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...POCUS > Numbers > Flashcards

Numbers Flashcards

1
Q

LV Ejection Fraction - Normal to Severe dysfunction in %

A

> 70% Hyperdynamic >55% Normal 40-55% - Mild reduction in LVEF 30-40% - Moderate Reduction in LVEF <30% - Severe Reduction in LVEF

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2
Q

E Point Septal Separation (EPSS)

A

Normal 2-7 mm, >7mm is usualyl pathological for LVEF reduction. Measured in PSLA

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3
Q

Simpson’s Biplane Method

A

EF = (EDV - ESV) / EDV Need orthogonal views of LV in 4CH and 2CH views

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4
Q

Fractional Shortening

A

FS% = (LVEDD - LVESD) / LVEDD x 100% LV Internal Diameter measured in PSLA Normal LVEF - 25-45% Mild reduced - 20-24% Moderately reduced - 15-19% Severe - <14% Not great if there are regional wall motion abnormality, LBBB, off axis, dysynchronous contraction

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5
Q

Cardiac Output Method (VTI/LVOT)

A

CO = SV x HR SV = flow x area VTI (Velocity Time Integral) x (LVOT^2 x pi/4) x HR Normal CO = 3.6 L/min, VTI ~ 20cm, LVOT ~ 2cm Measured in A5CH and PSLA

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6
Q

Tricuspid Annular Plane Systolic Excursion (TAPSE)

A

TAPSE measured by M-mode Measured between end-diastole and peak systole TAPSE < 17 mm is highly suggestive of RV systolic dysfunction

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7
Q

RV Function - S’ (TASV - Tricuspid Annular Systolic velocity)

A

S’ - movement of RV using PW Doppler on RV lateral wall >10cm/s is normal <10cm/s indicates some RV dysfunction

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8
Q

MAPSE

A

Mitral Annular Plane Systolic Excursion Normal > 10mm, <8mm Abnormal

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9
Q

Characterization of Pericardial Effusion

A

Characterization of Pericardial Effusion (measure in diastole) Trivial - Posterior AV groove Small <10mm Moderate <20mm Large > 20mm, surrounds heart

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10
Q

Thoracic and Abdominal Aorta Measurements

A

Aortic Root (Sinus of Valsalve) <45mm Aortic Root (Sinotubular junction) <36mm Aortic Arch (just proximal to innominate artery) <36mm Abdominal Aorta <3cm

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11
Q

Risk of Rupture for AAA based on size

A

Risk of Rupture 3-4cm - 0.5% 4-5cm - 1% 5-6cm - 3% 6-7% - 9-10% >7cm - 25%

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12
Q

Ultrasonographic features of Deep Vein Thrombosis (DVT)

A

Non-compressible under pressure Hyperechoic vasculature Color Augmentation - increase flow with calf muscle contraction Spectral Doppler/PWD - increase flow with calf contraction Phasic Flow/Valsalva Should have changes in velocity with breathing Vessels proximal to clot won’t have this change while vessels distal to clot should

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13
Q

US Features of a Baker’s Cyst

A

Posterior knee, usually proximal to trifurcation of PV ‘Speech Bubble’ appearance

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14
Q

IVC measured and corresponding CVP

A

<2cm and phasic - hypovolemic (3mmHg) >2cm and plethoric - hypervolemic (8mmHg) <2cm plethoric/>2cm phasic - ?Euvolemic (15mmHg)

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15
Q

RV Systolic Pressure and RV EF (also used for 60/60 Rule)

A

?Low Yield Assess RV Function by assessing RVSP, using modified Bernoulli Equation. 4xV^2 (measure flow with doppler in 4CH view) 4 x velocity^2 Peak at level at TV within the RV Pulmonary Artery Systolic Pressure 4V ^2 + Right atrial Pressure

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16
Q

US Features of Cardiac Tamponade

A

RA Systolic Collapse RV Diastolic Collapse Plethoric IVC Respiratory Variation in Valvular Flow (>25% in TV, >15% in MV ) Large PCE

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17
Q

Correlate ECG leads to Wall motion abnormalities on 4CH/PSLA/PSSA view

A

LAD

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18
Q

US Features of Pulmonary Embolism

A

McConnell’s Sign (Hyperdynamic Apex) Distended RV Thrombus in RV Plethoric IVC DVT on LE Doppler, or VTE in IVC Pleural Effusion Focal B lines Subpleural consolidation > 0.5cm, <3cm <0.5cm, viral, atelecstasis >3cm, CA, PNA

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19
Q

60/60 Rule for PE

A

PA Systolic Pressure <60 + Pulmonary Acceleration time <60ms 96% Sp for PE if both present PASP

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20
Q

What is McConnell’s sign?

A

Hyperkinesis of RV apex with hypokinesis of RV wall, often with Rv dilation

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21
Q

How to calculate size of Pleural Effusion?

A

Pleural Effusion Quantification Balik = distance between viseceral and parietal pleura in mm x 20 = mL (Probe is transverse)

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22
Q

Bosniak Criteria for Renal Cysts

A

Renal Cyst Classification (Bosniak) I(0% CA) - Thin wall, Simple fluid II (5% CA) - Thin septa, IIF - Irregular wall, >3cm in size, multiple septa III(50% CA) - Thick septa, calcifications, or mass >3cm IV (100% CA) - Soft tissue components with enhancement

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23
Q

Normal Kidney measurements

A

Length 9-13cm Width 5cm Depth 3cm

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24
Q

Describe the stages of hydronephrosis

A

I - Renal pelvic dilation alone II - Pelvis and caliceal dilation. medulla and cortex and normal (Major Calices) III - Meduall is short and thin, cortex normal (Minor Calices) IV - Cortex is thin, <2mm, no corticomedulary dilation (Cortical Thinning) I is mild, II-III is moderate, III-IV is severe

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25
Q

Ultrasonographic Features of Acute Cholecystitis

A

2/3 for Cholecystitis Gallbladder wall thickening >3mm Pericholecystic fluid GS Sonographic Murphy’s CBD <7mm is normal

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26
Q

US Features of Appendicitis

A

Blind-Loop Non compressible No peristalsis >6mm in diameter Wall thickness >3mm Echogenic/periappendiceal fat ring of fire/HJyperemia of appendix appendicolith targetoid appearance on TV view Sonographic tenderness over RLQ RLQ Free Fluid/Periappendiceal fluid collection

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27
Q

US Features of Pyloric Stenosis

A

US Features Muscle thickness >3mm Channel length >17mm Cross section diameter >15mm

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28
Q

US Features of Intussussception

A

US features Pseudo-kidney mass Target Sign +/- color - if no color could be sign of ischemia

29
Q

US Features of Diverticulitis

A

US Thick walled outpouching with hypoechoic thickening of adjacent bowel Increased vascularity

30
Q

US Features of SBO

A

Thin gut wall with hyperperistalsis To and Fro Movement of intraluminal contents Piano key sign - prominent Plicae Circularis Distal bowel may be small than proximal bowel

31
Q

Bladder volume calculation

A

Bladder Size LxWxH x 0.7 (constant will change depending on shape) constant will range from 0.5-0.7 depending on source

32
Q

Criteria for IUP transabdominally

A

Criteria for IUP transabdominally discriminatory zone for TV US is >1500-3000 mIU/ml, 3000-6000 for TA Uterine-Bladder Juxtaposition Gestational sac > 25mm Fetal Pole/Yolk Sac 5mm of uterine tissue in all planes (Myometrial Mantle) Decidual Reaction - Heterogenous tissue around GS, thicker endometrium around HS +/-FHR

33
Q

Findings Diagnostic for Pregnancy Failure (Doubilet et al. 2013 NEJM)

A

Findings Diagnostic for Pregnancy Failure (Doubilet et al. 2013 NEJM) Crown rump length >7mm and no FHR Mean GS Diameter > 25mm and no embryo Absence of Embryo >2wk after scan showing GS Absence of Embryo >11d after scan showing GS with YS

34
Q

Findings suspicious for Pregnancy Failure, but not diagnostic

A

Findings suspicious for Pregnancy Failure CRL < 7mm and no FHR Mean Sac diameter 16-24mm and no embryo No Embryo 6-10d after scan showing GS+YS No Embryo 6wk after LMP Empty Amnion Enlarged YS >7mm Small GS in relation to Embryo

35
Q

US features of Gestation Trophoblastic Disease (Molar Pregnancy)

A

US Features Snowstorm

36
Q

US Features of Ovarian Torsion

A

Ovarian enlargement, usually >5cm or with a mass/cyst Decreased doppler flow, absent doppler flow but not sensitive, can have torsion even with doppler flow Causes of FN Dual blood supply from uterine artery and ovarian artery Torsion/detorsion incorrect PRF/gain

37
Q

US features of a normal Ovary

A

Normal Ovary is 2.5-5cm long, 1.5-3cm wide, and 0.5-1.5cm thick Normal to have Corpus Luteal cysts <2.5cm before it can be called an irregular ‘cyst’, can still be physiologic

38
Q

US Features of Hemorrhagic Cyst

A

Cyst >2.5cm, anechoic, can look like normal cyst larger ovarian cyst, difficult to differentiate initially later on may see features of clotting blood Lysis, septations, retraction, thickened rim Can hemorrhage into the cyst, or into the pelvis

39
Q

US Features of Retain Products of Conception (RPOC)

A

US Findings Thickened Endometrium > 10mm Endometrial/Intrauterine Mass with Internal vascularity Should visualize endometrial strip, don’t confuse with myometrium

40
Q

US Features of Fibroids

A

Well defined, solid mass with circumferential doppler vascularity. usually <8cm Can be iso or hypoechoic, may distort uterus, may have shadowing Can be complicated by Calcifications, Cystic Degerenation (complex), necrosis (Avascular)

41
Q

When to use CRL vs BPD to assess Gestational AgeÉ

A

Crown Rump Length Up to 12-14wks, or 85mm Biparietial Diameter >12-14 wks GA, or >85mm CRL

42
Q

List 5 structures from most echogenic to least

A

Darling Parents so love Kids [more to less] Diaphragm > Pancreas > Spleen > Liver > Kidney(cortex)

43
Q

Describe the Following Signs for Lung US Bar-code Sign Lung Point Lung Sliding Seashore Sign Bat Sign Quad Sign/Sinusoid Sign Hepatization Shred Sign/Fractal/Tissue Like sign Pleural Shred Lung Flapping Hematocrit sign

A

Bar-code Sign

44
Q

Features of Pleural Malignancy on POCUS

A

Pleural thickening > 10mm Diaphragmatic pleural thickening > 7mm Pleural Nodularity

45
Q

How to Measure Optic nerve sheath diameter (ONSD) and normal measurements

A

Want to get about 15 degrees off axis laterally from pupil to lens Measure 3mm deep >5-6mm is abnormal, <4-5mm in kids Papilledema - if Bulging Optic nerve

46
Q

Compare/Contrast Retinal Detachment vs Vitreal detachment

A

VD

47
Q

US Features of Globe Rupture

A

Absense of anterior chamber nonsphreical glab of globe (guitar pick/ovoid shape) blood in posterior chamber Retinal detachment retrobulbar hematoma

48
Q

US findings of Epididymitis

A

Epididymitis Enlarged hypoechoic epididymis Hyperemia of epididymis Reactive Hydrocele Scrotal wall thickening

49
Q

US findings or orchitis

A

Orchitis US findings Enlarged hhypoechoic testicle, Hyperemia of testicle, Decrease Arterial resistance

50
Q

US findings of testicular Torsion

A

Enlarged, hypoechoic compared to contralateral Decreased vascular flow on power doppler decreasing PRF (Color scale) can optimize image to assess slower flows

51
Q

US Features of Malignancy Thyroid Nodule

A

Higher Risk for Malignancy Solid > Cystic Hypoechoic > Hyperechoic Poorly demarcated > Well defined edges Calcifications > no calcifications Bigger > Smaller

52
Q

Indications to Biopsy thyroid nodule

A

Nodule >1cm with microcalcifications Nodule > 1.5cm that is predominantly solid Nodule > 2cm with mixed components Nodule demonstrating growth Nodule with ipsilateral abnormal LN (>7mm in short axis)

53
Q

US Features of Thyroiditis (Hashimoto’s Graves)

A

Hypervascularity (Thyroid Inferno) Diffusely hypoechoic, inhomogenous

54
Q

Name the Salivary Glands

A

Parotid Glands (higher up, adjacent/anterior to Ears) Drained by Stensen’s duct into oral cavity Submandibular Glands Beneath jaw and within level I of neck drained by Wharton’s Duct Sublingual Glands Beneath tongue, anterior and superior to submandibular gland

55
Q

List 3 Extrinsic Neck Masses/cysts

A

Thyroglossal Duct Cyst Most Common midline neck mass, seen in adolescents with URTIs Branchial Cleft Cyst Solitary cystic mass on Lateral aspct of neck at angle of mandible under SCM Remnant of embryonic development May be connected to mouth and lead to infections Zenker’s Diverticulum Esophogeal outpouching Cystic Hygroma Congenital lymphatic malformation, often seen at birth Associated with Turner’s Syndrome, Down’s syndrome, Klinefelter(XXY), Trisomy 18, Trisome 13

56
Q

US of Cellulitis

A

US Features of Cellulitis Cobblestoning Hyperemia Thickening of Dermis

57
Q

US features of an abscess

A

US features of Abscess Anechoic/Complex COllection Swirl Sign Hyperemia Thickening Capsule

58
Q

US features of Necrotizing Fasciitis

A

US Features (STAFF - Subcutaneous thickening, Air, Fasicial Fluid) Subcutaneous thickening Air in tissue Shadowing, Dirty Shadowing Fascial Fluid >4mm of fluid, deeper and adjacent to Fascia A Lines in skin tissue

59
Q

US features of Fat necrosis

A

Fat Necrosis Variable appearance, poorly demarcated, often posterior enhancement, solid/cystic components

60
Q

US findings of Lipoma

A

Isoechoic to subcut fat, Encapsulated, Linear Reflectors, compressible, avascular ?PAthology, ?Melanoma, ?Lipsarcoma features Heterogenous, Focal hyperechogenicity, vascularity

61
Q

US findings of an inclusion cyst

A

Epidermal components entering the dermis, usually through minor trauma/scratch US findings Avascular, homogenous, +/- hyperechogenic foci, hypoechoic clefts, ‘pseudotestes sign’

62
Q

US of a Lymph node

A

Normal US 0.5-2cm in size Oval, homogenous with hyperechogenic hilum hilar vascularity perinodal edema

63
Q

High risk features of breast cyst for Malignancy

A

Malignant Features Marked Hypoechogenicity Taller > Wide Angular MArgins Spiculated Contour Posterior Acoustic Shadowing, Punctate Calcifications, Duct Extension BRanch Pattern Multilobulations Benign Features on US Intense Uniform hyperechogenicity vs fat Wider than tall (long axis) Thin echogenic capsule Gentle Lobulations

64
Q

Describe the RUSH Protocol

A

Perera, P. et al. 2010. EMCNA. The RUSH Exam

65
Q

Decribe the Blue Protocol

A

3 point longitudinal scan bilaterally in

66
Q

Describe the FALLS Protocol

A

Lichenstein, D. 2013. Heart, Lung and Vessels. FALLS-protocol

67
Q

Describe the SESAME protocol

A

Lichtenstein, D. 2015. AIT. Critical care ultrasound in cardiac arrest. Technological requirements for performing the SESAME-protocol — a holistic approach Least Disruptive for CPR Lungs for PTX, B lines Legs for DVT Belly for FF Heart for Tamponade, Cardiac STandstill

68
Q

Describe the ABCDE Protocol

A

ACBDE protocol. Adding TTE to assess for Volume status in trauma patients. ‘Full Heart’ & Plethoric IVC in hypotensive patient vs Hyperdynamic Heart + Flat IVC Hemorrhagic Shock vs. TBI, CHF/MI/LVFailure, Spinal Shock, PE, Stroke

69
Q

High risk findings for malignancy on a Thyroid US. Indications to Biopsy

A

Higher Risk for Malignancy Solid > Cystic Hypoechoic > Hyperechoic Poorly demarcated > Well defined edges Calcifications > no calcifications Bigger > Smaller Nodule >1cm with microcalcifications Nodule > 1.5cm that is predominantly solid Nodule > 2cm with mixed components Nodule demonstrating growth Nodule with ipsilateral abnormal LN (>7mm in short axis)

...POCUS (7 decks)

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