Question Bank – Pulmonary (Basic)

A 60 year old female with a history of hypertension, diabetes, and smoking presents to your clinic with 3 weeks of shortness of breath and dyspnea with minimal exertion.  Her combined cardiac and lung ultrasound findings are below.  What is the most probable diagnosis for this patient’s dyspnea?

Bilateral

The landmark article published by Lichtenstein and al., “A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact”, is considered the sentinel article that made way for the field of pulmonary ultrasonography.  While the “comet-tail” is now known as B lines, what type of artifact gives rise to these findings?

What causes the appearance of “ants marching on a log” and what does this finding suggest?

What pathological finding is visible in the ultrasound below?

A 30 year old female with a history of asthma presents with shortness of breath and wheezing. She ran out of her albuterol. You perform a bedside ultrasound and see the following.

In addition to pleural sliding, what other artifacts visible?

According to the article published by Al Deeb et al. in 2014 titled Point of Care Ultrasonography for the Diagnosis of Acute Cardiogenic Pulmonary Edema in Patients Presenting with Acute Dyspnea: a Systematic Review and Meta-analysis”, these authors concluded what sensitivity and specificity for the lung ultrasound diagnosis of Acute Cardiogenic Pulmonary Edema?

In the article by Lichtenstein et al titled “Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure The BLUE Protocol”, the authors demonstrated which of the following?

What anatomical landmarks are illustrated below?

The most specific finding for a pneumothorax is the _______________.

To obtain a clear image of the pleural line, the sound waves must reach the pleura at approximately 90 degrees.  This angle refers to the angle of insonation.  To achieve a more perpendicular angle to the pleura, what probe motion is used below?

A 74 year old female presents to your clinic with complaints of a productive cough and chills for the last week. She is breathing comfortably and her O2 sat is 98% on room air. She has less energy than usual. She is found to have rales in the right lower hemithorax.

An ultrasound of the right lower hemithorax shows the following:

The rest of her lung ultrasound shows A lines throughout.

What would be the most appropriate next step in management?

In “Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis” by Chavez et al. published in 2014, what is the pooled sensitivity and specificity for the lung ultrasound diagnosis of pneumonia?

The following image suggests which of the following?

A 45 year old male presents with orthopnea, exertional dyspnea and shortness of breath. The patient’s bedside ultrasound shows the following on both sides of the thorax.

What is the most likely diagnosis for this patient’s shortness of breath?

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 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

The yellow arrow on this image indicates which anatomic structure?

What finding does the yellow arrow on this image indicate?

The following scan is taken from the lung apex bilaterally in a supine patient who has undergone intubation. This image effectively rules out right mainstem intubation. (True/False)

An 88 year old patient presents with altered mental status. A transverse view of an intercostal space in the right mid chest indicates which of the following?

A 68 year old male with a history of deep venous thrombosis presents with shortness of breath and altered mental status. The following clip rules out pulmonary embolism as the source of dyspnea. (True/False) 

The finding on this clip is more suggestive of B lines from infection rather than B lines from pulmonary edema. Which of the following are seen on this scan? 

A 56 year old morbidly obese female with history of heart failure with preserved ejection fraction and COPD from an 80 pack year smoking history presents with shortness of breath. Lung auscultation reveals decreased breath sounds and faint wheezing. Bilateral lung ultrasound shows the following. What is most likely?

An 8-hour old neonate born at 34 weeks gestation develops tachypnea. The following lung ultrasound is performed and consistent with this clip throughout all lung fields. Which of the following is true?

The following lung ultrasound is performed with a sagittal axillary view in a patient with shortness of breath. The findings are most consistent with which of the following? 

Which of the following are present in this clip and what do they tend to indicate?

A 17 year old non-verbal male with severe cerebral palsy presents with decreased appetite and mental status changes noticed by their caregiver. Which of the following is likely based on these lung ultrasound findings?

Based on the following clip, is pulmonary effusion present or absent in this area?

The appearance of consolidated lung in the lung base in this clip is likely a false positive due to mirror image artifact. (True/False)

In this 74 year old male with one day of fever and shortness of breath, a chest Xray is performed and read as normal. Lung ultrasound shows the following. What is present?

An 88 year old female presents with tachypnea, O2 saturation of 81% on room air, and diffuse wheezing. Lung ultrasound shows the following diffusely and bilaterally. Which of the following will likely lead to quickest resolution of these findings?

Which of the following is true regarding this clip?

Which of the following is true regarding an interpretation of this clip as “Diffuse B lines present.”

This pattern is seen in the right lung base in this 74 year old male with shortness of breath and no known medical history. The remainder of the bilateral lung ultrasound is normal. Which of the following is true?

The vertical bright white artifacts indicated by the yellow arrow in this clip are?

A 68 year old male in a motor vehicle accident is flown by helicopter to a critical access hospital where the following lung ultrasound is obtained. Which of the following is true?

A 45 year old male undergoes a CABG procedure and a day later in the ICU a radiograph shows left lower lobe consolidation – “pneumonia vs. atelectasis.” The following lung ultrasound is obtained. The patient is afebrile. Which of the following is more likely? 

Which of the following may be the cause of this lung ultrasound finding?

The sonographic appearance of this pleural effusion is?

A 22 year old male presents with diffuse tachypnea, low oxygen saturation, and high fever on day 10 of influenza infection. What is the best treatment for this lung ultrasound finding?

The appearance of consolidated lung in the lung base in this clip is likely a false positive due to mirror image artifact. (True/False)

The sonographic appearance of this pleural effusion is?