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radiology > ULS > Flashcards

ULS Flashcards

1
Q

ocular ddx

A

retinal detachment

floating membrane

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2
Q

cobble stoning is seen with cellulitis of abscess

A

cellulitis

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3
Q

how can ULS help with pain mngmt

A

nerve block

helps to isolate nerve plexus under fascia layer

takes away all the pain for a femur fracture

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4
Q

ACUTE DYSPNEIC PATIENT ddx

A 
MI
PE
COPD
asthma 
CHF
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5
Q

A lines

A

seen in a normal aerated lung

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6
Q

vertical b line artifacts

A

interstitial edema

air water are creating vertical artifact

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7
Q

B lines with fat IVC and dyspnea

A

decompensating heart failure

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8
Q

hip arthrocentesis

A

helps visual landmarks in bigger pts
the more tissue you have to get through the harder it is to see below it

when injecting local anesthetic and steroids

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9
Q

goes deep
seen as kind of grainy
good for seeing the aorta

A

low frequency probe

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10
Q

allows for the visualization of superficial structures that are tender

A

high frequency probe

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11
Q

bright or white described as

A

hyperechoic

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12
Q

things which are fluid are seen as

A

dark or anachoic

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13
Q

most solid organs

A

appear more grey

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14
Q

few or no echoes (appears black)

A

Anechoic (echolucent)

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15
Q

Reflects many echoes (appears bright or white)

A

Hyperechoic (echogenic

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16
Q

Poor Propagation

A

Air

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17
Q

Very Echogenic (Very Bright)

A

■ Bone

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18
Q

Echogenic (bright)

A

Muscle

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19
Q

Echogenic (less bright)

A

Liver/Kidney

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20
Q

Hypoechoic (Dark) usually indicative of

A

Blood/Fluid

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21
Q

the dot of the probe marker

A

usually facing pts head or right

structures on the right side of the screen correlate to the right side of the body if the probe marker is on the right

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22
Q

Define how ultrasound images are created.

A

Ultrasonic waves are emitted by the probe (aka “transducer”) and are either transmitted through OR bounce back from the objects they touch

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23
Q

increasing the gain on the US

A

will make it go from dark to really bright

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24
Q

How much sound is transmitted vs reflected is called

A

acoustical impedance

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25
Q

As the density of the object increases, impedance will

A

also increase

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26
Q

From greatest to least acoustic impedance:

fluid
gas
bone

A

bone > gas > fluid

fluid mainly transmits the sound waves and does not reflect

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27
Q

Gas, bone, & stones will

A

Gas, bone, & stones reflect sound waves so well that they cast a shadow (which is why it’s hard to see
stuff deep to a bone or deep to bowel gas)

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28
Q

5 adv of ULS

A

No ionizing radiation

  • No known side effects
  • “real-time” images
  • Produces little or no pt discomfort
  • Small, portable, inexpensive, ubiquitous
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29
Q

disadv of ULS

A

Difficulty penetrating through bone Can’t do the head! (except eyeballs)

  • Gas-filled structures reduce its utility
  • Difficulty penetrating through fat tissue - Depends heavily on operator skill
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30
Q

what are the clinical indications of ULS the biliary tract

A

Cholelithiasis Cholecystitis

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31
Q

M mode

A

stands for motion

allows you to see the movement of what’s going through this line

waves on the beach

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32
Q

RUQ pain would use ULS for what structure

A

biliary tract

Cholelithiasis Cholecystitis

  • First-choice study for RUQ pain or suspected problems of biliary system; Better than CT!
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33
Q

mitral stenosis and M mode

A

loose “kick”

get flat E and A wave

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34
Q

indication for cardiac ULS

A

Pneumothorax
Pleural effusion
Pulmonary edema
Heart – valves (sorta), contractility, size, effusion

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35
Q
  • Study of choice in ED for acute dyspnea is known as

what can it help with

A
  • Study of choice in ED for acute dyspnea (i.e. the “Triple Scan”)

● Great for determining hypo- vs hyper-volemia
● Can also suggest causes of dyspnea (cardiac? Lung?

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36
Q

lets you see colors of moving fluid

A

Power Doppler

torsion
non traumatic pain and swelling

low flow state in testicals difficult to pick up on ULS

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37
Q

spectral dopplar

A

allows you to differentiate between arteries and veins

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38
Q

shadows

A

can help you differentiate artifacts that are thick and hard

like gallstones from sludge

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39
Q

WES

A

wall echo shadow sign from a ton of stoned

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40
Q

GOAL of fast exam

A

detect those pts that need an urgent laparotomy

identify shock in the early phases in order to increase perfusion.

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41
Q

Unstable + positive FAST

go to

A

OR

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42
Q

Stable + positive FAST

A

CT

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43
Q

Stable + negative FAST

A

Stable + negative FAST → CT vs. re-examine

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44
Q

Indications for FAST

A

■ Blunt Abdominal Trauma
■ Penetrating Abdominal Trauma
■ Unexplained Hypotension after Trauma
■ Evaluation of Pregnant Patient after Trauma

45
Q

○ FAST Exam – 4 views

A

4 views of a FAST exam

46
Q

what are we looking for in a FAST exam

A

FAST exam looks for abdominal fluid collection, as well as pericardial effusion

47
Q

what did we do before the FAST exam

A

diagnostic peritoneal lavage

DPL

48
Q

FAST stands for

A

Focused Assessment with Sonography in Trauma

49
Q

how much fluid must be around to be detected in ULS

A

■ How much fluid for a positive FAST? → 350 cc

50
Q

FAST sensitivity for bleeds

A

87%

51
Q

neg ULS and CT

A

can still have issues

could need observation for 24 if they are still tender or can’t eat without vomiting

52
Q

RUQ FAST what’s it called

what plane

probe in what orientation

A

Hepatorenal – Mid axillary line or slightly posterior; 11th ICS, at level w/ lower sternum to start.

Probe in cranial-caudal orientation

Coronal plane.

53
Q

Morrison’s pouch

what is it and what are we worried about

A

between liver & R kidney (liver
normally abuts kidney)

looking for dark stripe of fluid worried about blood in this area

54
Q

what should we be checking for in a RUQ ULS

A

Check the pleural space ( shouldn’t be able to see detail
in the lung! If yes → fluid!)
● Check Subphrenic space (pleura is white curved line
that normally abuts liver)
● Check Morrison’s pouch between liver & R kidney (liver
normally abuts kidney)
● Check inferior pole of R kidney

55
Q

what can give us a false positive Morisson’s pouch

A

perinephric fat pad

56
Q

what will a hem -thorax look like on a FAST exam

A

can see in RUQ as black above the liver

57
Q

Mid-epigastrium, with probe dot toward 9 o’clock, imaging through to heart.

A

Subxiphoid
doesn’t work great is pregnant or heavy pain

can do substernal

58
Q

LUQ what is it called and what is the placement

A

Splenorenal –

Like RUQ but a bit more inferior and posterior (brace hand on the bed). Post axillary line, 10th ICS, coronal plane.

59
Q

what are we looking for in the LUQ

A

Check subphrenic space & pleural space (OFTEN fluid is
here 1st between dome of spleen and diaphragm!)
● Check spleen
● Check interface between L kidney and spleen
● Check inferior pole of kidney

60
Q

where do we usually see bleeding first in the LUQ

A

usually between spleen and diaphragm before

diaphragm and kidney

61
Q

dark circular fluid near the spleen

A

gastric fluid sign

62
Q

two views used to look at the pelvis

A

transverse and sagittal

63
Q

how do you know if the probe is angles correctly in pelvic exam

A

Angle probe down into pelvis until you see base of

bladder w/ vaginal stripe (or prostate).

64
Q

sharp angles in a pelvic exam

A

are indicative of abnormal fluid collection

65
Q

usually where to we start with a focus echo

A

start out adjacent to the sternum and point to the pts right shoulder

66
Q

apical 4

A

down at the apex shooting up with the probe marker towards right leg

good for assessing chamber size

helps if you roll the pat on their left

breath out and hold

aim upwards toward right shoulder

67
Q

sub-xiphoid probe marker should be pointed

A

just below the right nipple

68
Q

best view for pts with COPD

A

subxiphoid

usually displaced inferiorly

69
Q

if there is a pericardial effusion what are we worries about

A

tamponade with quick accumulation of fluid

70
Q

beck’s triad

A

for tamponad

JVD
hypotension
muffled heart tones

71
Q

pulses paradoxes

A

seen with tamponade and creating negative pressure

tight space leads to r ventricular diastolic collapse

bp goes down

72
Q

what will tell us if we have tamponade in ULS

A

right ventricle collapse with effusion

will look like the wave

73
Q

comet tail artifacts

A

are normal in ULS of lunges

74
Q

With regards to the aorta when would you get an ULS and what would you be looking for?

A

First-choice study for asymptomatic pulsatile abdominal mass

CT + contrast is the gold std for characterizing the aneurysm

Abdominal Aortic Aneurysm
Aortic dissection

75
Q

with regard to the kidneys why would you get a ULS

A
  • First-choice study for renal colic
  • Primarily looks for hydronephrosis
  • Cannot visualize ureters or stones.
76
Q

with regards to the female reproductive system why would you get a ULS

A
  • First-choice study for pelvic mass or pelvic pain in female
  • First-choice study for evaluating ovaries

Leiomyomas (MC uterine tumor)
Ovarian cysts
PID
Intrauterine pregnancy (vs. ectopic) trans-vaginal US best

77
Q

when would you use a cT in the pelvic area for a woman

A

CT used for staging/evaluating masses found on ULS

78
Q

why would us use ULS for the male reproductive system

A

Testicular or scrotal mass
Testicular torsion

*First-choice study for acute scrotal pain

79
Q

why would you use ULS for SST

A

First-choice for quick distinction between abscess vs. joint-capsule effusion

*First choice for joint dislocations

Abscess
Joint capsule effusion
Subluxation/Dislocation

80
Q

why would you get a ULS of the venous/arterial system

A
  • Useful pre- and post-op screening for
    vascular procedures
    *Study of choice for DVT (especially sensitive in a symptomatic pt with DVT above the knee)
  • Refer for more thorough US exam if neg.

Carotid artery stenosis
DVT

81
Q

why would you get a ULS of the cardiac/lung region

A

Study of choice in ED for acute dyspnea (i.e. the “Triple Scan”)

  • As above, refer for more thorough exam (CT, echocardiogram) if questionable data

Pneumothorax
Pleural effusion
Pulmonary edema
Heart - valves (sorta), contractility, size, effusion

82
Q

what are we looking for with a FAST other than abd fluid

A

Pleural effusion

Certain cardiac abnormalities (tamponade

83
Q

what types of procedural guidance would ULS be useful for

A

Tapping joint capsules for fluid
US-guided venous catheter
US-guided nerve block

  • Much better than “landmark” method for tapping joints
  • Much better than “putting a central line in everyone we can’t get an IV into”
  • Great for pain relief
84
Q

what can cast an acoustic shadow

A

Bone, metal, glass, stones cast an acoustic shadow

E.g. ribs cast a shadow over all structures visualized through the ribcage

85
Q

Edge artifact

A

can also cast a shadow (occurs at edge of hollow organ like gallbladder)

86
Q

what is on the ddx for a triple scan

A 
CHF
COPD
Asthma 
PNA
PE
Effusion
ARDS
Metabolic 
pneumothorax
87
Q

what are the three views we are looking at in a triple scan

A

lung
echo
IVC

88
Q

Questions we want to answer when utilizing echocardipgraphy in a triple scan

A

LV function normal poor or hyper-dynamic? (look at EF)
(visual)

pericardial effusion? tamponade?

signs of heart strain?

89
Q

what will an IVC look like in an echo that will clue you to the dx

A

▪ IVC that expands/contracts normally during respiration = euvolemia

▪IVC that remains expanded and full = hypervolemia, PE, tamponade, tricuspid-reg, CHF

90
Q

what are you looking for in a lung with the triple scan

A

A-lines: look like horizontal lines parallel to the pleura, surrounded by a “cloud” of artifact

B line: interstitial edema
liquid or air is creating an artifact
(non-cardiogenic pulm edema)

91
Q

. Parasternal long axis in a triple scan helps visualize

A

Look at mitral valve, LV, aortic outflow, RV

Examine for pericardial effusion &/or tamponade physiology (i.e. RV collapse)

92
Q

how do you hold the Parasternal long axis in a triple scan helps visualize

A
  • probe over 2nd - 4th IC space, dot toward 9:00
93
Q

how do you hold the probe for IVC view (sub-xyphoid

A
  • probe dot cranial, probe facing midline but slightly toward R shoulder
94
Q

. Parasternal short axis

A

probe probe over 2nd - 4th IC space, just turn so dot faces pts R hip

95
Q

indications for ocular ULS

A 
retinal detachment
vitreous hemorrhage
vitreous detachment
foreign body 
lens dislocation
retrobulbar hematoma
pupillary light reflex 
optic nerve sheath diameter
96
Q

virtuous hemorrhage will appear as

A

echogenic / hyperechoic

new hemorrhage : small dots or lines

97
Q

viterous attachment

A

thick hyper-echoic linear density

usually thinner and smoother than retinal detachment and will not be anchored
will occur in front of the optic nerve

98
Q

retrobulbar hematoma is seen as what on ULS

A

displaced optic nerve

99
Q

which side to gallstones typically fall to?

A
  • Fall to the dependent side
100
Q

describe the appearance of gallbladder sludge on ULS

A

Sludge looks gravel-y but does NOT cast a shadow

101
Q

what is the usual measurement of the aorta

A

Aorta normally measures <3cm across

102
Q

describe the appearance of hydropnephrosis on ULS

A
  • Normal kidney is 9-12cm x 4-5cm x 3-4cm (bar of soap)
  • Normal renal sinus is echogenic; surrounding pyramids & cortex are hypoechoic.
  • Hydronephrosis:
  • Dilated and fluid-filled (hypoechoic) renal pelvis
  • Severe hydronephrosis may distort the dimentions of the kidney, too
103
Q

LV contractility variable, RV dilation variable, A-lines, IVC variable (often collapsing)

A

Not ADHF

Asthma/COPD, Acidosis, Small PE

104
Q

LV contractility normal, focal B-lines/consolidation, IVC non-plethoric (flat)

A

non-plethoric (flat)

Pneumonia

105
Q

LV contractility good, diffuse B-lines, IVC collapsing

A

Non-Cardiogenic Pulmonary Edema (ARDS)

106
Q

LV contractility good, diffuse B-lines, IVC plethoric/variable, BP high

A

Diastolic Failure, Flash Pulmonary Edema

107
Q

Elbowing mitral valve and LA enlargement, diffuse B-lines, IVC plethoric

A

Critical Mitral Stenosis Pulmonary Edema

108
Q

Cholecystitis dx on ULS

A

Thickening of gallbladder wall (>3mm)

  • Pericholecystic fluid (fluid just outside gallbladder)
  • Positive “Sonographic Murphy’s sign” (NOTE: only + if the
109
Q

common site for AAA

A

Commonly occur distal to the renal arteries, often near the bifurcation

radiology (13 decks)

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