Exit this survey EM Ultrasound Exam 1. Question Title * 1. What is your name? Question Title * 2. A 35 year old female presents to the ED with a complaint of swelling to her left leg. She states that it began as a small bump and has since become more swollen, more red, and more painful. Her VS are BP 110/70, HR 100, T 100.5. An image of her leg is shown below. Which of the following is true regarding ultrasound in the diagnosis of cellulitis and abscess? a. There is no need to perform an ultrasound as physical exam is most reliable in distinguishing cellulitis and abscess. b. It is impossible to distinguish cellulitis from abscess by ultrasound. c. Ultrasound is useful in determining the size of an abscess, as well as in identifying surrounding structures that may complicate incision and drainage. d. Cellulitis is defined on ultrasound by a dark (hypoechoic) fluid collection surrounded by thickened subcutaneous tissue Question Title Image for question #2 Question Title * 3. A 60 year old man presents with a complaint of right flank pain radiating to his anterior abdomen. He has never had this type of pain before. His PMH is significant for HTN. His VS are BP 160/70, HR 80, T 99.0. His ultrasound is shown below. What is his diagnosis? a. Abdominal aortic aneurysm (AAA) b. Nephrolithiasis c. Aortic dissection d. Unable to determine on this image Question Title Image for question #3 Question Title * 4. Which of the following is correct regarding the use of ultrasound to diagnose AAA? a. The normal size of the aorta is less than 3cm b. When the aorta can be visualized from the xiphoid process to its bifurcation at the umbilicus, ultrasound is 100% sensitive for the detection of a AAA. c. Detecting acute rupture of a AAA can be difficult as it frequently ruptures into the retroperitoneum, a space that is difficult to visualize by ultrasound. d. All of the above are correct. Question Title * 5. A 20 year old man presents to the ED following a car accident. He is obtunded and was intubated prior to arrival secondary to decreased mental status. His initial VS are BP 110/70, HR 110, RR 16, T 98.0. His FAST exam is shown below. What is the next appropriate step to address these findings? a. CT scan b. Diagnostic peritoneal lavage c. Take the patient to the operating room for an exploratory laparatomy d. Repeat the ultrasound in 15 minutes Question Title Image for question #5 Question Title * 6. What is the name for the type of artifact shown below? a. Acoustic shadowing b. Comet tail c. Acoustic window d. Reverberation Question Title Image for question #6 Question Title * 7. Which of the following tissues or organs are seen as hyperechoic on ultrasound? a. Bones b. Bladder c. Muscle d. Vitreous Humor of the eye Question Title * 8. A 30-year-old man is brought into the ED with a gunshot wound to his right flank. His VS are BP 70/50, HR 110, and RR 22. His exam is significant for a single gunshot wound to his right flank midway between his iliac crest and his right costal margin. His abdomen does not appear distended but is rigid and exquisitely painful to palpation. The trauma surgeon on duty asks you to perform a FAST exam. What do you tell her? a. As the patient is hypotensive, the FAST exam will definitely be positive for free fluid. b. A FAST exam will reliably determine whether or not the peritoneum has been violated. c. The FAST cannot be repeated if it is initially negative. d. A FAST exam may provide confirmation of intra-abdominal injury, but cannot be relied upon in penetrating trauma to definitively diagnose injury. Question Title * 9. A 35 year old man presents to the ED status post a motor vehicle collision complaining of chest pain. Which of the following might prevent an adequate view of the patient’s abdominal windows? a. Subcutaneous air from a pneumothorax b. A full bladder c. A hemothorax d. Severe pain Question Title * 10. The above patient’s VS are BP 70/50, HR 110, RR 32. His FAST is shown below. What is the next step in this patient’s management? a. Chest tube b. Emergent laparotomy c. Emergent pericardiocentesis d. CT scan Question Title Image for question #10 Question Title * 11. Identify the structure highlighted by the arrow in the image below: a. Liver b. Spleen c. Pericardium d. Stomach Question Title Image for question #11 Question Title * 12. Which of the following is correct regarding ultrasound? a. High frequency transducers provide increased depth of penetration but lack resolution. b. HIgh frequency transducers provide increased resolution but lack depth of penetration. c. Low frequency transducers provide increased resolution but lack depth of penetration. d. None of the above are correct. Question Title * 13. A 30 year old man presents with a complaint of swelling to his right thigh. On exam, there is a 6x6 cm area of erythema and tenderness to his anterior thigh. His ultrasound is shown below. Which is the following is correct regarding the findings seen on ultrasound? a. This finding indicates soft tissue edema from any cause. b. This finding is consistent with myositis. c. This finding is consistent with a large fluid collection. d. This finding is not specific enough to make a definitive diagnosis. Question Title Image for question #13 Question Title * 14. A 50 year old man presents with abdominal pain and is noted to have a pulsatile abdominal mass on physical exam. Which of the following may prevent full evaluation of his abdominal aorta? a. Obesity b. Intestinal gas c. Severe abdominal pain d. All of the above Question Title * 15. A 15 year old boy is brought to the ED following a fall from a second story window. He is confused and disoriented, but is clutching his stomach. His VS are BP 60/40, HR 120, RR 22, T 96.0. His FAST exam is shown below. Which of the following is the most appropriate next step? a. Emergent laparotomy b. Pericardiocentesis c. Pelvis x-ray d. CT scan Question Title Image for question #15 Question Title * 16. Identify the structure shown highlighted by the arrow in the image below: a. Aorta b. Inferior Vena Cava c. Vertebral body d. Psoas muscle Question Title Image for question #16 Question Title * 17. Which of the following best describes the correct technique for measuring the abdominal aorta? a. Measurements should be taken in the transverse plane to avoid inaccurate measurements. b. One measurement at any point along the course of the abdominal aorta is sufficient. c. Measurements taken in either the transverse or sagittal plane are equally accurate. d. As most aneurysms occur below the renal arteries, a measurement taken at this point is sufficient to rule out a AAA. Question Title * 18. A 75 year old man presents to the ED complaining of feeling very weak and dizzy. He has a history of HTN. His VS are BP 60/40, HR 90, RR 30. An ultrasound of his aorta is seen below. Which of the following is correct regarding his diagnosis? a. If a FAST exam is negative, then it is unlikely that he has a ruptured AAA. b. The patient should have a CT scan with intravenous contrast to confirm the diagnosis before any other treatment is initiated. c. The patient should be assumed to have a ruptured AAA based on his clinical presentation and ultrasound and vascular surgery should be consulted emergently. d. The patient’s ultrasound is normal. Question Title Image for question #18 Question Title * 19. A 50-year-old man is brought to the ED following an MVC with a complaint of severe abdominal pain. His VS are BP 100/60, HR 90, and RR 16. His exam is significant for bruising across his lower abdomen and diffuse tenderness to palpation. You perform a FAST, which is shown below. The trauma team asks you if you can tell where the free fluid is coming from. What do you tell them? a. There is no free fluid visible on the FAST. b. As the free fluid is localized to the right upper quadrant, there is almost certainly a liver laceration. c. Although there is free fluid present on the ultrasound, you are unable to determine the location of injury. d. The image is not sufficient to determine if there is free fluid. Question Title Image for question #19 Question Title * 20. Identify the structure highlighted by the arrow in the image below: a. Vertebral Body b. Diaphragm c. Psoas muscle d. Aorta Question Title Image for question #20 Question Title * 21. A 15 year old girl is brought to the ED by her parents with a “spider bite”. An examination of her right leg reveals an erythematous, indurated area over her left calf. She is extremely apprehensive during the exam but allows you to perform an ultrasound. Based on the image that you see below, what is the next step in this patient’s care? a. Discharge her on PO antibiotics b. Incision and drainage c. CT scan d. Formal ultrasound by the radiologist Question Title Image for question #21 Done