Ultrasound (Kane) Final Exam COPY Flashcards
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
S3
In which decade did ultrasound become popular in medicine?
A) 1930s
B) 1940s
C) 1950s
D) 1960s
C) 1950s
S3
Ultrasound in the military is primarily associated with __________.
A) radar
B) satellites
C) submarines
D) aircraft
C) submarines
S3
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
S3
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
S4
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
S5
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
S5
When ultrasound waves encounter a surface, they can be:
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. *
S5
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
S5
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
S6
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
S7
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
S7
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.
S7
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
S8
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
S9
Piezoelectric crystals change shape with __________ impulse and generate __________ waves.
A) electric; light
B) chemical; electrical
C) thermal; sound
D) electrical; sound
B) electrical; sound
This is an actual image of a piezoelectric crystal
S9
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
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
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
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
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
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
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
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
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
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. *
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.
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
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
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
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
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
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
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
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
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
Slide 23
What is an advantage of using the out-of-plane approach in ultrasound-guided procedures?
A) The entire needle is visibe when out of plane
B) The needle is positioned directly under the plane of ultrasound
C) The image is 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
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
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).
Slide 26
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
Slide 31
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
Slide 31
Matching
- Morison’s pouch - B. Right upper quadrant (RUQ)
- Peri-splenic view - A. Left upper quadrant (LUQ)
- Suprapubic view - C. Pelvic view
- Cardiac view - D. Pericardium
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 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 *
Slide 37
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
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
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, B, E
More size to antrum, walls are thinning out and the starry night might look like gasnbubbles
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
“ground or stained glass look?
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
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)
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
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%
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
Slide 40
