A 35 year old female was brought in after a motor vehicle collision. She was the unrestrained driver in the accident and a passenger in her car died at the scene. Her blood pressure is 74/46, heart rate is 132, temperature 98.2, oxygen saturation 98% on room air. Nurses have already started giving her the fluid bolus you ordered. She is complaining of abdominal pain. Her FAST (Focused Assessment with Sonography in Trauma) was positive for free fluid in Morison's Pouch. What do you do now?
A. Call the trauma surgeons for an emergent exploratory laparotomy
B. Continue to search for other causes of unstable vitals and pain
C. Give her morphine and re-assess her abdominal pain in 10 min
D. Reassure her that her abdominal pain is likely from her seat belt and is common in motor vehicle accidents
When performing a Trans-abdominal US in pregnancy which statement is most accurate?
A. Air filled bowel loops always appear to move with peristalsis
B. An empty bladder provides an optimal acoustic window.
C. A full bladder provides and optimal acoustic window
D. Fluid filled bowel loops appear fixed in the pelvis
A 30-year old male presents to the emergency department with right flank pain, dysuria and hematuria. After intravenous fluid hydration and analgesia, a bedside renal ultrasound shows mild right-sided hydronephrosis. An aortic ultrasound is within normal limits. Which of the following statements is correct regarding this patient?
A. CT scanning can be avoided as a stone would be likely to pass spontaneously
B. CT scanning should be obtained as a stone would not likely pass spontaneously
C. There is a high grade ureter obstruction present
D. There is direct correlation of renal function with the degree of hydronephrosis
You are performing a Focused Assessment with Sonography in Trauma (FAST) exam. While trying to evaluate the splenorenal space, you are having trouble due to overlying ribs. How can you improve your visualization?
A. Have the patient turn on their side
B. Instruct the patient to perform a valsalva maneuver
C. Place your knuckles on the bed and turn probe obliquely
D. Use a larger probe
An 18 year old female presents with abdominal pain and vaginal bleeding. A bedside pregnancy test is positive. Your bedside US reveals free fluid in Morison's Pouch and a suspicious adnexal mass. She is hemodynamically stable and her Beta HCG is in process. What is the most appropriate course of action?
A. Immediate surgical evaluation irrespective of the beta
B. Preform formal ultrasound only if the Beta is above the discriminatory zone of 1500
C. Preform formal ultrasound only if the Beta is below the discriminatory zone of 1500
D. Next day follow up is appropriate if the beta is less than 100
You have a hemodynamically unstable who has an abdominal aortic aneurysm on ultrasound exam, but you do not identify free fluid on your FAST exam, you next step in management should include:
A. Call vascular surgery and prepare for operative management
B. Consider other causes of hemodynamic instability
C. Obtain a CT scan to rule out rupture
D. Perform serial FAST exams
A 23-year old male presents to the emergency department with sudden onset of left flank pain radiating to the groin, nausea, and vomiting. When performing bedside renal ultrasound for evaluation of the patient's symptoms, the goal of your study is to:
A. Determine the length and width of each kidney
B. Evaluate for secondary findings such as hydronephrosis
C. Identify the specific renal stone within the kidney
D. Visualize a stone within the ureter
What is the most specific sign of pneumothorax?
B. Comet Tail
C. Lung Point
When performing the gallbladder exam, the patient can be placed in which position to aid visualization?
A. Full Exhalation
B. Left Lateral Decubitus
D. Right Lateral Decubitus
Which of these mistakes in the performance of an abdominal aorta ultrasound if likely to result in an overestimation of the diameter?
A. An off center cut of the aorta in long axis
B. Applying excess pressure to the patients abdomen during the exam
C. Measuring from the inner lumen to inner lumen of the abdominal aorta
D. Mistakenly measuring a dilated inferior vena cava in the short axis
A nurse calls you to the bedside of an obese patient with abdominal pain. He is unable to insert a peripheral IV and asks for your assistance. You decide to use ultrasound to identify a peripheral vein to cannulate. How do you distinguish between the brachial from the basilic veins?
A. The brachial veins are more lateral and have an accompanying artery
B. The basilic vein is more lateral and does not have an accompanying artery
C. The brachial veins are more medial and have an accompanying artery.
D. The basilic vein is more lateral and does not have an accompanying artery
According to ACEP, how many credentialed exams are required before a clinician may begin to utilize a particular ED ultrasound application in routine clinical work?
A 95 year old male presents to the Emergency Department with right upper quadrant pain. When evaluating his gallbladder, which of the following findings on ultrasound is abnormal?
A. Anterior wall thickness of 8 mm
B. Common bile duct diameter of 8 mm
C. Posterior wall thickness of 8 mm
D. Portal vein thickness of 8 mm
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