Question Bank

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

Which of the following positioning techniques can help you visualize the abdominal aorta?

A 45 y/o female is suffering from abdominal pain after meals.  What ultrasound mode is used to scan her gallbladder in the image below?

A 45 y/o with a history of kidney stones presents with acute onset of L flank pain.  A renal ultrasound shows finding consistent with mild hydronephrosis.  To determine whether or not what appears to be hydronephrosis are actually the renal vessels, what machine mode is used below to troubleshoot this potential pitfall?

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?

Where are 90% of AAA’s located?

Which of the following descriptions of ultrasound frequency and probe selection is most accurate?

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

A 23 year old male is involved in an accident falling forward off of his bicycle hitting his abdomen on the handlebars.  He is in severe abdominal pain and has visible bruising over his left flank and around his umbilicus.  You perform an ultrasound exam which shows free fluid in the left upper quadrant between the diaphragm and the spleen concern for a splenic injury.  How do you describe the appearance of fluid on an ultrasound and what happens to sound waves that create this appearance?

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

Sometimes you have to exert some force with the probe to see if the vein will collapse, especially for fluffier or for more musclebound patients. How do you know how hard is hard enough to compress for either a positive or negative POCUS DVT scan?

This patient’s abdominal aorta measures 4.3cm at its greatest diameter.  Do they have a abdominal aortic aneurysm by definition?

An iliac aneurysm is by definition greater than how many centimeters wide?

The following image is taken in the sagittal plane in the abdominal right upper quadrant.  In this view, the sonographer is evaluating Morrison’s Pouch, the space between the liver and kidney, to evaluate for free fluid concerning for hemoperitoneum in the setting of trauma.  In which direction, relative to the patient, is the probe marker pointing?

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:

To evaluate for a DVT, the linear probe is used in the popliteal region.  In the following video, what probe movement is used to rule out the presence of a popliteal DVT?

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?

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?

In the sagittal plane, the probe marker points in which direction?

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?

The presence of the liver superior to the diaphragm is an example of what type of artifact?

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 47 y/o male with a history of peptic ulcer disease presents with worsening pain in the right upper quadrant after meals.  An H2 blocker and PPI provide him with no relief.  His clinician performs the ultrasound below.  Applying pressure to the probe causes him more pain.  What artifact present below confirms the patient’s diagnosis?

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?

You measure the inner wall to inner wall of the abdominal aorta?

What medications are indicated for this patient with leg swelling? (This scan is being done behind the patient’s knee)

You are considering the diagnosis of an aortic dissection in patient with searing chest pain that radiates to the back. You have just scanned the entire course of the abdominal aorta to the proximal iliac arteries and you do not see a dissection flap. If you want to rule out an aortic dissection, your next step is to:

What pathology is seen here?

From inguinal area down to the knee crease, what are the three key junctions/branches of the femoral vein?

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?

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

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?

In addition to compression, color and pulse wave doppler are necessary to rule in or out the diagnosis of lower extremity DVT.

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

As you are scanning down the distal thigh towards the knee, which techniques are most helpful to be able to visualize the femoral vein as it courses deeper toward the bone?

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?

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

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?

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:

What is the most reliable sonographic landmark when trying to locate the abdominal aorta?

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 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?

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?

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

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?

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?

What the sensitivity and specificity of POCUS for the diagnosis of DVT?

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.

The saphenous vein joins with the common femoral vein _____; the popliteal vein is _____ the popliteal artery.

Does this patient have a DVT?

This 38 year old construction worker patient presents with shoulder pain x 7 days, specifically with difficulty and pain abducting arm. Here is your POCUS scan of his supraspinatus tendon. What is the best next step for this patient?

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 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?

Identify the highlighted image below:

Identify the highlighted image below:

Identify the highlighted structure below:

Identify the structure highlighted below:

What structure is highlighted in the image below?

Identify the structure highlighted below:

Identify the structure highlighted in the image below:

Identify the structure highlighted in the image below:

Identify the structure highlighted in the image below:

Identify the structure highlighted in the image below:

Identify the image highlighted below:

Identify the structure highlighted below:

Identify the structure highlighted below:

Identify the structure highlighted below:

Which cardiac view is obtained in the image below?

Identify the cardiac view obtained in the image below:

Which cardiac view is obtained in the image below?

Which cardiac view is obtained in the image below?

A 45 year old female with a long standing history of hypertension and methamphetamine use presents to clinic for follow up after recent hospitalization for congestive heart failure.  Her shortness of breath has improved.  Considering the focused cardiac questions, what pathological findings are present in the image below?

A 63  year old female with a long standing history of hypertension, diabetes, coronary artery disease presents to clinic for follow up after recent hospitalization for congestive heart failure.  Her shortness of breath has improved.  Considering the focused cardiac questions, what pathological findings are present in the image below?

A 53 year old female with a history of breast cancer undergoing chemotherapy presents with acute onset of shortness of breath and chest pain.  Her bedside echo shows the following finding:

Based on the ultrasound above, what is your most likely diagnosis?

A 65 year old male with a history of congestive heart failure, COPD, hypertension, and diabetes presents to the clinic with shortness of breath.  His vital signs are within normal limits.  He reports he gets more short of breath with minimal exertion.  He has no chest pain.

His bedside cardiac and lung ultrasound shows the following findings:

Right Thorax:

Left Thorax:

What is your most likely diagnosis for this patient’s acute dyspnea?

A 63 year old female with a history of COPD, hypertension, and diabetes presents to the clinic with cough, subjective fever, and shortness of breath. Her CXR shows a right lower lobe pneumonia.

Her cardiac echo shows what finding?

What structure is highlighted in the image below?

What structure is highlighted in the picture below?

What finding is highlighted in the image below?

What finding is highlighted in the image below?

A 23 year old female with acute onset of left flank pain radiating to the groin presents to clinic.  She has urinalysis with red blood cells.  You perform the ultrasound which shows the image below.

What finding is highlighted in the image below?

A 23 year old male presents to the emergency department with left flank pain.  He has a long history of chronic pain.  He is complaining of pain mostly in his back.  His urinalysis shows no signs of acute infection or hematuria.

A bedside ultrasound of the left kidney shows the following findings.

What conclusion can you draw of the left kidney?

A 65 year old female with a history of hypertension and diabetes presents with flank pain, weight loss, and hematuria. Her vital signs are within normal limits.  Her WBC, creatinine, platelets and hemoglobin are normal.

Her bedside ultrasound shows the following finding of the let kidney.

What is an appropriate next step in management?

A 45 year old female presents with acute flank pain radiating to the groin and hematuria and you suspect an acute ureteral obstruction from a kidney stone.

Which of the following are indications for obtaining further imaging such as a CT scan?

A 35 year old female presents with right flank pain radiating to the groin, nausea, vomiting and hematuria. Your history and physical exam is suspicious for an obstructing kidney stone. Her vitals are within normal limits. She has no tenderness in the RLQ or RUQ. Her gallbladder ultrasound shows no signs of stones or sonographic Murphy’s sign. Her WBC count, CRP, Hg, PLT, Renal Function are all normal. Her urinalysis shows no signs of infection.

Her right and left kidney ultrasound show the following:

What is an appropriate next step in management?

A 63 yo male presents with difficulty urinating, lower abdominal fullness, and pain.  His creatinine is elevated from 0.7 to 3.5.

A bedside ultrasound of his bladder following a void trial shows the following:

What is the more likely diagnosis and what is the most appropriate treatment?

What focused questions are answered by the Focused Assessment with Sonography For Trauma exam?

What focused questions are answered by the extended FAST exam?

A 46 year old female is involved in a motor vehicle accident.  She was rear ended and hit her chest on the steering wheel.  She was wearing a seatbelt.  She is complaining of pain over the ribs.  Her Xray shows no signs of rib fracture.

What conclusion can be drawn from the following ultrasound?

A 35 year old female fell off of her bicycle and is complaining of abdominal pain.  She has bruising throughout her abdomen and has significant pain in the left upper part of the abdomen.  Her FAST exam shows the following:

What conclusion can be drawn?

T/F.  In the FAST exam, it is sufficient to evaluate the pelvic view in the transverse plane.

T/F.  In the FAST exam, it is sufficient to evaluate the RUQ view between the liver and kidney (Morrison’s pouch).

A 21 year old male falls off of his roller skates while going down hill.  He presents with over his clavicle and is found to have a fracture.  An extended FAST exam is performed.

What conclusion can be drawn based on this ultrasound in the right lung apex?

A 48 year old male is involved in a motorcycle accident and is complaining of rib pain and shortness of breath.  A bedside ultrasound is performed of the lungs and shows the following finding in M-Mode.

Based on the above, what conclusion can you draw?

A 42 year old female fell off her bike on her way to work.  She has abrasions on her arms and legs and across her chest.  She is complaining of pain in her ribs and shortness of breath.

An ultrasound of her lungs showing the following:

Right Mid-Clavicular Line

Left Mid-Clavicular Line

A 57 year old male involved in a high speed motor vehicle accident on the highway.  He is brought to the emergency department with multiple contusions to the chest and shortness of breath.  An extended FAST exam is performed.  What conclusion can be drawn based on the following finding:

Right Costophrenic Angle

Left Costophrenic Angle

True/False.  It is adequate to scan the lower extremity venous at two points, the femoral and the popliteal veins, in order to rule out DVT.

Identify the structure highlighted below in the popliteal fossa:

Identify the structure highlighted below in the popliteal crease

Identify the structure visible below in the popliteal crease:

Identify the saphenous vein (Images obtained from the right goin):

A)

B)

C)

D)

Identify the Femoral Vein (Image obtained from below the R inguinal Ligament):

A)

B)

C)

D)

Identify the structure highlighted below (Image obtained below the Right Inguinal Ligament):

A 35 year old female presents to your clinic with unilateral leg pain and swelling.  An ultrasound of the painful leg is performed to evaluate for a deep venous thrombosis.  The highlighted image below is non compressible.

What is the appropriate next in management?

A 48 year old female presents to your clinic complaining of leg pain and swelling.  She recently returned 3 days ago after going on vacation to South Africa (a 13 hour plane ride).   You perform a bedside ultrasound that shows the following:

Right popliteal fossa

What is an appropriate next stop in management?

A 65 year old male underwent an open reduction external fixation orthopedic surgery after fracturing his right hip 2 weeks ago.  He is seen in clinic for a follow up appointment and noticed that his right leg has been more swollen than usual.

A bedside ultrasound in clinic is performed and shows the following finding from the right popliteal fossa:

What is the most appropriate next step in management?

A 57 year old male with a history of homelessness and chronic alcoholism presents complaining of pain and swelling in his legs, primarily his left leg.  He says his legs are always swollen because he has a hard time elevating them.  He has no history of shortness of breath, orthopnea, or exertional dyspnea.  You perform a bedside ultrasound of the left leg to evaluate him for a deep venous thrombosis.

Based on this ultrasound below the left inguinal canal, what is the next appropriate step in management?

A 73 year old female presents to your clinic with pain radiating from her right gluteus down her right leg. She also noticed that the leg appears slightly more swollen. On her exam, the legs appear symmetric. The patient also reports she was treated for a deep venous thrombosis over 10 years ago which she developed after having hip surgery.

You perform a bedside ultrasound that shows the following finding:

What is the most appropriate next step in management for this patient?

Identify the structure highlighted below in the right upper quadrant:

Identify the structure that the arrow is pointing in the right upper quadrant:

Identify the structure highlighted in the image below:

Identify the structure highlighted below:

A 52 year old female with a history of obesity and diabetes, presents for the 3rd time for upper abdominal pain.  She says it gets worse after she eats.  She was treated with omeprazole and ranitidine as well as treated for H. Pylori however her symptoms have not improved.  Her vital signs are normal.  Her labs show a mild elevation aspartate transaminase (AST) and alanine transaminase (ALT) of 110, 115 respectively and her WBC count is normal.

After performing your physical exam, your bedside ultrasound of the RUQ shows the following.  Upon visualizing this finding, gentle pressure applied causes the patient discomfort.

What is the most likely diagnosis?

A 45 year old female G5P4 with a history of obesity, presents for her 4th visit for upper abdominal pain.  She says it gets worse after she eats.  She was treated with omeprazole and ranitidine as well as treated for H. Pylori however her symptoms have not improved.  Her vital signs are normal.

After performing your physical exam, your bedside ultrasound of the RUQ shows the following.  Upon visualizing this finding, gentle pressure applied causes the patient discomfort.

What is the most appropriate next step in patient management?

What structure is highlighted below in the parasternal long view?

In the parasternal short view, what structure(s) is(are) highlighted below?

In the Apical 4 Chamber View, what structure is highlighted below?