E-Fast Exam

Question 1

RUQ Landmark

Answer 1

Xiphoid process and posterior axillary line.
sonographic landmark: double density of the kidney.

Question 2

RUQ areas of interest

Answer 2

caudal tip of the liber
hepto-renal interface.

Question 3

LUQ landmark

Answer 3

xiphoid process and left posterior axillary line.
sonographic landmark: double density of kidenyL

Question 4

LUQ area of interest:

Answer 4

subdiaphragmatic space superior to the spleen (6-9oclock)
Spleno-renal interface.

The phrenicocolicligament restricts the amount of fluid that will collect in the splenorenal space, so the focus of the exam should be directed towards the subdiaphragmatic area and the caudal margin of the spleen.

Question 5

pelvis area of interest

Answer 5

urterovesicular and rectouterine space.

Question 6

TF FAST exam can detect retroperitoneal injury

Answer 6

false.
Does NOT detect
- Hollow viscus injury
- Diaphragm injury
- Solid organ injury
- Retroperitoneal injury
- Mesenteric injury
it can only detect >400-500ml of free fluid reliably.

Question 7

WhichofthefollowingisTRUEwithrespecttoaccuracyoftheFASTexam?
a.ThechanceofdefinitieFASTexamisdirectlyproportionaltothepatient’sBMI
b.Abdominaladhesionsfrompriorabdominalsurgerydecreasethesensitivityof
FAST
c. Pleural blebs and prior pleurodesis may result in false-negatives for pneumothorax
d.SubcutaneousemphysemaaidsintheFASTexam

Answer 7

B

Question 8

3 causes of false positive FAST exam

Answer 8

1. hollow viscous injury (ex/ gall bladder, bladder or bowel rupture
2. Ascites
3. Fluid contained within a hollow viscous mistaken for intraperitoneal (NB free fluid has sharp edges, contained fluid has a round border)

Question 9

sensitivity and specificity of eFAST

Answer 9

sensitive: 74%, specific: 97%

Question 10

describe the pathophysiology of the spine sign

Answer 10

the spine is a medial structure. With the porbe placed at the posterior axillary line pointing toward the xiphoid, a lung filled with air should scatter the ultrasound, resulting in poor penetration and no image generation of the psine. When the pleural space becomes filled with fluid, there is a large relative decrease in attenuation and ability to visualize the hyperechnoic spine.