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CUMC Anesthesia CCM > NBE CCE Exam Review > Flashcards

NBE CCE Exam Review Flashcards

Prep for the NBE exam. Note that this tool is meant to help with the rote memorization aspect of ultrasonography and is not meant to replace the knowledge and skills that come from dedicated study of the foundations, concepts, and practical application of CCUS. - David Wang

1
Q

TAPSE cutoff?

A

c. Lateral TV

c. M-mode

c. Cutoff: > 16 normal

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2
Q

IVC collapsibility with spontaneous breathing:

RAP < 5 mmHg: IVC < […cm] & > 50% collapsibility with sniff

A

RAP < 5 mmHg: IVC < 2.1 cm & > 50% collapsibility with sniff

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3
Q

IVC collapsibility with spontaneous breathing:

What is RAP if IVC > 2.1 cm & less than 50% collapsibility with sniff

A

RAP >15 mmHg

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4
Q

IVC collapsibility with spontaneous breathing:

What is RAP if IVC > 2.1 cm & > 55% collapsibility, OR IVC < 2.1 cm & < 55% collapsibility

A

RAP 8 mmHg

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5
Q

PE:

60/60 sign?

A
  • *a. RVSP <60 mmHg
    b. PA acceleration time < 60 sec**

The 60/60 sign in echocardiography refers to the coexistence of a truncated right ventricular outflow tract acceleration time (AT <60 ms) with a pulmonary arterial systolic pressure (PASP) of less than 60 mmHg (but more than 30 mmHg). In the presence of right ventricular failure, it is consistent with an acute elevation in afterload, commonly due to an acute pulmonary embolism.

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6
Q

McConnell’s sign: coexistence of akinesia of the […region]

A

McConell’s sign (for PE): coexistence of akinesia of the mid-free right ventricular wall with preserved apical contractility

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7
Q

RV hypertrophy: what cutoff in thickness?

A

> 5mm

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8
Q

Best view for Rv hypertrophy:

A

Subcostal 4 chamber

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9
Q

Pulm HTN/ RVSP / PAP calc:

PA mean is calculated with what measurement at pulmonic valve?

A

velocity at the beginning of the PR signal, aka early diastole (using cw doppler across PV)

https://youtu.be/XXFTnz8ys3k

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10
Q

Pulm HTN/ RVSP / PAP calc:

PAD is calculated with what measurement at the pulmonic valve?

A

velocity at the end of the PR signal

https://www.youtube.com/watch?v=XXFTnz8ys3k&ab_channel=LukeHoward

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11
Q

Pulm HTN/ RVSP / PAP calc:

PAD equation using pulmonic valve?

A

4 * (VED)2 + RAP

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12
Q

How to calculate mean PAP using RVOT?

A

Mean PAP= 90 – (0.62 x RVOT AT in msec)

AT = acceleration time, measured via pulsed-wave doppler

https://www.youtube.com/watch?v=vbTQyep26qY&ab_channel=LukeHoward

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13
Q

PV diastolic gradient equation?

A

PV diastolic gradient: PAD - RAP

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14
Q

AS severity:

Aortic jet velocity (m/s): cutoff for mild?

A

2.6-2.9

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15
Q

AS severity:

Aortic jet velocity (m/s): cutoff for severe?

A

> 4.0

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16
Q

AS severity:

Mean gradient (mmHg): cutoff for severe?

A

> 40 by ESC guidelines

> 50 by AHA/ACC

(probably reasonable to assume on the test that they won’t pick something in between so only need to know one of these)

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17
Q

AS severity:

Mean gradient (mmHg): cutoff for mild?

A

< 20 by ESC guidelines

< 30 by AHA/ACC

(probably reasonable to assume on the test that they won’t pick something in between so only need to know one of these)

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18
Q

AS severity:

AVA (cm2): cutoff for mild?

A

> 1.5

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19
Q

AS severity:

AVA (cm2): cutoff for severe?

A

< 1.0

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20
Q

AS severity:

Indexed AVA (cm2): cutoff for mild?

A

> 0.85

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21
Q

AS severity:

Indexed AVA (cm2): cutoff for severe?

A

< 0.6

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22
Q

AS severity:

Velocity ratio: cutoff for mild?

A

> 0.50

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23
Q

AS severity:

Velocity ratio: cutoff for severe?

A

< 0.25

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24
Q

AS severity:

Which measurement is adjusted for BMI?

A

AVA, hence the indexed AVA.

NB: the validiy of indexed AVA is somewhat controverisal in the literature from what I read

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25
Q

TTE PSAX view:

name the AV leaflets

A

Right, left, noncoronary

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26
Q

AV:

Which is better for morphologic evaluation, TTE or TEE?

A

TEE

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27
Q

AV:

Which is better for flow evaluation, TTE or TEE?

A

TTE

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28
Q

AS:

AVR is reasonable for asymptomatic patients with aortic velocity ≥ […m/s]) and low surgical risk

A

AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity ≥5.0 m/s) and low surgical risk

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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29
Q

AS:

AVR is reasonable for asymptomatic patients with aortic velocity ≥ […m/s]) and low surgical risk

A

AVR is reasonable for asymptomatic patients with very severe AS (stage C1, aortic velocity ≥5.0 m/s) and low surgical risk

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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30
Q

AS:

AVR is recommended for symptomatic patients with […severity of AS] who have symptoms by history or on exercise testing

A

AVR is recommended for symptomatic patients with severe high-gradient AS who have symptoms by history or on exercise testing (stage D1)

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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31
Q

AS:

AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF under what condition?

A

AVR is reasonable in symptomatic patients with low-flow/low-gradient severe AS with reduced LVEF (stage D2) with a low-dose dobutamine stress study that shows severe AS flow or gradient: an aortic velocity ≥4.0 m/s (or mean pressure gradient ≥40 mm Hg) with a valve area ≤1.0 cm2 at any dobutamine dose

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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32
Q

AS:

AVR is reasonable in symptomatic patients who have low-flow/low-gradient severe AS who are normotensive and have an LVEF ≥50% under what condition?

A

AVR is reasonable in symptomatic patients who have low-flow/low-gradient severe AS (stage D3) who are normotensive and have an LVEF ≥50% if clinical, hemodynamic, and anatomic data support valve obstruction as the most likely cause of symptoms

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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33
Q

AS:

AVR is indicated for patients with […severity] AS when undergoing other cardiac surgery

A

AVR is indicated for patients with severe AS when undergoing other cardiac surgery

NB: “reasonable” to replace if you have moderate AS and undergo cardiac surgery, but not “indicated”

J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185

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34
Q

AS:

How to calculate velocity ratio?

A

velocity ratio = VLVOT / VAV

Some debate on if we should use peak velocity or VTI, so both can be used?

This is also known as velocity index, or dimensionless index (note I am not 100% sure about this please correct me if I’m wrong)

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35
Q

AS:

how to calculate indexed AVA?

A

AVA / BSA

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36
Q

AS:

AVR may be considered for asymptomatic patients with […severity of AS] and rapid disease progression and low surgical risk

A

AVR may be considered for asymptomatic patients with severe AS (stage C1) and rapid disease progression and low surgical risk

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37
Q

AI severity:

Central jet width compared to LVOT: cutoff for mild?

A

< 25%

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38
Q

AI severity:

Central jet width of LVOT: cutoff for severe?

A

>= 65%

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39
Q

AI severity:

pressure half time (ms): cutoff for mild?

A

> 500 ms

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40
Q

AI severity:

vena contracta (cm2): cutoff for severe?

A

> 0.6 cm2

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41
Q

AI severity:

vena contracta (cm2): cutoff for mild?

A

< 0.3

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42
Q

AI severity:

Jet depth: cutoff for severe?

A

head of papillary muscle

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43
Q

AI severity:

Jet depth: cutoff for moderate?

A

tip of anterior MV leaflet

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44
Q

AI:

is dehiscence of AV prosthesis alone an idication for valve replacement?

A

No

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45
Q

AI severity:

Flow reversal indicates severe AI when and where?

A

holodiastolic flow reversal in descending aorta

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46
Q

AI severity:

Which of the following is reliable in eccentric jets?

  • Vena Contracta
  • Jet width/LVOT diameter
  • Regurgitant flow and regurgitant fraction
  • Flow reversal in aorta
  • Area of jet in Short axis
  • Adequate CW
  • LV size
A

Yes:

• Vena Contracta- if clearly defined

• Regurgitant flow and regurgitant fraction

• Flow reversal in aorta

• LV size –always look at the scale!

Less reliable indicators of severity:

  • Jet width/LVOT diameter
  • Area of jet in Short axis
  • Adequate CW jet recording may be difficult- “bidirectional”
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47
Q

AI:

AVR is reasonable for asymptomatic patients with severe AR with normal LV systolic function (LVEF ≥50%) but with severe LV dilation […criteria]

A

AVR is reasonable for asymptomatic patients with severe AR with normal LV systolic function (LVEF ≥50%) but with severe LV dilation (LVESD >50 mm, stage C2)

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48
Q

AI:

AVR is indicated for symptomatic patients with […severity] AR regardless of LV systolic function.

A

AVR is indicated for symptomatic patients with severe AR regardless of LV systolic function (stage D)

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49
Q

AI:

AVR is indicated for asymptomatic patients with chronic severe AR and LV systolic dysfunction (LVEF < […%]) (stage C2)

A

AVR is indicated for asymptomatic patients with chronic severe AR and LV systolic dysfunction (LVEF <50%) (stage C2)

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50
Q

MV:

identify the commissures

A

anterolateral, posteromedial

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51
Q

TTE PSAX MV:

identify the leaflets

A

anterior, posterior

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52
Q

MR severity:

jet area (cm2): cutoff for mild

A

< 4 cm2

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53
Q

MR severity:

size of flow convergence (cm): cutoff for severe, with a Nyquist of 40cm/s

A

>=1.0 cm = large flow convergence = severe

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54
Q

MR severity:

central jet size (% of LA): cutoff for severe?

A

> 50% of LA

NB: ASE says this must be combined WITH vena contracta >=0.7cm

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55
Q

MR severity:

vena contracta (cm): cutoff for severe?

A

>= 0.7 cm

NB: ASE says this must be combined WITH a large central jet, or wall impinging jet of any size. I think this means they’ll provide multiple criteria if this is asked.

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56
Q

MR severity:

regurgitant volume (ml / beat): cutoff for severe?

A

>= 60

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57
Q

MR severity:

regurgitant fraction (%): cutoff for severe?

A

>=50

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58
Q

MR severity:

Severe if systolic flow reversal in […location]

A

s-wave in pulmonary veins

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59
Q

MR severity:

severity if MV flail leaflet is seen?

A

severe

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60
Q

MR severity:

severity if ruptured papillary muscle is seen?

A

severe

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61
Q

MS severity:

valve area (cm2): cutoff for mild?

A

> 1.5

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62
Q

MS severity:

valve area (cm2): cutoff for severe?

A

< 1.0

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63
Q

MS severity:

mean gradient (mmHg): cutoff for mild?

A

< 5

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64
Q

MS severity:

mean gradient (mmHg): cutoff for severe?

A

> 10

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65
Q

MS severity:

pulmonary artery pressure (mmHg): cutoff for severe?

A

> 50

NB: this is a supportive finding; I don’t think you can call severe MS by this alone

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66
Q

MS severity:

pulmonary artery pressure (mmHg): cutoff for mild?

A

< 30

NB: this is a supportive finding; I don’t think you can call severe MS by this alone

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67
Q

MS severity:

[…criteria] is the time interval between maximum mitral gradient in early diastole and the time point where the gradient is half the maximum initial value

A

pressure half-time

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68
Q

MS severity:

Equation for MVA by continuity equation?

A

MVA = (VTILVOT)* (cross-sectional areaLVOT) / (VTIMV)

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69
Q

MS severity:

Equation for MVA by pressure half-time?

A

MVA = 220/T1/2

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70
Q

MS severity:

Equation for MVA by deceleration time?

A

MVA = 750/DT

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71
Q

Ross procedure:

what 2 valve lesions can develop over time?

A

Pulmonic stenosis, aortic insufficiency

Ross: “This involves replacing the aortic valve with the patient’s own pulmonary valve, which has the capability to grow with the patient. In turn, the pulmonary valve and lower portion of the pulmonary artery are replaced by a pulmonary homograft.”

http://www.pted.org/?id=valve3

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72
Q

PS severity:

peak jet velocity (m/s): cutoff for mild

A

< 3

73
Q

PS severity:

peak jet velocity (m/s): cutoff for severe

A

> 4

74
Q

PS severity:

peak gradient (mmHg): cutoff for mild

A

< 36

75
Q

PS severity:

peak gradient (mmHg): cutoff for severe

A

> 64

76
Q

PS severity:

equation for calculating pressure gradient?

A

ΔP = 4v2

v = peak velocity by CWD

NB: this is an application of the modified bernoulli equaiton

77
Q

PS severity:

two TTE views for calculating peak PA systolic gradient?

A

PSAX view at aortic valve level

PLAX RVOT view

and then you use CWD through the PV

78
Q

RVSP calculation:

using TR jet: what equation?

A

RVSP =4(TR VMax)2 + RA pressure

79
Q

Secondary indices of elevated RA pressure:

Tricuspid E/E’ cutoff?

A

Tricuspid E/E’ >6

80
Q

Secondary indices of elevated RA pressure:

HV systolic filling fraction Vs/(Vs+Vd) cutoff?

A

Diastolic flow predominance in hepatic vein (HV) i.e. HV systolic filling fraction Vs/(Vs+Vd) <55%

81
Q

Restrictive CM vs Constrictive pericarditis:

A pericardial thickness exceeding […mm] is highly suggestive of constrictive pericarditis

A

Restrictive CM vs Constrictive pericarditis:

A pericardial thickness exceeding 4 mm is highly suggestive of constrictive pericarditis

NB: can have constrictive with less than 4mm i.e. this measure is specific but not sensitive for constrictive pericarditis

https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H12

82
Q

Restrictive CM vs Constrictive pericarditis:

Where to measure TDI to differentiate? What phase of cardiac cycle?

A

Early diastolic Doppler tissue velocity E’ at mitral annulus

83
Q

Restrictive CM vs Constrictive pericarditis:

Hepatic venous flow difference?

A

with constrictive pericarditis, there is a reversal of forward flow during expiration, since the right ventricle becomes less compliant as the left ventricle fills more.

In contrast, reversal of hepatic vein flow occurs during inspiration in restrictive cardiomyopathy.

https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H13

84
Q

Restrictive CM vs Constrictive pericarditis:

TDI cutoffs?

A

Restrictive CM: < 8

Constrictive pericarditis: > 12

The early diastolic Doppler tissue velocity at the mitral annulus (E’) is decreased (<8 cm/sec) in restrictive cardiomyopathy, due to an intrinsic decrease in myocardial contraction and relaxation. In contrast, the transmitral E’ is frequently increased (>12 cm/sec) in constrictive pericarditis, since the longitudinal movement of the myocardium is enhanced because of constricted radial motion

https://www.uptodate.com/contents/differentiating-constrictive-pericarditis-and-restrictive-cardiomyopathy#H13

85
Q

PFO management:

Optimal vent settings?

A

lower PEEP

86
Q

ASD:

Identify A-E

A

A superior sinus venosus ASD;

B, secundum ASD;

C, inferior sinus venosus ASD;

D, ostium primum ASD or partial AV septal defect;

E, secundum ASD without posterior septal rim

https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.592055

87
Q

Name that lesion!

TTE view

A

PFO

coudn’t find a nice TTE pic

88
Q

CO determination:

stroke volume equation?

A

VTILVOT * areaLVOT

aka: VTILVOT * pi * (LVOT diameter / 2)2

89
Q

CO determination by stroke volume:

LVOT area: what view, what point in cardiac cycle?

A

PLAX, measure in mid systole, measure under leaflet insertion

90
Q

CO determination by stroke volume:

LVOT VTI: what view? CW or PW?

A

A5C

PW doppler

NB: doppler should only show closing click (not sure how they’d test this detail)

91
Q

Equation for pulmonary to systemic flow ratio?

A

Qp/Qs

Qp = RVOT VTI * π * (RVOT / 2)2

Qs = LVOT VTI * π * (LVOT / 2)2

aka: (VTI*area) / (VTI*area)

92
Q

Tamponade:

chamber collapse may not be present under what condition?

A

concomitant pulmonary hypertension

93
Q

Tamponade:

cutoff for MV flow changes during inspiration?

A

MV > 30% change in E’ velocity with respiration

94
Q

Tamponade:

cutoff for TV flow changes during inspiration?

A

TV > 60% change in E’ velocity with respiration

95
Q

A5C LVOT VTI:

Name that pathology!

A

Dagger outflow VTI = dynamic LVOT obstruction

(classically HOCM, also seen in Takotsubo, MI)

96
Q

HOCM management:

vasopressor of choice?

A

phenylephrine

euvolemia, adequate systemic vascular resistance (SVR), and sinus rhythm at a slow to normal heart rate (ie, 60 to 80 beats per minute) should be the goal during the entire perioperative period, while increases in contractility or pulmonary vascular resistance (PVR) are avoided

https://www.uptodate.com/contents/anesthesia-for-patients-with-hypertrophic-cardiomyopathy-undergoing-noncardiac-surgery#H1316682774

97
Q

Volume responsiveness:

most accurate method? cw or pw?

A

Aortic VTI

PW doppler at or within 1 cm of aortic valve

NB: LVOT doesn’t change during cycle so it’s a proxy for change in SV

98
Q

Volume responsiveness:

By aortic VTI: cutoff in %?

A

>12% change = fluid responsive

99
Q

Volume responsiveness:

By SVC respiratory variation on TEE: cutoff in %?

A

> 36%

100
Q

Volume responsiveness:

IVC distensibility index: cutoff in %?

A

> 18%

this is (IVCmax - IVCmin)/IVCmin

NB this is only in MV patients

101
Q

Volume responsiveness:

limitations of the respiratory variation model (Ao VTI, IVC, SVC):

tidal volume, HR, and lung compliance restrictions?

A

TV >= 8 ml/kg

HR < 120

compliance > 30

Other crtieria:

intubated, synchronous with vent

sinus only, no arrhythmia

no intraabd HTN

102
Q

Volume responsivness:

by passive fluid challenge: which method is most accurate?

A

Aortic VTI

NB: oli specifically mentions IVC diameter change is not accurate enough

103
Q

Volume responsivness:

by passive fluid challenge: cutoff for Aortic VTI?

A

> 12%

104
Q

Name that finding!

A

Myxoma

mostly in LA near fossa ovalis

can have a stalk

https://asecho.org/wp-content/uploads/2016/04/4.17-Tighe-Cardiac-Masses.pdf

105
Q

Name that lesion!

A

Papillary fibroelastoma

differentiate from veg by: location in mid valve, usually no valve dysfx

https://asecho.org/wp-content/uploads/2016/04/4.17-Tighe-Cardiac-Masses.pdf

NB: there are tons of case reports about PFEs looking like veg or thrombus and vice versa - so I am guessing it’ll be textbook presentations only on exam

106
Q

TEE ME 4c

Name that finding!

A

Normal PPM lead

NB could probably confuse this an PA catheter easily - PA cath would need another view to show it going further

Almomani A, Siddiqui K, Ahmad M. Echocardiography in patients with complications related to pacemakers and cardiac defibrillators. Echocardiography. 2014 Mar;31(3):388-99. doi: 10.1111/echo.12483. Epub 2013 Dec 17. PMID: 24341293.

107
Q

Name that finding!

A

LVAD inflow cannula

TTE PLAX

NB: I also see a big ol’ pleural effusion

https://www.asecho.org/wp-content/uploads/2018/01/Asch-Echo-Assessment-of-LVADs.pdf

108
Q

what view is used to confirm IABP placement?

A

TEE: ME descending aorta (LAX and SAX)

NB: not sure if you can use TTE

Klopman, Matthew A. MD*; Chen, Edward P. MD†; Sniecinski, Roman M. MD, FASE* Positioning an Intraaortic Balloon Pump Using Intraoperative Transesophageal Echocardiogram Guidance, Anesthesia & Analgesia: July 2011 - Volume 113 - Issue 1 - p 40-43 doi: 10.1213/ANE.0b013e3182140b9a

109
Q

Name that finding!

A

Eustachian valve

Carson W, Chiu SS. Eustachian valve mimicking intracardiac mass. Circulation. 1998 Jun 2;97(21):2188-.

110
Q

PLAX: Name that finding!

A

Type A Dissection. Another pic in short axis:

https://asecho.org/wp-content/uploads/2015/01/2015_Thoracic-Aorta.pdf

111
Q

What cardiac structure is most affected by blunt chest trauma?

A

RV (most anterior structure)

112
Q

Name that finding!

A

Mechanical MV

113
Q

LAA emptying velocity: cutoff that increases thrombus formation?

A

< 20 cm/s

114
Q

What setting do you adjust with contrast echocardiography

A

decrease the mechanical index (aka the power)

at higher mechanical index, the microbubbles get destroyed and you get attenuation

https://www.asecho.org/contrast-zone/the-basics/

115
Q

what TTE view?

A

PLAX RV inflow

NB: I know it’s hard to tell from a still image..

http://pie.med.utoronto.ca/tte/TTE_content/standardViews.html

116
Q

what TTE view?

A

suprasternal long axis

http://pie.med.utoronto.ca/tte/TTE_content/standardViews.html

117
Q

Diastolic dysfunction:

E/A cutoff for normal?

A

0.8

118
Q

Diastolic dysfunction:

E/A cutoff for mild diastolic dysfunction?

A

E/A <= 0.8

119
Q

Diastolic dysfunction:

E/A cutoff for moderate diastolic dysfunction?

A

0.8 < E/A < 2.0

this is pseudonormalization

120
Q

Diastolic dysfunction:

E/A cutoff for severe diastolic dysfunction?

A

E/A >= 2.0

121
Q

Diastolic dysfunciton:

how to measure e’? (mode, location)

A

tissue doppler imaging of mitral annulus

122
Q

Diastolic dysfunction:

E/e’ cutoff for normal?

A

< 10

123
Q

Diastolic dysfunction:

E/e’ cutoff for severe dysfunction?

A

>= 14

124
Q

Diastolic dysfunction:

E/e’ cutoff for moderate dysfunction?

A

10-14

NB: this is how you can differentiate normal from pseudonormal E/A

125
Q

Diastolic dysfunction:

e’ TDI: should you use lateral or septal annulus?

A

lateral annulus

Velocities at the septal ring are probably also affected by the motion of the right ventricle. Thus, many investigators suggest the use of the lateral ring. Studies have shown that those measurements are more closely correlated with filling pressures. However, especially in the presence of regional wall motion abnormalities which may also reduce annular velocity, it is best to use an average of the septal and the lateral E` wave velocity.

https://www.123sonography.com/book/338

126
Q

Amyloidosis:

[…chamber] wall thickening

A

biventricular wall thickening

https://www.brighamandwomens.org/heart-and-vascular-center/procedures/cardiac-amyloidosis-echocardiographic-appearance

127
Q

Amyloidosis:

[…chamber] enlargement

A

bi-atrial enlargement

also you have atrial immobility, follow the link

https://www.brighamandwomens.org/heart-and-vascular-center/procedures/cardiac-amyloidosis-echocardiographic-appearance

128
Q

Takotsubo:

what segments are akinetic?

what segments are hypercontractile?

A

akinesia of the apical and mid-ventricular segments

basal segments are hypercontractile

https://youtu.be/n9HS_Mm5OOA

129
Q

Takotsubo:

dilation of what segment?

A

LV apex

aka apical ballooning

130
Q

Name that finding!

A

LV aneurysm

https://youtu.be/PT7w0wI95Hc

131
Q

LV aneurysm vs pseudoaneurysm: which one has endocardium in the wall?

A

Aneurysm: scarred myocardium and endocardium

pseudoaneurysm wall consists only of the epicardium, pericardium and hematoma

https://radiopaedia.org/articles/left-ventricular-pseudoaneurysm?lang=us

132
Q

Name that finding!

A

perimembranous VSD

https://youtu.be/K7OFrdxRVBc

133
Q

What type of MI is associated with posterior MV tethering?

A

inferior

NB: I think inferior MI causes tethering in general, not just posterior

Video of tethering (coudln’t find a good still): https://youtu.be/JgqOJozoDXY

134
Q

PSAX AV level

Name that lesion!

A

PE

much easier to see in live video: https://youtu.be/-HBA19SYD8Q

135
Q

Pleural effusion:

transudative vs. exudative cutoff in total protein ratio?

A

Transudative: total protein fluid:serum ratio <0.5

136
Q

Pleural effusion:

transudative vs. exudative cutoff in LDH ratio?

A

transudative: LDH fluid:serum ratio <0.6

137
Q

Lung point:

can be seen with what type of pneumothorax?

A

only diagnoses a partial pneumothorax, NOT visible with a complete lung collapse

138
Q

Pneumothorax:

absence of lung sliding - more or less specific in the ICU population?

A

less specificity ie. more false positives.

too many other things can cause absent lung sliding. More reading here: https://rebelem.com/ultrasound-detection-pneumothorax/

139
Q

Pneumothorax:

absence of lung sliding in ICU population: what findings can improve the specificity for diagnosing PTX?

A

absence of B lines

B lines = inflated lung, so if you have no lung sliding but present B lines then unlikely to be pneumothorax.

https://rebelem.com/ultrasound-detection-pneumothorax/

140
Q

Pneumothorax:

A lines: present or absent in PTX?

A

Present

so not a lot of clinical utility in itself for PTX

141
Q

Thoracic ultrasound:

name that finding!

A

Lung consolidation

liver and diaphragm on top. Note the spine sign below consolidated lung

142
Q

Thoracic ultrasound:

name that finding!

A

air bronchograms

143
Q

Thoracic ultrasound:

what air bronchograms are present in pneumonia?

A

Dynamic air bronchograms are present in pneumonia

Statis air bronchograms suggest atelectasis

https://nephropocus.com/2019/07/01/dynamic-air-bronchograms-ultrasound-sign-of-pneumonia/

144
Q

Identify the cricothyroid membrane

A

https://litfl.com/airway-ultrasound-longitudinal-views/

1m youtube with cross sectional views: https://youtu.be/Ot61Z5rx1bI

145
Q

Thoracic ultrasound:

lung pulse to differentiate between mainstem and esophageal intubation?

A

esoph: lung pulse bilaterally
mainstem: lung pulse on L

146
Q

Thoracic ultrasound:

name that finding!

A

pleural thickening

also B lines and pleural roughness. in this setting, think pneumonia but can be also due to scarring, fibrosis, empyema, pleuritis.

147
Q

Paracentesis:

what vessels are these?

A

inferior epigastric

148
Q

Name that finding!

A

splenic injury

149
Q

Name that finding!

A

free fluid in morrison’s pouch

150
Q

Name that finding!

A

white: splenic hematoma
black: fluid in splenorenal recess

151
Q

Name that finding!

A

DVT of the common femoral vein

note that you don’t have to see the clot to diagnose - just noncompressibility is enough

152
Q

Name that finding:

image is of the groin

A

Lymph node.

distinguish from dvt:

LN in xsection will be nodular, not tubular

LN will tend to be superficial

for common fem and popliteal, DVT is paired with artery

https://youtu.be/jRCEdEscqKE?t=399

153
Q

Which probe is in the 5-2 MHz range?

A

curved array

154
Q

Which probe is in the 10-5 MHz range?

A

linear

155
Q

Equation for Nyquist limit?

A

Nyquist limit = Pulse Repetition Frequency (PRF)/2

156
Q

Equation for axial resolution?

A

Axial resolution = spatial pulse length/2

or (# cycles in the pulse x wavelength)/2

minimum distance that can be differentiated between two reflectors parallel to US beam

157
Q

How to reduce aliasing without causing range ambiguity?

A

Decreasing the pulse repetition period (PRP) to increase the PRF and the Nyquist limit

seems like there’s a lot more to it: https://esp-inc.com/techniques-to-avoid-aliasing/

158
Q

Name that finding!

PWD of RVOT

A

Early systolic notching, suggests PE

more here: https://www.ultrasoundgel.org/posts/rKnyrNg993xeihgRkADy5Q

159
Q

AI severity:

pressure half time (ms): cutoff for severe?

A

< 200 ms

160
Q

MR severity: EROA?

A

>0.4 cm2

161
Q

LV function: GLS Normal range?

A

<= - 20%

GLS = (MLs-MLd)/MLd

162
Q

TTE better for?

A

effusion

LV apex

IVC and hepatic veins

chamber quantification

163
Q

TEE better for?

A

shunt

dissection

valve assessments

CPR response

thoracic aorta

MCS placement

164
Q

RV FAC cutoff?

A

<35% is abnormal

165
Q

LVOT VTI cutoff?

A

>18cm is normal

166
Q

IVC collapsibility index vs. Distensibility index?

A

Collapsibility predicts RAP, while distensibility predicts fluid responsiveness

167
Q

Diastolic dysfunction:

Criteria in patients with normal LVEF?

A

Average E/e’ > 14

Septal e’ < 7 cm/s

Lateral e’< 10 cm/s

TR velocity > 2.8 cm/s

LA volume index>34 ml/m2

3 or more criteria indicates dysfunction

168
Q

MAPSE cutoff?

A

>11 in men, >13 in women

Correlates with >=55% LV function

Can’t use with MV disease or MAC

169
Q

E point Septal separation cutoff?

A

>7mm

Associated with EF <=30%

170
Q

Diastolic dysfunction:

Criteria for grade III dysfunction with abnormal EF?

A

E/A >= 2

171
Q

Diastolic dysfunction:

Criteria for grade I dysfunction with abnormal EF?

A

E/A <=0.8 and E <= 50 cm/s

E/A <=0.8 and E >= 50 cm/s OR 0.8<= E/A <= 2 with one of the below criteria

Average E/e’ > 14

TR velocity > 2.8 cm/s

LA volume index>34 ml/m2

172
Q

Diastolic dysfunction:

Criteria for grade II dysfunction with abnormal EF?

A

E/A <=0.8 and E >= 50 cm/s OR 0.8<= E/A <= 2 with TWO of the below criteria

Average E/e’ > 14

TR velocity > 2.8 cm/s

LA volume index>34 ml/m2

173
Q

Sensitivity and specificity for ROSC?

A

sens 92%, spec 80%

Systematic Review, Acad Emerg Med 2012

174
Q

Specificity for 60/60?

A

94%

175
Q

Pericardial effusion size?

A

<0.5cm - < 50mL

<1cm - < 100mL

1-2cm - 100-500mL

>2cm - >500mL

176
Q

FAST free fluid size?

A

thin-250cc

0.5cm-500cc

1cm-1L

177
Q

Pleural effusion size?

A

<0.3cm - 15-30mL

1cm - < 75-150mL

2cm - 300-600mL

>3.5cm - 1500-2500mL

178
Q

B lines indicate?

A

>=7mm apart may be interstitial process, <3mm or confluent more likely alveolar

CUMC Anesthesia CCM (2 decks)

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