVEF ≥50%) but with severe LV dilation (**LVESD \>50 mm**, stage C2)
48
AI:
## Footnote
AVR is indicated for symptomatic patients with **[...severity]** AR regardless of LV systolic function.
AVR is indicated for symptomatic patients with **severe** AR regardless of LV systolic function (stage D)
49
AI:
AVR is indicated for asymptomatic patients with chronic severe AR and LV systolic dysfunction (LVEF \< **[...%]**) (stage C2)
AVR is indicated for asymptomatic patients with chronic severe AR and LV systolic dysfunction (**LVEF \<50%**) (stage C2)
50
MV:
identify the commissures
anterolateral, posteromedial
51
TTE PSAX MV:
identify the leaflets
anterior, posterior
52
MR severity:
jet area (cm2): cutoff for mild
\< 4 cm2
53
MR severity:
size of flow convergence (cm): cutoff for severe, with a Nyquist of 40cm/s
\>=1.0 cm = large flow convergence = severe
54
MR severity:
central jet size (% of LA): cutoff for severe?
\> 50% of LA
NB: ASE says this must be combined WITH vena contracta \>=0.7cm
55
MR severity:
vena contracta (cm): cutoff for severe?
\>= 0.7 cm
NB: ASE says this must be combined WITH a large central jet, or wall impinging jet of any size. I think this means they'll provide multiple criteria if this is asked.
56
MR severity:
regurgitant volume (ml / beat): cutoff for severe?
\>= 60
57
MR severity:
regurgitant fraction (%): cutoff for severe?
\>=50
58
MR severity:
Severe if systolic flow reversal in **[...location]**
s-wave in **pulmonary veins**
59
MR severity:
severity if MV flail leaflet is seen?
severe
60
MR severity:
severity if ruptured papillary muscle is seen?
severe
61
MS severity:
valve area (cm2): cutoff for mild?
\> 1.5
62
MS severity:
valve area (cm2): cutoff for severe?
\< 1.0
63
MS severity:
mean gradient (mmHg): cutoff for mild?
\< 5
64
MS severity:
mean gradient (mmHg): cutoff for severe?
\> 10
65
MS severity:
pulmonary artery pressure (mmHg): cutoff for severe?
\> 50
NB: this is a supportive finding; I don't think you can call severe MS by this alone
66
MS severity:
pulmonary artery pressure (mmHg): cutoff for mild?
\< 30
NB: this is a supportive finding; I don't think you can call severe MS by this alone
67
MS severity:
**[...criteria]** is the time interval between maximum mitral gradient in early diastole and the time point where the gradient is half the maximum initial value
pressure half-time
68
MS severity:
Equation for MVA by continuity equation?
MVA = (VTILVOT)\* (cross-sectional areaLVOT) / (VTIMV)
69
MS severity:
Equation for MVA by pressure half-time?
MVA = 220/T1/2
70
MS severity:
Equation for MVA by deceleration time?
MVA = 750/DT
71
Ross procedure:
what 2 valve lesions can develop over time?
**Pulmonic stenosis, aortic insufficiency**
Ross: "This involves replacing the aortic valve with the patient's own pulmonary valve, which has the capability to grow with the patient. In turn, the pulmonary valve and lower portion of the pulmonary artery are replaced by a pulmonary homograft."
http://www.pted.org/?id=valve3
72
PS severity:
peak jet velocity (m/s): cutoff for mild
\< 3
73
PS severity:
peak jet velocity (m/s): cutoff for severe
\> 4
74
PS severity:
peak gradient (mmHg): cutoff for mild
\< 36
75
PS severity:
peak gradient (mmHg): cutoff for severe
\> 64
76
PS severity:
equation for calculating pressure gradient?
**ΔP = 4v2**
v = peak velocity by CWD
NB: this is an application of the modified bernoulli equaiton
77
PS severity:
two TTE views for calculating peak PA systolic gradient?
**PSAX view at aortic valve level**
**PLAX RVOT view**
and then you use CWD through the PV
78
RVSP calculation:
using TR jet: what equation?
RVSP =4(TR VMax)2 + RA pressure
79
Secondary indices of elevated RA pressure:
Tricuspid E/E' cutoff?
Tricuspid E/E' \>6
80
Secondary indices of elevated RA pressure:
HV systolic filling fraction Vs/(Vs+Vd) cutoff?
Diastolic flow predominance in hepatic vein (HV) i.e. HV systolic filling fraction Vs/(Vs+Vd) **\<55%**
81
Restrictive CM vs Constrictive pericarditis:
A pericardial thickness exceeding **[...mm]** is highly suggestive of constrictive pericarditis
Restrictive CM vs Constrictive pericarditis:
A pericardial thickness exceeding **4 mm** is highly suggestive of constrictive pericarditis
NB: can have constrictive with less than 4mm i.e. this measure is specific but not sensitive for constrictive pericarditis
https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H12
82
Restrictive CM vs Constrictive pericarditis:
Where to measure TDI to differentiate? What phase of cardiac cycle?
**Early diastolic** Doppler tissue velocity E’ at **mitral annulus**
83
Restrictive CM vs Constrictive pericarditis:
Hepatic venous flow difference?
**with constrictive pericarditis, there is a reversal of forward flow during expiration,** since the right ventricle becomes less compliant as the left ventricle fills more.
In contrast, **reversal of hepatic vein flow occurs during inspiration in restrictive cardiomyopathy.**
https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H13
84
Restrictive CM vs Constrictive pericarditis:
TDI cutoffs?
**Restrictive CM: \< 8**
**Constrictive pericarditis: \> 12**
The early diastolic Doppler tissue velocity at the mitral annulus (E') is decreased (\<8 cm/sec) in restrictive cardiomyopathy, due to an intrinsic decrease in myocardial contraction and relaxation. In contrast, the transmitral E' is frequently increased (\>12 cm/sec) in constrictive pericarditis, since the longitudinal movement of the myocardium is enhanced because of constricted radial motion
https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H13
85
PFO management:
Optimal vent settings?
lower PEEP
86
ASD:
Identify A-E
A **superior sinus venosus** ASD;
B, **secundum** ASD;
C, **inferior sinus venosus** ASD;
D, ostium **primum ASD** or partial AV septal defect;
E, **secundum ASD** without posterior septal rim
https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.592055
87
Name that lesion!
TTE view
PFO
coudn't find a nice TTE pic
88
CO determination:
stroke volume equation?
VTILVOT \* areaLVOT
aka: VTILVOT \* pi \* (LVOT diameter / 2)2
89
CO determination by stroke volume:
LVOT area: what view, what point in cardiac cycle?
**PLAX, measure in mid systole,** measure under leaflet insertion
90
CO determination by stroke volume:
LVOT VTI: what view? CW or PW?
**A5C**
**PW doppler**
NB: doppler should only show closing click (not sure how they'd test this detail)
91
Equation for pulmonary to systemic flow ratio?
Qp/Qs
## Footnote
**Qp = RVOT VTI \* π \* (RVOT / 2)2**
**Qs = LVOT VTI \* π \* (LVOT / 2)2**
aka: (VTI\*area) / (VTI\*area)
92
Tamponade:
chamber collapse may not be present under what condition?
concomitant **pulmonary hypertension**
93
Tamponade:
cutoff for MV flow changes during inspiration?
MV \> 30% change in E' velocity with respiration
94
Tamponade:
cutoff for TV flow changes during inspiration?
TV \> 60% change in E' velocity with respiration
95
A5C LVOT VTI:
Name that pathology!
Dagger outflow VTI = **dynamic LVOT obstruction**
(classically HOCM, also seen in Takotsubo, MI)
96
HOCM management:
vasopressor of choice?
**phenylephrine**
euvolemia, adequate systemic vascular resistance (SVR), and sinus rhythm at a slow to normal heart rate (ie, 60 to 80 beats per minute) should be the goal during the entire perioperative period, while increases in contractility or pulmonary vascular resistance (PVR) are avoided
https://www.uptodate.com/contents/anesthesia-for-patients-with-hypertrophic-cardiomyopathy-undergoing-noncardiac-surgery#H1316682774
97
Volume responsiveness:
most accurate method? cw or pw?
**Aortic VTI**
**PW** doppler at or within 1 cm of aortic valve
NB: LVOT doesn't change during cycle so it's a proxy for change in SV
98
Volume responsiveness:
By aortic VTI: cutoff in %?
\>12% change = fluid responsive
99
Volume responsiveness:
By SVC respiratory variation on TEE: cutoff in %?
\> 36%
100
Volume responsiveness:
IVC distensibility index: cutoff in %?
\> 18%
this is (IVCmax - IVCmin)/IVCmin
NB this is only in MV patients
101
Volume responsiveness:
limitations of the respiratory variation model (Ao VTI, IVC, SVC):
tidal volume, HR, and lung compliance restrictions?
**TV \>= 8 ml/kg**
**HR \< 120**
**compliance \> 30**
Other crtieria:
intubated, synchronous with vent
sinus only, no arrhythmia
no intraabd HTN
102
Volume responsivness:
by passive fluid challenge: which method is most accurate?
Aortic VTI
NB: oli specifically mentions IVC diameter change is not accurate enough
103
Volume responsivness:
by passive fluid challenge: cutoff for Aortic VTI?
\> 12%
104
Name that finding!
**Myxoma**
mostly in LA near fossa ovalis
can have a stalk
https://asecho.org/wp-content/uploads/2016/04/4.17-Tighe-Cardiac-Masses.pdf
105
Name that lesion!
Papillary fibroelastoma
differentiate from veg by: location in mid valve, usually no valve dysfx
https://asecho.org/wp-content/uploads/2016/04/4.17-Tighe-Cardiac-Masses.pdf
NB: there are tons of case reports about PFEs looking like veg or thrombus and vice versa - so I am guessing it'll be textbook presentations only on exam
106
TEE ME 4c
Name that finding!
Normal PPM lead
NB could probably confuse this an PA catheter easily - PA cath would need another view to show it going further
Almomani A, Siddiqui K, Ahmad M. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators. Echocardiography. 2014 Mar;31(3):388-99. doi: 10.1111/echo.12483. Epub 2013 Dec 17. PMID: 24341293.
107
Name that finding!
**LVAD inflow cannula**
TTE PLAX
NB: I also see a big ol' pleural effusion
https://www.asecho.org/wp-content/uploads/2018/01/Asch-Echo-Assessment-of-LVADs.pdf
108
what view is used to confirm IABP placement?
TEE: ME descending aorta (LAX and SAX)
NB: not sure if you can use TTE
Klopman, Matthew A. MD\*; Chen, Edward P. MD†; Sniecinski, Roman M. MD, FASE\* Positioning an Intraaortic Balloon Pump Using Intraoperative Transesophageal Echocardiogram Guidance, Anesthesia & Analgesia: July 2011 - Volume 113 - Issue 1 - p 40-43 doi: 10.1213/ANE.0b013e3182140b9a
109
Name that finding!
Eustachian valve
Carson W, Chiu SS. Eustachian valve mimicking intracardiac mass. Circulation. 1998 Jun 2;97(21):2188-.
110
PLAX: Name that finding!
Type A Dissection. Another pic in short axis:
https://asecho.org/wp-content/uploads/2015/01/2015\_Thoracic-Aorta.pdf
111
What cardiac structure is most affected by blunt chest trauma?
RV (most anterior structure)
112
Name that finding!
Mechanical MV
113
LAA emptying velocity: cutoff that increases thrombus formation?
\< 20 cm/s
114
What setting do you adjust with contrast echocardiography
**decrease the mechanical index** (aka the power)
at higher mechanical index, the microbubbles get destroyed and you get attenuation
https://www.asecho.org/contrast-zone/the-basics/
115
what TTE view?
PLAX RV inflow
NB: I know it's hard to tell from a still image..
http://pie.med.utoronto.ca/tte/TTE\_content/standardViews.html
116
what TTE view?
suprasternal long axis
http://pie.med.utoronto.ca/tte/TTE\_content/standardViews.html
117
Diastolic dysfunction:
E/A cutoff for normal?
0.8
118
Diastolic dysfunction:
E/A cutoff for mild diastolic dysfunction?
E/A \<= 0.8
119
Diastolic dysfunction:
E/A cutoff for moderate diastolic dysfunction?
**0.8 \< E/A \< 2.0**
this is pseudonormalization
120
Diastolic dysfunction:
E/A cutoff for severe diastolic dysfunction?
E/A \>= 2.0
121
Diastolic dysfunciton:
how to measure e'? (mode, location)
tissue doppler imaging of mitral annulus
122
Diastolic dysfunction:
E/e' cutoff for normal?
\< 10
123
Diastolic dysfunction:
E/e' cutoff for severe dysfunction?
\>= 14
124
Diastolic dysfunction:
E/e' cutoff for moderate dysfunction?
10-14
NB: this is how you can differentiate normal from pseudonormal E/A
125
Diastolic dysfunction:
e' TDI: should you use lateral or septal annulus?
**lateral annulus**
Velocities at the septal ring are probably also affected by the motion of the right ventricle. Thus, many investigators suggest the use of the lateral ring. Studies have shown that those measurements are more closely correlated with filling pressures. However, especially in the presence of regional wall motion abnormalities which may also reduce annular velocity, it is best to use an average of the septal and the lateral E` wave velocity.
https://www.123sonography.com/book/338
126
Amyloidosis:
**[...chamber]** wall thickening
**biventricular** wall thickening
https://www.brighamandwomens.org/heart-and-vascular-center/procedures/cardiac-amyloidosis-echocardiographic-appearance
127
Amyloidosis:
**[...chamber]** enlargement
**bi-atrial** enlargement
also you have atrial immobility, follow the link
https://www.brighamandwomens.org/heart-and-vascular-center/procedures/cardiac-amyloidosis-echocardiographic-appearance
128
Takotsubo:
what segments are akinetic?
what segments are hypercontractile?
akinesia of the apical and mid-ventricular segments
basal segments are hypercontractile
https://youtu.be/n9HS\_Mm5OOA
129
Takotsubo:
dilation of what segment?
**LV apex**
aka apical ballooning
130
Name that finding!
LV aneurysm
https://youtu.be/PT7w0wI95Hc
131
LV aneurysm vs pseudoaneurysm: which one has endocardium in the wall?
**Aneurysm**: scarred myocardium and endocardium
pseudoaneurysm wall consists only of the epicardium, pericardium and hematoma
https://radiopaedia.org/articles/left-ventricular-pseudoaneurysm?lang=us
132
Name that finding!
perimembranous **VSD**
https://youtu.be/K7OFrdxRVBc
133
What type of MI is associated with posterior MV tethering?
inferior
NB: I think inferior MI causes tethering in general, not just posterior
Video of tethering (coudln't find a good still): https://youtu.be/JgqOJozoDXY
134
PSAX AV level
Name that lesion!
**PE**
much easier to see in live video: https://youtu.be/-HBA19SYD8Q
135
Pleural effusion:
transudative vs. exudative cutoff in total protein ratio?
Transudative: total protein fluid:serum ratio \<0.5
136
Pleural effusion:
transudative vs. exudative cutoff in LDH ratio?
transudative: LDH fluid:serum ratio \<0.6
137
Lung point:
can be seen with what type of pneumothorax?
only diagnoses a **partial pneumothorax**, NOT visible with a complete lung collapse
138
Pneumothorax:
absence of lung sliding - more or less specific in the ICU population?
**less specificity** ie. more false positives.
too many other things can cause absent lung sliding. More reading here: https://rebelem.com/ultrasound-detection-pneumothorax/
139
Pneumothorax:
absence of lung sliding in ICU population: what findings can improve the specificity for diagnosing PTX?
**absence of B lines**
B lines = inflated lung, so if you have no lung sliding but present B lines then unlikely to be pneumothorax.
https://rebelem.com/ultrasound-detection-pneumothorax/
140
Pneumothorax:
A lines: present or absent in PTX?
**Present**
so not a lot of clinical utility in itself for PTX
141
Thoracic ultrasound:
name that finding!
**Lung consolidation**
liver and diaphragm on top. Note the spine sign below consolidated lung
142
Thoracic ultrasound:
name that finding!
air bronchograms
143
Thoracic ultrasound:
what air bronchograms are present in pneumonia?
**Dynamic air bronchograms are present in pneumonia**
Statis air bronchograms suggest atelectasis
https://nephropocus.com/2019/07/01/dynamic-air-bronchograms-ultrasound-sign-of-pneumonia/
144
Identify the cricothyroid membrane
https://litfl.com/airway-ultrasound-longitudinal-views/
1m youtube with cross sectional views: https://youtu.be/Ot61Z5rx1bI
145
Thoracic ultrasound:
lung pulse to differentiate between mainstem and esophageal intubation?
esoph: lung pulse bilaterally
mainstem: lung pulse on L
146
Thoracic ultrasound:
name that finding!
**pleural thickening**
also B lines and pleural roughness. in this setting, think pneumonia but can be also due to scarring, fibrosis, empyema, pleuritis.
147
Paracentesis:
what vessels are these?
inferior epigastric
148
Name that finding!
splenic injury
149
Name that finding!
free fluid in morrison's pouch
150
Name that finding!
white: splenic hematoma
black: fluid in splenorenal recess
151
Name that finding!
**DVT** of the common femoral vein
note that you don't have to see the clot to diagnose - just noncompressibility is enough
152
Name that finding:
image is of the groin
**Lymph node.**
distinguish from dvt:
LN in xsection will be nodular, not tubular
LN will tend to be superficial
for common fem and popliteal, DVT is paired with artery
https://youtu.be/jRCEdEscqKE?t=399
153
Which probe is in the 5-2 MHz range?
curved array
154
Which probe is in the 10-5 MHz range?
linear
155
Equation for Nyquist limit?
Nyquist limit = Pulse Repetition Frequency (PRF)/2
156
Equation for axial resolution?
**Axial resolution = spatial pulse length/2**
or (# cycles in the pulse x wavelength)/2
minimum distance that can be differentiated between two reflectors parallel to US beam
157
How to reduce aliasing without causing range ambiguity?
**Decreasing the pulse repetition period (PRP)** to increase the PRF and the Nyquist limit
seems like there's a lot more to it: https://esp-inc.com/techniques-to-avoid-aliasing/
158
Name that finding!
PWD of RVOT
Early systolic notching, suggests PE
more here: https://www.ultrasoundgel.org/posts/rKnyrNg993xeihgRkADy5Q
159
AI severity:
pressure half time (ms): cutoff for severe?
\< 200 ms
160
MR severity: EROA?
\>0.4 cm2
161
LV function: GLS Normal range?
\<= - 20%
GLS = (MLs-MLd)/MLd
162
TTE better for?
effusion
LV apex
IVC and hepatic veins
chamber quantification
163
TEE better for?
shunt
dissection
valve assessments
CPR response
thoracic aorta
MCS placement
164
RV FAC cutoff?
\<35% is abnormal
165
LVOT VTI cutoff?
\>18cm is normal
166
IVC collapsibility index vs. Distensibility index?
Collapsibility predicts RAP, while distensibility predicts fluid responsiveness
167
MAPSE cutoff?
\>11 in men, \>13 in women
Correlates with \>=55% LV function
Can't use with MV disease or MAC
168
E point Septal separation cutoff?
\>7mm
Associated with EF \<=30%
169
Sensitivity and specificity for ROSC?
sens 92%, spec 80%
Systematic Review, Acad Emerg Med 2012
170
Specificity for 60/60?
94%
171
Pericardial effusion size?
\<0.5cm - \< 50mL
\<1cm - \< 100mL
1-2cm - 100-500mL
\>2cm - \>500mL
172
FAST free fluid size?
thin-250cc
0.5cm-500cc
1cm-1L
173
Pleural effusion size?
\<0.3cm - 15-30mL
1cm - \< 75-150mL
2cm - 300-600mL
\>3.5cm - 1500-2500mL
174
B lines indicate?
\>=7mm apart may be interstitial process, \<3mm or confluent more likely alveolar
