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:
The following ultrasound exam is performed on a patient with lower abdominal pain. Please answer the following questions regarding this ultrasound.
i. The ALARA principle is not being adhered to on this ultrasound. What does ALARA stand for? (10pts)
a) As Low As Risk Averted
b) As Low As Reasonably Achievable
c) As Long As Risk Averted
d) As Little As Reasonably Achievable
ii. MI & TI are acronyms for two different measures of the effect ultrasound has on tissue. What do they stand for? (10pts)
a) Medium Index & Thermoregulatory Index
b) Medium Index & Thermal Index
c) Mechanical Index & Thermoregulatory Index
d) Mechanical Index & Thermal Index
iii. What mode should have been used to calculate the fetal heart rate to follow the ALARA principle? (10pts)
a) a-mode
b) b-mode
c) m-mode
d) d-mode
Courtesy of DH
i. The ALARA principle is not being adhered to on this ultrasound. What does ALARA stand for? (10pts)
a) As Low As Risk Averted
b) As Low As Reasonably Achievable
c) As Long As Risk Averted
d) As Little As Reasonably Achievable
ii. MI & TI are acronyms for two different measures of the effect ultrasound has on tissue. What do they stand for? (10pts)
a) Medium Index & Thermoregulatory Index
b) Medium Index & Thermal Index
c) Mechanical Index & Thermoregulatory Index
d) Mechanical Index & Thermal Index
iii. What mode should have been used to calculate the fetal heart rate to follow the ALARA principle? (10pts)
a) a-mode
b) b-mode
c) m-mode
d) d-mode
Courtesy of DH
Question 2
A 77y/o female nursing home patient presents with fever and altered mental status. Her temperature is 102.1, heart rate is 137, and blood pressure is 93/47. On exam the patient is alert but confused. She has no headache or meningmus. Her lungs are clear to auscultation. She winces to palpation of her back. The following image is obtained during a RUSH (Rapid Ultrasound in Shock and Hypotension) exam. What is the next step for the most timely definitive management of this patient? (10pts)
a) 30cc/kg IV fluid bolus of crystalloids
b) CT scan of the abdomen and pelvis with contrast
c) Foley catheter placement
d) Subspecialty consultation for procedural intervention
Courtesy of SI
a) 30cc/kg IV fluid bolus of crystalloids
b) CT scan of the abdomen and pelvis with contrast
c) Foley catheter placement
d) Subspecialty consultation for procedural intervention
Courtesy of SI
Question 3:
A 30 y/o male IV drug user presents with pain in his left lower leg. The patient admits his preferred injection sight is his left foot. The following ultrasound is performed evaluating his anterior left lower leg. What lab information would be helpful to obtain prior to consulting subspecialty services for a suspicion of necrotizing fasciitis? (10pts)
a) CRP, WBC, Hgb, Sodium, Creatinine, & Glucose
b) WSR, WBC, Hgb, Sodium, Creatinine, & Glucose
c) Lactic Acid, WBC, Hgb, Sodium, Creatinine, & Glocuse
d) None of the above
Courtesy of AR
a) CRP, WBC, Hgb, Sodium, Creatinine, & Glucose
b) WSR, WBC, Hgb, Sodium, Creatinine, & Glucose
c) Lactic Acid, WBC, Hgb, Sodium, Creatinine, & Glocuse
d) None of the above
Courtesy of AR
Question 4:
A 16 y/o female presents with right lower quadrant pain and anorexia. You do a bedside ultrasound which is shown above. Which of the following findings is least consistent with a diagnosis of appendicitis? (10pts)
a) 7mm noncompressible, blind tubular structure with a 2mm wall thickness
b) 8mm noncompressible, blind tubular structure with periappendiceal fluid
c) 7mm compressible, blind tubular structure with peristalsis
d) 6.5mm non compressible, blundstructure with an appendicolith
Courtesy of RB & DH
a) 7mm noncompressible, blind tubular structure with a 2mm wall thickness
b) 8mm noncompressible, blind tubular structure with periappendiceal fluid
c) 7mm compressible, blind tubular structure with peristalsis
d) 6.5mm non compressible, blundstructure with an appendicolith
Courtesy of RB & DH