Ultrasounds Of The Block
Welcome to SIU's EM Residency "Ultrasounds of the Block" curriculum (formerly known as "Ultrasound of the Month"). First instituted as a friendly competition to spark increased volume of bedside studies, it has now become a melee of ultrasound fun. As part of an asynchronous curriculum in emergency ultrasound, all ultrasounds performed at our clinical sites are reviewed for quality assurance by ultrasound director. Each block a few images/clips are selected because of an interesting finding, a high quality image showing great anatomy, or because they carry an important teaching point. These “Ultrasounds of the Block” are then displayed online with clinical vignettes and questions to test residents and their knowledge. The competition aspect of the curriculum is that residents gain points by performing any selected "Ultrasounds of the Block" and for answering monthly questions correctly. Each year a winner is announced based on overall points and surprised with trophy gifts to cherish and gloat about for the many years to come.
Past "Ultrasounds of the Block" can be viewed by clicking here. This blocks "Ultrasounds of the Block" can be viewed below.
Ultrasounds Of The Block (B7)
Question 1:
A dialysis patient presents to the emergency department with altered mental status. They have a temperature of 37.2, respirations of 18, a heart rate of 98, and a blood pressure of 106/65. They are saturating 95% on RA. A POC lactic returns a value of 1.6. They have no meningmus, no rashes, and no evidence of skin sores or changes. The following ultrasound is performed on the patient as part of their assessment. Based upon the images obtained, what physical exam finding would help in identify an urgent need for dialysis? (10pts)
a) lower extremity swelling
b) bibasilar cracklers
c) audible friction rub
d) dry mucous membranes
Courtesy of AS
a) lower extremity swelling
b) bibasilar cracklers
c) audible friction rub
d) dry mucous membranes
Courtesy of AS
Question 2
The following ultrasound is performed on a patient with nausea, vomiting, and abdominal pain. The probe is placed around the area where the patient states they feel the most pain. What ultrasound findings would suggest an incarcerated hernia leading to bowel obstruction as the cause of this patients symptoms. (10pts)
a) dilated loops of bowel, thin bowel wall, free fluid in the hernia sac, peristalsis, no doppler flow around vizualized bowel
b) dilated loops of bowel, thick bowel wall, no free fluid in the hernia sac, lack of peristalsis, no doppler flow around vizualized bowel
c) dilated loops of bowel, thick bowel wall, free fluid in the hernia sac, lack of peristalsis, doppler flow around vizualized bowel
d) dilated loops of bowel, thin bowel wall, no free fluid in the hernia sac, peristalsis, doppler flow around vizualized bowel
Courtesy of SB & RS
a) dilated loops of bowel, thin bowel wall, free fluid in the hernia sac, peristalsis, no doppler flow around vizualized bowel
b) dilated loops of bowel, thick bowel wall, no free fluid in the hernia sac, lack of peristalsis, no doppler flow around vizualized bowel
c) dilated loops of bowel, thick bowel wall, free fluid in the hernia sac, lack of peristalsis, doppler flow around vizualized bowel
d) dilated loops of bowel, thin bowel wall, no free fluid in the hernia sac, peristalsis, doppler flow around vizualized bowel
Courtesy of SB & RS
Question 3:
The following lung ultrasound is performed on a tall very thin patient with dyspnea. They are tachycardiac, tachypneic, and hypoxic. It is difficult to hear breathsounds on the side where this ultrasound is being performed. What findings seen on this ultrasound suggest this patient does not have a pneumothorax as a cause of their symptoms. (10pts)
a) presence of a pleural slide
b) lack of a pleural slide
c) reverberation artifact
d) presence of a lung point
Courtesy of AS
a) presence of a pleural slide
b) lack of a pleural slide
c) reverberation artifact
d) presence of a lung point
Courtesy of AS
Question 4:
The following ultrasound is performed on a patient with groin pain. They have a temperature of 38.2, respirations of 20, a heart rate of 92, and a blood pressure of 98/65. What is the next best step for definitive management? (10pts)
a) bedside I&D
b) IV fluids
c) surgical consultation
d) CT scan
Courtesy of RL
a) bedside I&D
b) IV fluids
c) surgical consultation
d) CT scan
Courtesy of RL