Ultrasonagraphy Flashcards
1
Q
- What is ultrasound?
A
Sound waves with frequencies higher than the human audible range
2
Q
- What is the upper limit of Human sound wave freq considered to be?
A
Approx. 20kHz
3
Q
- What are the sound wave frequencies of :
-Elephants
-Whistle
-Dolphins
?
A
Elephants = 15-30Hz Whistle = 18-22kHz Dolphins = 160kHz
4
Q
- What are the two main functions of the ultrasound probe?
A
- Emit a sound wave
2. Receive echoes from the original sound wave
5
Q
- What are the two results that could happen whenever an ultrasound wave passes through a tissue boundary?
A
-> It can be reflected
OR
-> Will pass through and continue propagating (moving )
6
Q
- If an ultrasound wave is passing a tissue, which will reflect MORE of the sound
-Adjacent tissues with varying densities
OR
-Adjacent tissues with similar densities
A
Adjacent tissues with varying densities will reflect more of the sound wave, adjacent tissues with similar densities will reflect less..
7
Q
- What do the pixels of the ultrasound image represent?
A
The intensity of the sound and the depth that it has been reflected from
8
Q
- Knowing that an ultrasound image depends on depth , what creates a poor image and what creates a good image in ultrasound?
A
Poor image = Air in lungs and fluid (urine,bile,cysts)
Good image = Bone
9
Q
- Out of bone and fluid, which ones are low amplitude and high amplitude
A
Bone = High Amplitude = Strong Reflection = Good Picture
Fluid = Low Amplitude = Poor Reflections = Poor Image
10
Q
- What are some clinical Applications of ultrasound?
A
-Abdominal
-Gynaecology
-Obstetrics
-Urinary
-Breast
-Lungs
and many more…
11
Q
- What are 6 advantages of using Ultrasound?
A
- No radiation
- No documented side effects in human
- Usually non-invasive
- Well tolerated
- “Real time” imaging
- Results immediate
- Widely Accessible
12
Q
- What are 4 disadvantages of using ultrasound?
A
- Quality of picture dependant on patient habitus ( physique)
- Training is more resource intensive for departments compared to other modalities
- Effectiveness and accuracy are highly operator dependant
- May be side effects we don’t know off yet
13
Q
- In what two parts of the body can ultrasound be invasive?
A
- Transvaginal
- Endoanal
14
Q
- When is ultrasound painful?
A
In gallbladder stone
15
Q
- Ultrasound is dependant on patient habitus. Does resolution increase or decrease with increased BMI?
A
Decreases
16
Q
- Why do we have a selection of different types of transducers?
A
Increased choice of technical variables = Optimisation of image
17
Q
- What can you have choice over in different transducers?
A
- Sector Width
- Scan depth (resolution)
- Patient Habitus
- Field of view
18
Q
- What does Obstetric mean?
A
Relating to Childbirth
19
Q
- What is major advantage of using obstetric ultrasound over X-ray/CT?
A
No Ionising Radiation
20
Q
- How far into pregnancy are all Women in the UK offered an ultrasound?
A
12/20 weeks
21
Q
- Approx. how many mm’s is the foetus at 12 weeks?
A
45-48mm
22
Q
- What does the 12 week scan detect?
A
- Foetal Viability (ability to survive outside uterus)
- Number of foetus’s
- Gross Anatomy
- Major Abnormalities
- Morphology of ovaries
- Accurate gestational age
23
Q
- What is Anencephaly?
A
skull isn’t fully formed so brain soft tissue is exposed to the acidic amniotic fluid
24
Q
- What is Omphalocele/Exomphalos ??
A
herniation of abdominal organs due to the skin not fusing properly
25
25. What is Blighted Ovum/Missed Miscarriage?
empty sack with no baby that causes the same symptoms as pregnancy
26
26. What is Molar Pregnancy?
non-viable fertilised egg that won’t come to full term implants in the uterus
27
27. What is Cystic Hygroma?
fluid-filled sac that results from a blockage in the lymphatic system
28
28. In the 12 week scan we can test for chromosomal abnormalities, which syndrome would we test for?
Down Syndrome
29
29. How is down syndrome caused?
Random mutations in the egg before fertilisation
30
30. Is down syndrome common for babies with older or younger mums
Older mums
31
31. Throughout the world what is the frequency of Down Syndrome?
3 per 2000 births
32
32. How do we test for down syndrome in the 12 week ultrasound?
Foetal nuchal translucency (NT) screening uses ultrasound to measure the size of the nuchal pad (skin containing fluid) at the nape of the foetal neck This is often larger in babies with Down syndrome.It should be performed between 11 weeks and 13 weeks + 6 days.
33
33. What could be the future in terms of down syndrome testing?
Non-invasive prenatal testing where foetal cells are tested for Down's
34
34. What abnormalities are identified in the 20 week scan?
- ones that might cause the baby life-limiting conditions
- ones that might benefit from antenatal treatment
- ones that require early intervention following delivery
35
35. What are some standard aims of the 20 week pregnancy scan?
- Placenta Localisation
- Foetal Biometry (anatomic measurements)
- Fibroid Monitoring(abnormal growths that develop in or on a woman's uterus)
- Liquor Assessment (amniotic fluid assessment)
36
36. One abnormality that can be picked up in the 20 week scan is Spina Bifida- what is this?
The spine pulls down cerebellum and mis-shapes it. It also shows frontal bone indentations that look like a lemon(Lemon Sign).
37
37. An abnormality that can be identified in the 20 week scan is Achondroplasia/Dwarfism , what are some symptoms of this condition?
/Frontal Bossing (protrusion), Bowing of long bones (curving), Thickened soft tissue surrounding the long bones.
38
38. An abnormality that can be identified in the 20 wk scan is Low Lying Placenta , how would you identify this?
o Measure the distance from the lowest edge of the placenta to the internal OS of the cervix.
o If the placenta is within 2.5cm of the cervix, then future scans are required.
39
39. What happens if a low lying placenta does not rise higher closer to the due date?
C-Section may be required
40
40. An abnormality that can be picked up in the 20wk scan is Talipes , what is this?
Club Foot
| Foot is like twisted to the side :(
41
41. Fill in the blank :
If one parent had the condition Talipes as a baby ,their baby would have a 1 in ** chance of also having talipes.
1 in 50
42
42. Can it be unilateral (one foot) and two feet ( bilateral)?
Yes
43
43. How can Talipes be managed /Corrected?
Ponseti Method - percutaneous surgical release of the tendon, which allows the ankle to be positioned at a right angle with the leg.
44
44. What are some risk factors for Talipes?
- Male
- Genetics
- Other Diseases
- Lifestyle - eg smoking or little amniotic fluid
45
45. For Obstetric Ultrasound, what weeks would be growth scans?
20 wks
28 wks
36 wks
46
46. What does the Umbilical Artery Doppler Assessment test for?
o Can be used to highlight the effects of pre-eclampsia and intrauterine growth restriction (IUGR)
o Is used more frequently now as is being suggested we can improve perinatal mortality and morbidity
47
47. What does :
- Anhydramnias
- Oligohydramnios
- Polyhydramnios
mean?
- Anhydramnias = Without fluid
- Oligohydramnios = Little Fluid
- Polyhydramnios = Too much fluid
48
48. Why would a pregnant women be referred from her GP for an early pregnancy ultrasound?
in cases of lower abdominal/pelvic pain, bleeding, confirmed history of recurrent miscarriage and sometimes due to previous obstetric history issues.
49
49. Fill in the blank:
The foetal pole is detected as an area of thickening along the periphery of a yolk sac (min **-**mm length for detection at **-*** weeks).
The foetal pole is detected as an area of thickening along the periphery of a yolk sac (min 1-2mm length for detection at 5-6 weeks).
50
50. At how many weeks and length should cardiac activity be detected?
6 weeks
| 4-5mm
51
51. Whats the difference between transabdominal vs transvaginal ultrasound?
Transabdominal = view of abdomen and pelvis, non-invasive
Transvaginal - probe into vagina, better view of uterus
52
52. What is Ectopic Pregnancy?
When egg implants outside of the uterine cavity
| Associated with severe pain and bleeding
53
53. What can ectopic pregnancy be caused by?
tubal damage (surgery, Pelvic Inflammatory Disease), endometriosis etc).
54
54. What is treatment of ectopic pregnancy dependant on, what two types of treatment available ?
Treatment is dependent on the individual and can be medical or surgical.
55
55. What is multiple pregnancy caused by?
Multiple pregnancy usually caused by delays in the fertilised egg reaching the womb before implanting.
56
56. What is transfusion syndrome?
dominant twin takes more amniotic fluid so the other one takes from blood vessels.
57
57. Define each of the following:
Dichorionic=
Monochorionic=
Lambda Sign=
Dichorionic= each twin has its own chorionic and amniotic sacs
Monochorionic=(identical) twins that share the same placenta.
Lambda Sign = triangular appearance->strongly suggests a dichorionic twin pregnancy->non-indentical
58
58. Does 3D/4D scans have diagnostic value?
Partially
| Can identify cleft lip
59
59. What is the difference between Chorionic Villus Sampling tests and amniocentesis tests ?
Chorionic Villus Sampling tests the placenta whilst amniocentesis tests the amniotic fluid – both for chromosomes.
60
60. Do Fibroids grow a lot?
Some fibroids (fibrous muscular tissue) grow until their blood supply can no longer support further growth, while others get very large and require surgical interventions (myomectomy/uterine embolization – blood supply cut off / hysterectomy – remove uterus).
61
61. What are Uterine Polyps?
Uterine Polyps are growths from the inner wall of the womb which extend throughout the cavity and into the cervix and vagina.
62
62. Are Uterine Polyps benign?
Usually benign but on rare occasion some can turn cancerous which is when surgery is considered.
63
63. What can be seen in a abdominal ultrasound?
- Liver
- Kidneys
- Aorta
- Pancreas
- Spleen
- Gallbladder/Biliary Tree
64
64. At what AP diameter is a section of the abdominal aorta considered aneurysmal ?
3cm in AP diameter
65
65. At what AP diameter is surgery considered for Abdominal Aortic Aneurysms?
5.5cm in AP diameter
66
66. What does EVAR stand for and what does it mean?
Endo Vascular Aortic Repair: placement of a stent-graft (fabric covered tube) into the aneurysm through a small hole in the blood vessels
67
67. What are three causes of Liver Cirrhosis/Ascites (scarring and build of fluid in liver)
- Genetics
- >Medication
- >Idiopathic (spontaneous)
68
68. Liver Cirrhosis can heal, but what is the consequence if it remains?
the blood supply can change directions towards the spleen
69
69. What causes gallstones?
Usually caused by an imbalance in the chemical makeup of bile in the gallbladder (high cholesterol/bilirubin)
70
70. What is Sonographic Murphys sign?
maximal abdominal tenderness from pressure of the ultrasound probe over the visualised gallbladder.
71
71. How do we use gravity in detection and how is the common Bile duct involved?
idk
| figure it out
72
72. What prep is needed for an gallstone ultrasound?
fat-free meals evening before the test and no eating 8-12 hours before
73
73. What would you be looking for in testicular ultrasound?
Testicular Lumps/Swelling around scrotum: Varicocele (dilated veins) and Hydrocele (fluid around testicles).
74
74. Following questions are about breast ultrasound:
- At what age does breast tissue become less dense
- What improves differentiates between solid and fluid filled area's? at what %
- What else does breast ultrasound allow for?
o Breast tissue under the age of 35 is denser, this causes difficulty with diagnosing the nature of breast lumps on mammograms- differentiation between solid and fluid filled areas is relatively poor.
o Ultrasound can make the differentiation at an improved rate (about 30% increased).
o Ultrasound also enables core biopsies to be taken of breast lumps to allow for histological investigation to allow for classification of the lump.
75
75. What is the purpose of Vascular DVT (Doppler- shows blood flow)
o Ultrasound excludes or confirm the presence of a deep vein thrombosis in cases of pain and swelling in the lower limbs.
o It is also used as a screening tool for DVT in post-operative patients and patients with known pulmonary embolus (to find the source of the clot).
76
76. How can we use Doppler to confirm DVT?
Using colour flow doppler we can demonstrate that the femoral vein is completely occluded by the lack of colour in this region.
77
77. What are the applications of Musculoskeletal Ultrasound?
Muscle/tendon tears, Inflammation, Nerve Entrapments, Soft tissue lumps, Cysts, Hernias, Paediatric CHD, Infant Torticollis (neck twisting), Early RA, Joint effusions, Injection Guidance (contrast and Therapeutic) and many more.
78
78. What does POCUS- FAST stand for?
POCUS (Point Of Care Ultrasound) – Fast (Focused Assessment with Sonography of Trauma):
79
79. What can we use FAST ultrasound for?
FAST is an ultrasound scan protocol undertaken at the time of presentation of a trauma patient.
80
80. Adv of FAST?
Ultrasound can detect as little as 20ml of free fluid, compared to the 200ml required with plain X-Ray.
