Ultrasound Flashcards
What algorithm can be used for PE in pregnancy?
What percentage of pregnany women have raised D dimer
Years
It increaes D dimer cut off if there are symptoms of PE
60%
What is the discrimintory zone in pregnancy”
What are the importnat bloods in ?ectopic
serum BCHG level above which and IUP should be seen
1000-2000
if cant be seen then ectopic or missed abortion
B hcg and Resus status for ?anti d
what are the surface landmarks for IJ insertion
sterno and claviculr heads of SCM
Clavicle
lateral to carotid artery
aim toward apex of triangle toward ipsalateal nipple at 30-45 degress
LP depths
torsion salvage times
history and exam features of pyloric stenosis
Treatment
History:
Under 12 weeks
projectile vomiting post food
hungry post food
Exam
Visible peristalsis
olive mass RUQ
dehydration signs
hypoglycamia
Treatment
Pyloromyotomy
correct sugar and elctrolytes
What are the alternatives to cholecystectomy
- Extracorporeal Shock Wave Lithotripsy (ESWL)
- Endoscopic Procedures (ERCP) - only for bile duct stones
- Percutaneous Cholecystostomy - temporary fix
- Palliation
why does jaundice happen in cholecystitis
choledocholithiasis
oedema
Mirizzi
types of NOF
What is mcconnells sign on echo
why does it happen
in PE - akenesia of right free wall with movement at the apex
RV tethered to LV
Wells criteria for DVT
Alvarado score for pancretitis
maximum local doses
echo anatomy - parasternal long
echo anatomy - parasternal short
echo - apical 4 chamber view
echo - subcostal view
process of serratus anterior nerve block
What are the radiation risks of
CXR
CTPA
VQ
in pregnancy
CXR - 5 days background
CTPA - 14% risk to breast tissue, miminal to fetus
VQ - theoretical increased risk to fetus and less to breast tissue - stll low
US findings for DVT
non compressible veins
Loss of respiratory phasity
loss of colour doppler flow
what does this show in DVT scan
no respiratory variation - loss pf phasity
treatment for PE in pregnacy
SC clexane 1mg/kg BD
consult vascular, haem and O + G
Admit
MDT for perinatal anticoagualtion
Why would you do a renal US over CTKUB for ?renal colic
- clear suspision of colic and not something else eg AAA
- recent diagnosis with CT and represent
what does this renal US show
dilatation of minor anr major calices
What is this?
Complex renal cyst
How effective are NSAIDS in renal colic?
same efficacy as mrphine
benefit if PR for vomiting and GI side effects
What is the FU for renal colic?
can stone for analysis
see GP in 4 weeks if not passed
usual safety ney
how big is normal CBD
What can cause dilatation?
LEss than 6mm + 1 for each 10 years of life after 60
Dilatation:
Chronic opioid use
PRegnancy
cholecystectomy
Sphincter of oddi dysfunction
what can be seen here
uterus, uterine sac and bladder
when does an ectopic need surgical management
peritonitic
Live ectopic
HCG over 5000
Near C section scar
advantages and disadvantages of using femoral line
advantages and disadvantages of using axillary or IJ
what is this and what do you do?
guidewide in vessel
rotate to in plane to see if vessel punctured
in v out plane and the risks they mitigate
What is this?
rib and shred sign
plus smal effusion
what is this
loculated consolidation - empyema
best probe for this?
what is it?
Where do you measure
how do you know its not a cyst?
curvilnear
AAA with thrombus
measure outer wall to outer wall
not cyst as its against veternral body
can you know for sure if AAA has ruptured using US?
no as may be retroperitoneal
AAA risk of rupture
what is this
endoluminal graft
what does this show on efast
fluid in RUQ
What is this?
barcode sign - between two ribs
pneumothorax
what is this
shows lung pulse + barcode sign - hypoventilation eg tube in too far
lung pulse v lung point
lung pulse - from cardiac
lung point - transition between lung sliding and none for pneumothorax
What view is this?
What does this show in PE
parasternal short axis view
dilated RV and condense LV
Acute becuse non dilated wall
causes of leg swelling
DVT
phlegmasia serulea dolens
CCF
cellulitis
renal failure
liver failure
nephrotic syndrone
what is this
large clot with limited compressibility
best probe for lung US
curvilinear as can see deeper structures
surface anatomy for lung US
vein v artery on US
what is this?
APO as over 3 B lines
What are A and B lines on lung US
A lines - reverberation artefact from pleural line
B - vertical hyperechoic suggesting increased lung density
label the uterus in ?ectopic
what is this?
thick walled GB with hyperaemia
Alcalculous cholecysitis
sonographic features of cholecystitis
How do you know its chronic?
GB wall over 3mm
sonographic murphys
wall hyperaemia
gall stones
sludge
pericholecystic stranding
thick wall with no other signs
US features of pyloruc stenosis
pyloric thickness over 3mm diameter
Canal length over 15mm
surgical and gastro causes of abdo pain in infant
gastro
pyloric stenosis
duodenal web
intersuccseption
pyloric stenosis
bezoar
GORD
biliary atresia
risk factors for pyloric stenosis
male
first born
pre term
young mother
formula fed
US features of appendicitis
thick wall
over 1.5cm dilatation
free fluid
increased vascularity
cuteneous supply to foot
label foot
Tom, Dick And Very Nervous Harry
An extension of the above mnemonic to include the position of the neurovascular bundle in tarsal tunnel.
Anterior to posterior
T: tibialis posterior
D: flexor digitorum longus
A: artery (posterior tibial)
V: vein (posterior tibial)
N: nerve (tibial)
H: flexor hallucis longus
anatomical landmarkds for foot block
Superficial peroneal - Many branches at the level of the ankle between the anterior border of the tibia to the superior aspect of the lateral
malleolus
saphenous - Runs in superficial fascia in between the medial malleolus and the tibialis anterior tendon which is prominent when the patient flexes the foot
Sural - the injection site, located lateral to the Achilles tendon and posteromedial to the lateral malleolus, is marked
what is this
testicular torsion - no supply to one
Normal appearance
Potential artefact
False positive
Efast
Normal appearance
Potential artefact
False positive
Gallbladder
Normal appearance
Potential artefact
False positive
Lung
Cardiac
Normal appearance
Potential artefact
False positive
AAA
Renal
how can you tell a seratus anterior block is working
complications of serratus anterior block
label wrist
femoral nerve block
label
causes of painless visual loss and differentiating assessment finding
causes of ankle pain with differentiating assessment
knee US - what is this
hyperechoic area suggestive of effusion
OA
gout
Septic arthitis
Colour, WCC, crystals, bacteria
4 ways of reducing shoulder
Fares - patient supine or prone
Move the limb anteriorly and posteriorly in small oscillating movements while continuing to apply traction
Once the limb abducted to 90 degrees, externally rotate at the shoulder with ongoing traction and oscillating
movements, continue to abduct
Reduction usually achieved at 120
causes of shock and US findings
Tension px - no lung sliding - lung point seen
Types of shock:
EF
IVC
Cardiac output
Diagnostic criteria for I.E
What conditions need to be met for I.E?
definite:
2 major
1 major and 3 minor
5 minor
Possible:
1 major and 2 minor
3 minor
Clinical signs of I.E
janeway lesions
oslers nodes
spinter haemorrhages
new heart murmurs
Roth spots
fatigue and malaise
conjunctival haemorrhage
treatment of I.E
Vanc and gent
haemodynamic resus
correct electrolytes
d/w cardio and cardiothoracics
additional ix for I.EC
TOE
Ct head
blood cultures
