MIDI Final

supine

left posterior oblique

left lateral decubitus

When looking at R kidney, what are the possible patient position options?

long axis, marker towards head

Probe orientation to view R kidney?

anterior axillary line

mid axillary line

mid clavicular line subcostal

What are the 3 possible acoustic windows to visualize the R kidney on US?

10th-12th

What approximate rib level is the probe at when viewing R kidney?

buildup of urine causes kidneys to swell/stretch

What is hydronephrosis?

anechoic "bear paw" with dilated calyces and renal pelvis

On US, how would the renal sinus appear in the setting of hydronephrosis?

potential space between liver and right kidney

What is Morrison's pouch?

curvilinear (can also use phased array)

What probe is used to visualize kidneys?

renal pyramids

The dots indicate:

the ability of a surface to bounce back an echo, such as a sound wave in a medical ultrasound

What is echogenicity?

echogenicity --> aka less clear picture is indicative of disease

There is ________ of the renal cortex in medical renal disease

supine

right posterior oblique

right lateral decubitus

Possible patient positions to visualize left kidney?

posterior axillary line at approx 9th-11th rib

MC acoustic window to visualize the left kidney?

hydronephrosis --> dilated calicies and pelvis

What is seen here?

medical renal disease--> increased cortical echogenicity

What is seen here?

abdominal

What US setting is used to visualize the kidneys?

men; flank

Nephrolithiasis is more common in _______ and presents with ______ pain

calcium

75% of renal stones contain ______

uric acid

struvite

cysteine

Less commonly, renal stones contain: (3)

Non-contrast CT

DX standard of care to ID nephrolithiasis (non-pregnant patients)

IV pyelography

Before non-contrast CT, ______ was used to DX nephrolithiasis

degree

US allows us to quantify ________ of hydronephrosis

size

Hydronephrosis correlates with ______ of nephrolith

5 mm

A ______ nephrolith will pass spontaneously 90% of the time

8 mm

A ______ nephrolith will pass spontaneously 5% of the time

degree of hydronephrosis

POCUS can evaluate the size of the nephrolith based upon the ______________ and not the actual size of the stone (non-contrast CT can do this)

greater than 3 months

CKD is an abnormality of renal structure or function that lasts

HTN and diabetes

Most significant risk factors of CKD

pre-renal

intrinsic

post-renal

How is CKD classified?

decreased perfusion

Pre-renal CKS is related to

vascular disease or interstitial kidney disease

Intrinsic CKD is related to

obstruction

Post-renal CKD is related to

renal size

cortical echogenicity

parenchymal thickness

Most helpful tools in obtaining DX of CKD:

9-13 cm

Normal renal size

hyperechoic

A ________ cortex is associated with CKD

15-20 mm

Normal kidney thickness

curvilinear (can also use phased array)

What probe should be used to visualize the bladder?

supine

What position should the patient be in to view the bladder?

just above pubic symphysis

When visualizing the bladder, where should the probe be placed to start?

anechoic

Urine appears _______ on US

6 mm

Normal bladder thickness

posterior

The trigone area is the _______ aspect of the bladder

in; out

On color doppler, red indicates fluid moving _______ and blue indicates fluid moving ______

complete or partial obstruction of the ureter

In setting of hydronephrosis, observing urine jets may aid in determining:

rectouterine pouch

In females, what area in the pelvic region do we observe for free fluid?

rectovesical space

In males, what area in the pelvic region do we observe for free fluid?

left

This urine jet is coming from what ureter?

long axis subxiphoid

Where should the probe be oriented to observe the aorta?

posterior

The aorta passes _____ to the diaphragm

by major anterior branches --> celiac axis and SMA

How is the aorta differentiated from IVC in abdominal region?

proximal; distal

Diameter of aorta tapers from _____ to ______

anterior

The aorta appears more ____ when you move inferiorly

infrarenal

Abdominal aortic aneurysms (AAA) are most often _______ in location

fusiform

Abdominal aortic aneurysms (AAA) are most often _______ in morphology

>/= 3 cm

Abdominal aortic aneurysms are greater than ____ in diameter

celiac axis and its branches (hepatic and splenic arteries)

What is the seagull sign on US?

SMA and renal vessels

What can be visualized at level of pancreas?

distal aorta

Where do most AAAs occur?

AAA

What is seen here?

seagull sign

What can we observe in this image?

5th

Intrauterine pregnancy should be visible on transvaginal POCUS at the ______ week of gestation

fallopian tubes, caruna, ovary

Extrauterine/ectopic pregnancy can be present in:

sagittal view of empty uterus

MOst significant POCUS view to obtain DX of extrauterine pregnancy is:

systematic assessment of pelvis to ID location of implantation

If an extrauterine pregnancy is ID on US, what is the next step?

cysts and leiomyomas

What other things can be found on the ovaries in US?

transvaginal US

What is the gold standard for assessment of ovarian cysts?

dermoid cyst

cystadenoma

endometrioma

What are some of the potential classifications of ovarian cysts?

leiomyomas

What are the MC gynecological tumors in the world (present in 20-50% of women)?

transvaginal

Is transabdominal or transvaginal superior in cases involving pelvic pathology?

focal dilations of the aorta at least 50% larger than normal

AAAs are described as:

Smoking

HTN

hyperlipidemia

presence of CT disorder

What are risk factors for AAA?

smoking

Most significant RF of AAA?

aneurysmal rupture

What is the most serious complication of an AAA?

80-95%

Mortality of AAA rupture

patients that have never smoked

Screening for AAA category 1:

patients that smoke

Screening for AAA category 2:

men 65-75 years based on HX and other RF

When should category 1 patient's be screened for AAA?

no

Is it recommended to screen for AAA in female patients who have never smoked?

men 65-75

When should category 2 patients be screened for AAA?

no

Is it recommended to screen for AAA in female patients who have ever smoked?

size and rate of expansion

Monitoring of known AAA is based upon:

4,0-5.5 cm

What is considered a "small" AAA?

6-12 months; 5.5 cm

Small asymptomatic AAAs are followed every _________ until they reach ______

when it is greater than 5.5 cm in diameter

When is SX or endovascular repair of AAA indicated?

0.5 cm

AAA with growth rate of greater than ______ during a 6 month period should be treated DESPITE their size

emergently treated

All symptomatic AAAs should be:

When evaluating the heart in Parasternal Long Axis (PLAX) where should the probe marker be oriented?

Right shoulder

During US evaluation of the cardiac cycle, you observe the atrioventricular valves to be open. Which part of the cardiac cycle represent?

Diastole

During the evaluation of the Inferior Vena Cava (ICV) what is the proper orientation of the probe marker?

Head

How many chambers of the heart should be will be observed during evaluation with the Subxiphoid view?

4

What US preset can be used during Subxiphoid evaluation of the heart?

Abdominal

Which transducer is the most appropriate for US evaluation of the lungs and pleura?

Linear array

What is the proper probe marker position during Apical-4-Chamber cardiac view?

Left axilla

What transducer is most appropriate to obtain an adequate POCUS view of the heart?

Phased array

When evaluating the right lung / pleura in zone one (1) you do not observe the normal "sliding" motion. What should you do next?

Slide the transducer caudally to scan zone 2 on the right

Which ultrasound mode is required to evaluate the "Sandy Beach Sign" of normal sliding pleura?

M-Mode

When can an Intrauterine Pregnancy (IUP) first be recognized by transvaginal ultrasound?

5 weeks

What best describes the identification of urine in the bladder?

Anechoic

Which of the following is the most significant risk factor associated with the development of an Abdominal Aortic Aneurysm (AAA)?

smoking

Which of the following patients would be the most appropriate to obtain AAA sonographic screening?

68-year-old female that smoked for 10 years

65-year-old-male that stopped smoking 10 years ago

75-year-old-male that has never smoked

70-year-old-female that currently smokes

65-year-old-male that stopped smoking 10 years ago