Ultrasound

Question 1

Indications for fascia iliac block

Answer 1

Femoral shaft#
Thigh anterior wound/procedure
Hip dislocation
Fracture neck of femur

Question 2

3 different approach to needle visualisation/ guidance using USS

Answer 2

In plane
Out of plane
Oblique
Ultrasound assisted (site marked prior inserting needle blind)

Question 3

Absolute contraindications to perform regional anaesthesia

Answer 3

Allergy to local anaesthetic
Infection at site
Agitated/ Confused
Acute or pre-existing Neuro deficit to that region
Recent local anaesthetic - above safe dosage

Question 4

Relative contraindication to perform regional anaesthesia

Answer 4

Risk of compartment syndrome
Multi trauma
Coagulopathy

Question 5

What drug and maximum dose use for femoral block?

Answer 5

Ropivacaine Max 3mg/kg less cardiac toxic than bupivocaine

Question 6

Benefits of performing an ultrasound guided femoral nerve block

Answer 6

• Improved safety: direct visualisation, decreased risk of arterial puncture, decrease risk of nerve damage
• More successful
• Decreased opioid requirements, including less side effects/ adverse events

Question 7

4 early clinical features of local anaesthetic toxicity

Answer 7

Tinnitus
Visual changes- loss of focus
Dizziness/ light headlines
Anxiety, agitation, confusion, disorientation, drowsiness
Perioral/ tongue numbness
Metallic taste

Question 8

Risk factors developing DVT

Answer 8

• Recent travel
• Acute medical illness with immobilisation for at least 3 days
• Oestrogen therapy
• Pregnancy/ post partum
• Active cancer
• Antiphospholipid syndrome
• Long haul travel
• Leg injury associated with reduced mobility for at least 3 days
• ongoing non malignant condition associated with 2x fold or higher increased recurrent VTE after stopping anticoagulant therapy( IBD/ chronic inflammatory states)

Question 9

Acute complications of DVT

Answer 9

Phlegmasia cerulea dolens
Phlegmasia Alba dolens
Pulmonary embolus

Question 10

Advantages abdominal FAST scan in HAEMODYNAMICALLY stable blunt trauma patient

Answer 10

• Identification of free fluid ( inc mortality/ morbidity)
• Repeatable
• No radiation

Question 11

Disadvantage abdo FAST in HAEMO Stable blunt trauma patient

Answer 11

• Cannot exclude solid organ injury( low send in stable pt)
• Cannot exclude retroperitoneal bleed / pelvic bleed/ bowel injury
• Skill operator required : potential for misinterpretation if not aware of artefacts

Question 12

List 3 causes that an lead to absence of lung sliding

Answer 12

Adhesions
Pleurodesis
Pain/ splinting
Contusions

Question 13

US findings help diagnose pneumothorax

Answer 13

1. Lung point
2. Absence of lung sliding
3. Lung pulse
4. Absent power slide
5. Absent b-lines

Question 14

US findings diagnose haemothorax

Answer 14

1. Location: Dependent/ lower
2. Description: Anechoic/ hypoechoic/+/- echogenic debris
3. Other: spine sign/ absent lung slide/ collapsed lung- whale tail

Question 15

US findings pericardial tamponade

Answer 15

1. Location: pericardial space/ global around heart
2. Description: effusion/ anechoic/hypoechoic:+/- echogenic debris
3. Other: fixed dilated IVC, chamber wall effects - RV diastolic collapse/ RA systolic collapse, swinging heart

Question 16

Features of intrauterine gestational sac

Answer 16

1. Smooth, ovoid appearance
2. Eccentric location
3. Presence of a yolk sac/ foetal pole/ foetal HR
4. Double deciding layer

Question 17

Features of pseudogestational sac

Answer 17

1. Irregular shape
2. Pointed edges
3. Central location
4. Absent yolk sac
5. Thick surrounding deco dual layer
6. Contain debris