Ultrasound (Kane) Final Exam Flashcards by Kaitlyn McDow

Who is credited with the early idea of using sound waves for “seeing” in nature; ie Bats and Dolphins?

A) Leonardo da Vinci
B) Lazzaro Spallanzani
C) Alexander Graham Bell
D) Thomas Edison

B) Lazzaro Spallanzani
1974

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In which decade did ultrasound become popular in medicine?

A) 1930s
B) 1940s
C) 1950s
D) 1960s

C) 1950s

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Ultrasound in the military is primarily associated with __________.

A) telephones
B) satellites
C) submarines
D) aircraft

C) submarines

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One major advantage of ultrasound in medicine is that it involves no __________ radiation.

A) ionizing
B) electromagnetic
C) thermal
D) nuclear

A) ionizing

Not exposing people to unecessary radiation

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Advantages of using ultrasound include:
Select 3

A) Identifying anatomical structures
B) Increasing the complexity of procedures
C) Increasing accuracy of needle placement
D) Relationship of needle to tissues

A) Identifying anatomical structures
C) Increasing accuracy of needle placement
D) Relationship of needle to tissues
Visualizing “seeing” the spread of local anesthetic around the nerve sheath

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Advantages of using ultrasound in needle placement can: (2)

A) Decrease the time
B) Decrease complications
C) Increase complications
D) Decrease the accuracy

A) Decrease the time required for needle placement -when you have experience
B) Decrease complications of needle placement -if you can see the needle better it prevents multiple attempts and potential damage to structure from digging around

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Ultrasound waves travel at a frequency range of __________.

A) 2-20 Hz
B) 20-20,000 Hz
C) 2-20 MHz
D) 20-200 MHz

C) 2-20 MHz

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The frequency range of audible sound is __________.

A) 2-20 Hz
B) 20-20,000 Hz
C) 2-20 MHz
D) 20-200 MHz

B) 20-20,000 Hz

Those are some big ears

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When ultrasound waves encounter a surface, they can be: (3)

A) Transmitted
B) Reflected
C) Radiate
D) Scattered

A) Transmitted -When an ultrasound beam passes through body tissues
B) Reflected -the return of the sound wave energy back to the transducer
D) Scattered -When an ultrasound wave changes direction in a less orderly manner

*Kane- Waves leave the probe, get sent out and they either get absorbed by a structure, pass by the structure and miss it totally or get reflected back and that is what we see on the ultrasound screen. *

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Ultrasound waves that are __________ back to crystals create __________ recorded by the computer.

A) transmitted; image
B) reflected; impulses
C) absorbed; sound
D) reflected; data

B) reflected; impulses

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Match the type of sound wave with their medium and the definitions of what they look like on an ultrasound

A. Transmitted through - 3. Fluid - i. No signal = anechoic = dark
B. Between - 1. Soft tissue/tendon/muscles/fat - iii. Iso/hypo = shades of gray
C. Reflected - 2. Bones/stones - ii. Lots of signal = hyperechoic = bright

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What term describes tissues that reflect more sound waves and appear bright on an ultrasound?

A) Anechoic
B) Hypoechoic
C) Isoechoic
D) Hyperechoic

D) Hyperechoic

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What term describes tissues that reflect fewer sound waves and appear dark on an ultrasound?

A) Anechoic
B) Hypoechoic
C) Isoechoic
D) Hyperechoic

B) Hypoechoic

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True or False

Echogenesis refers to the property of tissues to reflect sound waves during an ultrasound examination.

True - It determines how different tissues appear on an ultrasound image based on their ability to reflect or transmit sound waves. The concept of echogenesis helps in differentiating various types of tissues and structures within the body.

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Which one is a Solid mass or a Cystic mass?

A. Solid Mass
B. Cystic Mass

Telling between these can tell doctors if its sebacious, malignant… can help determine what the surgeons will do

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Where are piezoelectric crystals located in an ultrasound transducer?

A) In the power supply
B) Inside the head of the transducer
C) In the computer system
D) In the ultrasound gel

B) Inside the head of the transducer

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Piezoelectric crystals change shape with __________ impulse and generate __________ waves.

A) electric; light
B) chemical; electrical
C) thermal; sound
D) electrical; sound

D) electrical; sound

This is an actual image of a piezoelectric crystal

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The __________ transducer is best for __________ due to its high frequency (7-15 MHz) and better resolution.

A) linear array; superficial depth imaging
B) curved array; deep tissue imaging
C) phased array; large area imaging
D) linear array; deep tissue imaging

A) linear array; superficial depth imaging

Mostly flat - the circled part on the transducer is the indicator

S10

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The __________ transducer, with low frequency (2-5 MHz)
, is ideal for __________.

A) linear array; superficial structures
B) phased array; echocardiography
C) curved array; deep tissue imaging
D) sector array; vascular imaging

C) curved array; deep tissue imaging

S10

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The __________ transducer uses the __________ frequency (1-3 MHz) and is best for smaller areas.

A) linear; highest
B) curved; lowest
C) phased array; lowest
D) phased array; highest

C) phased array; lowest

S10

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Match the Transducer and it’s primary use

A. Linear array - 3. IJ, A-line, PIV
B. Curved array - 1. Kidney, liver, spleen, bladder, assess NPO status
C. Phased array - 2. Echocardiography, TEE pictures, subxiphoid, through ribs

S10

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Label the picture.
Axial
Saggital
Coronal

A. Coronal - divides the body into anterior and posterior parts
B. Saggital -plane that divides the body into right and left halves
C. Axial - * plane that divides the body into upper and lower parts*

Slide 11

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True or False

The dot or indicator on the ultrasound screen is on the same side or orientation of the patient. If the dot is on the right side, that is the patient’s right side.

True!

Will always go by the patient’s orientation

Slide 11

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On an ultrasound image, everything at the top of the image is __________ in the picture.

A) shallower
B) deeper
C) to the left
D) to the right

A) shallower

Kane - The ultrasound on your skin is going to encounter what it sees on the top of the image first.
Everything below that is deeper in the picture

Slide 11

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In the __________ approach, the ultrasound is used to identify and mark the target vessel, but cannulation is performed __________. A) dynamic; in real-time B) static; blindly C) dynamic; blindly D) static; in real-time

B) static; blindly *The static approach is for assessing patency (is the vessel open) and marking an appropriate insertion site The ultrasound is NOT used in real time during cannulation* ## Footnote Slide 13

The __________ approach involves viewing the needle puncturing the vessel wall in real-time with the ultrasound. A) static B) dynamic C) blind D) pre-procedure

B) dynamic *Using the ultrasound through the whole process* ## Footnote Slide 13

What are some ways to improve your ergonomics? Select 3 a. slide boards/sheets b. lift the bed up to your level c. bend over the bed to do an IV d. doing compressions on your tip toes e. ask for help for positioning

a. slide boards b. lift the bed up e. ask for help for positioning *Kane - think about this with everything you are doing. You are the one that has to be on your feet all day and you want to protect yourself. * ## Footnote Slide 14

# True or false Placing conductive gel inside the probe cover is not recommended as it can damage the piezoelectric crystals and not help with conductivity.

FALSE *You can placing conductive gel inside and outside the probe cover and it works just fine with conductivity.* ## Footnote Slide 15

To avoid sticking yourself with a needle while using a transducer probe, hold it like a __________ to keep your fingers away from the skin. A) fork B) pencil C) hammer D) brush

B) pencil ## Footnote Slide 16

What does the 'gain' control on an ultrasound machine adjust? A) The frequency of the ultrasound waves B) The depth of the ultrasound image C) The brightness of the image D) The focus of the image

C) The brightness of the image ## Footnote Slide 17

What is the usual form of the gain control on an ultrasound machine? A) Button B) Touchscreen C) Knob D) Slider

C) Knob ## Footnote Slide 17

What is the ideal appearance of fluid and soft tissue when adjusting the gain? A) Fluid should be white, and soft tissue should be dark grey. B) Fluid should be black, and soft tissue should be mid-grey. C) Fluid should be dark grey, and soft tissue should be white. D) Fluid should be mid-grey, and soft tissue should be black.

B) Fluid should be black, and soft tissue should be mid-grey. | Need to see differentiation between hyperchoic and hypoechoic ## Footnote Slide 18

How do you typically adjust the depth on an ultrasound machine? A) Using a knob B) Up and down arrows/buttons C) By touching the screen D) Using a slider

B) With up and down arrows/buttons ## Footnote Slide 20

In what measurment units does depth measures and where on an ultrasound screen does it typically show? A) In millimeters at the top of the screen B) In centimeters on the side of the screen C) In centimeters at the bottom of the screen D) In meters on the left of the screen

B) In centimeters on the side of the screen *Document the measurement for later use* ## Footnote Slide 20

What is the recommended starting point when adjusting the depth on an ultrasound machine? A) Medium depth B) Low depth C) Zero depth D) High depth

D) High depth *Start at high depth then work to bring object of interest into middle of screen. This helps get everything in the picture* ## Footnote Slide 20

What is another term sometimes used for in-plane vs. out-of-plane that is considered inaccurate? A) Long axis vs. short axis B) Depth vs. gain C) Frequency vs. amplitude D) Anterior vs. posterior

A) Long axis vs. short axis *The axis refers to the vessel* | In-plane is parallel to transducer and out-of-plane is crossectional ## Footnote Slide 22

In an in-plane approach, the needle is parallel to the ultrasound probe and should always be in the ____________ for procedures. A) long-axis B) short-axis C) sagittal-axis D) axial-axis

A) long-axis ## Footnote Slide 22

An advantage of the in-plane approach is that you can see the whole __________ and __________. A) transducer; tip B) needle; surrounding tissue C) needle; tip D) vessel; fluid

C) needle; tip *Kane - you can see it mushing down on the tissue. With regionals you can see the needle piercing the vessel and the fluid dissection expanding the tissue* ## Footnote Slide 23

A disadvantage of the in-plane approach is that it is easy to be __________. A) out of depth B) off plane C) out of focus D) off angle

B) off plane *Kane - Could be the same image if you were in front or behind the vessel and not in the vessel* ## Footnote Slide 23

What is an advantage of using the out-of-plane approach in ultrasound-guided procedures? A) The entire needle is visible when out of plane B) The needle is positioned directly under the plane of ultrasound C) The image is clear of where the tip of the needle is D) The needle is positioned in a parallel direction to the vessel

B) The needle is positioned directly under the plane of ultrasound ## Footnote Slide 25

What is a disadvantage of the out-of-plane approach? A) The entire needle is visible B) It is always clear or where the needle is C) It is unclear where the tip of the needle is D) The needle is always on plane

C) It is unclear where the tip of the needle is *Kane - not sure how deep it is, but I know it is in the vessel, it might be barely in the vessel or about to go through the vessel* ## Footnote Slide 25

# True or False It is best to visualize the needle in the vessel with just the in-plane/long-axis view.

False *Kane - You need the summative views of both in-plane and out-of-plane to really know where you are* ## Footnote Slide 25

The "vanishing sign" in ultrasound occurs when the tip of the needle or wire __________ as it enters the __________ of the vessel. A) brightens; wall B) disappears; lumen C) changes color; side D) moves; edge

B) disappears; lumen *Kane - Looking at the wire or tip of the needle in the center of a vessel. If the needle tip is correctly positioned, the needle tip should appear then disappear exactly in the center of the vessel. Its a way to prove the wire/needle is in the vessel and take a picture or you won't get paid (maybe $25).* ## Footnote Slide 26

Ultrasound-guided IV access is indicated for patients with a __________ of difficult cannulation or multiple failed attempts at IV. A) fear B) history C) future D) success

B) history ## Footnote Slide 28

Ultrasound-guided IV access should not be used as a substitute for __________ access in __________ situations. A) Intravenous; routine B) Intraosseous; life-threatening C) Intraosseous; stable D) Intravenous; emergency

B) Intraosseous; life-threatening *Kane - don't pull out the probe for emergencies, wastes time* ## Footnote Slide 28

A __________ probe with high frequency is typically used for ultrasound-guided IV access. A) linear B) curved C) phased array D) sector

A) linear *Kane- For IV acces its good to use superficial probes* ## Footnote Slide 28

For obese patients, a __________ probe might be used instead of a linear probe due to its greater __________ penetration. A) sector; superficial B) phased array; superficial C) curved; depth D) linear; depth

C) curved; depth ## Footnote Slide 28

What does the acronym FAST stand for in the context of ultrasound examinations? A) Focused Abdominal Screening Technique B) Focused Assessment with Sonography for Trauma C) Fast and Accurate Sonography Test D) Full Abdominal Sonography Technique

B) Focused Assessment with Sonography for Trauma *Done in the ER, with helicopters* ## Footnote Slide 31

What is one of the primary indications for performing a FAST exam? Select 3 A) Rule out free fluid in the pericardium B) Rule out free fluid in the abdomen C) Monitoring chronic conditions D) Traumas

A and B) Rule out free fluid in the abdomen and pericardium D) Traumas *Find things that have ruptured, leaking or a torn somewhere. Find things that are going to KILL YOU* ## Footnote Slide 31

Which probe is typically used for a FAST exam? A) Linear B) Phased array C) Curvilinear D) Sector

C) Curvilinear *Has more depth* ## Footnote Slide 31

# True or False There are no contraindications to a FAST exam

True *Kane-some data that suggests you can have cavitation injuries… too much ultrasound in one place, it cavitates the organs…probably unlikely* ## Footnote Slide 31

Matching

1. Morison’s pouch - C. Right upper quadrant (RUQ) 2. Peri-splenic view - A. Left upper quadrant (LUQ) 3. Suprapubic view - D. Pelvic view 4. Cardiac view - B. Pericardium ## Footnote Slide 32

What area are you scanning in this picture for the FAST exam? A. Right upper quadrant (RUQ) B. Left upper quadrant (LUQ) C. Pelvic view D. Cardiac View

A. Right upper quadrant (RUQ) - Morison’s pouch *Free fluid around the kidneys*

What area are you scanning in this picture for the FAST exam? A. Right upper quadrant (RUQ) B. Left upper quadrant (LUQ) C. Pelvic view D. Cardiac View

D. Cardiac View *Pericardial effusion - looking around the left ventricle first*

What area are you scanning in this picture for the FAST exam? A. Right upper quadrant (RUQ) B. Left upper quadrant (LUQ) C. Pelvic view D. Cardiac View

B. Left upper quadrant (LUQ) *Peri-splenic view*

What quadrant are you scanning in this picture for the FAST exam? A. Right upper quadrant (RUQ) B. Left upper quadrant (LUQ) C. Pelvic view D. Pericardium

C. Pelvic view *Bladder rupture*

What is the purpose of a pre-block scan in ultrasound-guided peripheral nerve blocks? A) To administer the block immediately B) To plan the route and prepare C) To measure the depth of the nerve D) To assess the patient's overall health

B) To plan the route and prepare *Kane - you want to scan for more time than it takes to do the block, map out your location and figure out the anatomy. Is it going to be hard, take a lot of time, taking medication after...* ## Footnote Slide 37

What does the term "heeling" refer to in the context of ultrasound-guided nerve blocks? A) Aligning the probe with the skin B) Rotating the probe 180 degrees C) Lining up the probe with the nerve bundle D) Increasing the ultrasound frequency E) Helps maintain perpendicular alignment

C) Lining up the probe with the nerve bundle *Kane - line up the probe with nerve bundle, not necessarily to the skin. Alter or heel the ultrasound probe to the nerve bundle * ## Footnote Slide 37

What should be verified before administering a nerve block to ensure accuracy? A) The nerve moves with the needle B) The nerve does not move with the needle C) The nerve is above the skin surface D) The nerve is surrounded by fluid

B) The nerve does not move with the needle ## Footnote Slide 37

What sensation indicates that the needle has passed through a fascial plane during a nerve block? A) Pain B) Resistance C) A pop D) Numbness

C) Fascial "pop" ## Footnote Slide 37

One of the indications for performing a gastric ultrasound is __________ fasting history. A) clear B) unclear C) recent D) strict

B) unclear *Can help with people who have diabetic gastroparesis or renal failure, they may have not had anything to eat, but they might still have something in their stomach. It can be diagnositc for RSI induction* ## Footnote Slide 38

Which of the following is an indication for performing a gastric ultrasound? A) Routine health check-up B) Adherence to fasting instructions C) Lack of adherence to fasting instructions D) Assessing bone density

C) Lack of adherence to fasting instructions ## Footnote Slide 38

On gastric ultrasound, a patient who is NPO typically has a stomach that appears __________ and __________. A) large; full B) small; empty C) distended; full of clear liquid D) hyper-echoic; full of solid food

B) small **antrum**; empty *Looks like a bullseye, the wall is thicker because its collapsed on itself, safe to go to the OR* ## Footnote Slide 39

What characteristics might be seen on a gastric ultrasound of a patient who has ingested clear liquids? select 3 A) Rounder, more distended stomach B) "Starry night" appearance C) Hyper-echoic areas D) Small, empty antrum E) Peristalsis starts

A) Rounder, more distended stomach B) "Starry night" appearance E) Peristalsis starts *More size to antrum, walls are thinning out and the starry night might look like gasnbubbles* ## Footnote Slide 39

Which features are associated with the presence of milk, thick fluids in the stomach on a gastric ultrasound? Select 2 A) Thinner walls B) Increased echogenicity C) "Starry night" appearance D) Small, empty antrum E) Hyper-echoic areas

A) Thinner walls B) Increased echogenicity ## Footnote Slide 39

What are the characteristics of a stomach containing solid food as seen on gastric ultrasound? A) Small, empty antrum B) "Starry night" appearance C) Thinner walls D) Hyper-echoic areas E) Increased echogenicity with thinner walls

D) Hyper-echoic areas *"ground or stained glass look?* ## Footnote Slide 39

What does an empty antrum (Grade 0) in both supine and right lateral decubitus (RLD) positions indicate in terms of aspiration risk? A) High aspiration risk B) Moderate aspiration risk C) Low aspiration risk D) No aspiration risk

C) Low aspiration risk ## Footnote Slide 40

What does the presence of fluid in both supine and RLD positions indicate in terms of antrum grading? A) Grade 0 B) Grade 1 C) Grade 2 D) Grade 3

C) Grade 2 *>75% likely the antrum will be >100ml of gastric volume (GV)* ## Footnote Slide 40

What gastric fluid volume (GV) is associated with a low risk of aspiration after a volume assessment? A) Greater than 1.5 ml/kg B) Less than 1.5 ml/kg C) Equal to 1.5 ml/kg D) No fluid present

B) Less than 1.5 ml/kg ## Footnote Slide 40

What gastric fluid volume (GV) is associated with a high risk of aspiration? A) Less than 1.0 ml/kg B) Less than 1.5 ml/kg C) Greater than 1.0 ml/kg D) Greater than 1.5 ml/kg

D) Greater than 1.5 ml/kg ## Footnote Slide 40

What does the presence of fluid in the antrum in the right lateral decubitus (RLD) position only indicate in terms of antrum grading? A) Grade 0 B) Grade 1 C) Grade 2 D) Grade 3

B) Grade 1 ## Footnote Slide 40

What is the estimated likelihood that a Grade 1 antrum contains less than 100 ml of gastric fluid volume (GV)? A) 25% B) 50% C) 75% D) 100%

C) 75% ## Footnote Slide 40

What are the correct steps for assessing gastric fluid volume in a patient using ultrasound? A) Measure the antral CSA, apply the model, and estimate total gastric fluid volume B) Measure the antral circumference, apply the model, and estimate total gastric fluid volume C) Measure the antral CSA, apply the model, and measure gastric pH D) Measure the gastric volume directly, apply the model, and estimate total gastric fluid volume

A) Measure the antral CSA, apply the model (table), and estimate total gastric fluid volume ## Footnote Slide 40