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 (B8)
Question 1:
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A cancer patient presents with shortness of breath and hypotension. What is the next best step that will most definitively improve this patients condition? (5pts)
A - IV fluids B - Pressors C - Pericardiocentesis D - Thrombolytics EC - What cardiac view is being shown? (5pts) A - SubX B - PSL C - PSS D - Apical Courtesy of BC |
Question 2:
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A cancer patient presents with shortness of breath and hypotension. What is the next best step that will most definitively improve this patients condition? (5pts)
A - IV fluids B - Pressors C - Pericardiocentesis D - Thrombolytics EC - What cardiac view is being shown? (5pts) A - SubX B - PSL C - PSS D - Apical Courtesy of JC |
Question 3:
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A cancer patient presents with shortness of breath and hypotension. What is the next best step that will most definitively improve this patients condition? (5pts)
A - IV fluids B - Pressors C - Pericardiocentesis D - Thrombolytics EC - What cardiac view is being shown? (5pts) A - SubX B - PSL C - PSS D - Apical Courtesy of JC |
Question 4:
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A cancer patient presents with shortness of breath and hypotension. What is the next best step that will most definitively improve this patients condition? (5pts)
A - IV fluids B - Pressors C - Pericardiocentesis D - Thrombolytics EC - What cardiac view is being shown? (5pts) A - SubX B - PSL C - PSS D - Apical Courtesy of JC |
Question 5:
A 85 y/o demented male presents from the nursing home with weakness, increased confusion, and foul smelling urine. His vitals are a temperature of 39.5, blood pressure of 70/40, heart rate of 120 (afib), a respiratory rate of 28, and sating 92% on RA. He receives a 30cc/kg bolus of IVF and remains hypotensive. The following ultrasound is performed. What would be the next appropriate step in management? (5pts)
A - 10cc/kg bolus of IVF B - 20cc/kg bolus of IVF C - Norepinephrine E - Digoxin EC - What is the measurement threashold for EPSS? A - 5mm B - 6mm C - 7mm D - 8mm Courtesy of JH |
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Question 6:
A 25 y/o female who is 8 weeks pregnant presents with nausea and vomiting. Her vitals are a temperature of 37.5, blood pressure of 80/40, heart rate of 120 (sinus), a respiratory rate of 28, and sating 99% on RA. She receives a 20cc/kg bolus of normal saline and her blood pressure improves. The following ultrasound is performed. What would be the next appropriate step in management? (5pts)
A - Another 20cc/kg bolus of normal saline followed by dextrose saline B - Another 20cc/kg bolus of normal saline followed by lactated ringers C - Metoclopramide E - Pyroxidine EC - What % collasibility in a spontaneously breathing patient correlates with a CVP < 7mmHg? A - <50% B - >50% C - <18% D - >18% Courtesy of JC |
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Question 7: What am I looking at?
A 65 y/o male with a history of afib on coumadin presents after falling off a roof. The patient is confused, opens his eyes when you talk to him, and moves his right arm as a nurse places an large bore IV in it. His vitals are a temp of 37.7, a blood pressure of 70/40, a heart rate of 140 (sinus), a respiratory rate of 28, and an oxygen saturation of 82%. The following ultrasound is performed during his primary survey. What is the most appropriate step in management? (5pts)
A - Intubation B - Apply a NRB mask C - Needle decompression D - Chest tube thoracostomy EC - What mode is being used on this ultrsound? (5pts) A - Amode B - Bmode C - Dmode D - Mmode Courtesy of ET & RT |
Question 8:
A 40 y/o male patient presents with 2 weeks of intermittent epigastric pain after he eats. He has some nausea but no vomiting. He has some mild discomfort to palpation of his abdomen. His vitals are normal and he has no past medical history and has a history of an appendectomy when he was 6. His labs are unremarkable and the following ultrasound is performed. What is the most appropriate step in this patient's management? (5pts)
A - Reassurance and follow-up with his primary care doctor B - Urgent surgical consult C - Emergency surgical consult D - Admission to the hospitalist for serial examinations EC - What is the wall thickness measurement threshold for acute cholecystitis? A - 2mm B - 3mm C - 6mm D - 7mm Courtesy of JH |
Extra Credit
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Answer the following (10pts):
What anatomical region of the body is being evaluated here? (Courtesy of MF) |