PreCourse Quiz

The Rapid Ultrasound In Shock (RUSH) exam is a rapid sonographic approach to narrow the differential for a patient’s cause of shock. What are the components of the RUSH exam?

A 65 year old female with a history of hypertension off medications for the last few months presents after progressive shortness of breath and orthopnea. She denies any chest pain, fevers. Her BP if found to be 80/40 and her HR 115. Her RUSH exam shows the following:

What is the most likely cause of the patient’s shock?

A 23 year female presents to the emergency department with abdominal pain and vaginal bleeding.  She is unsure of when her last menstrual period and she is sexually active.  She denies any history of trauma. She is found to be hypotensive and tachycardic and tender to palpation.  Her RUSH exam shows the following findings:

What is the most likely cause of this patient’s shock?

What is the most reliable sonographic landmark to localize the abdominal aorta?

From where to where should you correctly measure this abdominal aorta?

A 75 year old male with long standing history of smoking is seen in your clinic. The curvilinear probe is placed in the transverse plane in the abdominal midline above the umbilicus. The following image suggests:

A 45 year old female with obesity is experiencing pain in the right upper quadrant after meals. You decide to do an ultrasound to look for gallstones. What are the characteristics of the probe that will allow you to best visualize the gallbladder?

A 23 year old male fell off a bicycle and complains of rib pain, shortness of breath and abdominal pain. A focused assessment of sonography in trauma is performed (FAST exam). Which artifact seen above the diaphragm suggests that the patient does NOT have a hemothorax?

The Focused Assessment with Sonography in Trauma (FAST) exam has largely replaced diagnostic peritoneal lavage in acute trauma. The FAST exam seeks to answer which two focused questions:

A 27 year old healthy male fell off of a skateboard after attempting to do a jump. He is complaining of abdominal pain and has bruising around the left upper part of his abdomen just beneath the ribs. His BP is 90/60 and HR 118.
Given the findings above of the left upper quadrant, what would be your next step in management?

A 35 year old was roller blading down a hill, tripped and fell and hit her chest.  She denies any head trauma, headache, neck pain, abdominal pain or loss of conscious.  She hit her chest and feels lots of pain with some shortness of breath.   An Extended FAST exam was performed.  The finding above suggests:

What are the most important sonographic questions when ultrasounding the gallbladder?

A 55 year old female sees you in clinic after several weeks of right upper quadrant pain with meals. She denies fevers, chills, nausea, vomiting. The ultrasound below suggests?

If you are unable to find the gall bladder with a supine patient, what should you do?

A 30 year male with acute L flank pain radiating to the groin and hematuria presents to your clinic. Which probe do you select to scan the kidney and why?

A 35 year old male with acute onset of L flank pain radiating to the groin presents to your office. He has had multiple CT scans in the past which have shown ureteral stones. He has never had urological interventions as the stones have always passed on their own. He denies any fevers & chills. You perform a bedside ultrasound which shows the following image. What finding is present?

You perform an ultrasound of the right kidney and visualize hypoechoic area in the renal pelvis.  You suspect the presence of hydronephrosis.

For confirmation, you use color mode and see the following image.

What do these findings suggest?

Point of care ultrasound (POCUS) differs from comprehensive radiology ultrasound in that POCUS, we seek to answer focused clinically relevant questions at the bedside. The focused cardiac echo answers which focused questions?

A 45 y/o male with a long standing history of methamphetamine use presents to your clinic with several weeks of shortness of breath.  He denies any coughing and fevers.  A bedside ultrasound is performed revealing the following findings on parasternal long axis view.  What findings are present below?

The Apical 4 Chamber view is often the most difficult cardiac view to obtain. Which patient position helps obtain an apical 4 Chamber view?

72 y/o male with history of COPD presents with SOB and dyspnea on exertion. A bedside lung ultrasound is performed showing a bright hyperechoic line representing the pleura. It appears to be sliding therefore ruling out the presence of pneumothorax at this intercostal space. Which finding below suggests the lung if full of air at this intercostal space?

A 45 yo presents to your clinic with shortness of breath, orthopnea, bilateral leg swelling and recent weight gain.  Which artifact present below would you expect to find on this patient’s ultrasound?

A 45 y/o female with a history of breast cancer presents to your clinic complaining of shortness of breath and pleuritic chest pain.  She has diminished breath sounds in the right lower hemithorax.  What finding is present below?

A 16 year old male presents with RLQ pain, nausea, vomiting and positive straight leg raise.  The ultrasound probe is placed in the RLQ at the point of maximal tenderness for the patient.  What sonographic finding is present below?

A 23 year sexually active male presents to your clinic with testicular pain and swelling. Ultrasound exam below suggests what finding?

A 65 year old diabetic experiences sudden onset of diminished vision in her left eye.  She describes it as “seeing flashes and floaters.”  A bedside US performed showed the following:

What is the diagnosis?

What best describes the axis of the vessel and the procedural approach.

What axis and procedural approach is shown below?

A 35 year wrestler thinks he stepped on something and feels like something is stuck under his foot.  The ultrasound below shows a foreign body.  What technique can be useful to better visualize foreign bodies near the surface of the skin?

A 17 year female with a history of diabetes presents to you with fever, pain, swelling, warmth and redness in the right leg.  Her ultrasound is negative for DVT though shows the following image.  What does this finding suggest?

A 15 year old male presents with a bump on his arm, pain, redness and swelling.  He has been on antibiotics for 5 days and but it is not getting any better.  There is no spontaneous drainage.   Your ultrasound exam over the area of swelling suggests the presence of:

The use of ultrasound is useful to distinguish cellulitis from abscess and can minimize the number of dry taps performed.

If you have having difficulty visualizing the common femoral vessels when scanning the inguinal area, what position change can help?

What landmark is the most important to see in the inguinal area of the DVT exam? The exam of this area shown below suggests:

When you are scanning the popliteal area from behind the knee crease, which vessel is typically on top (closest to the probe)?  This scan of the popliteal region suggests what finding?

The following image of the heart in the apical 4 chamber window is in which mode?