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Hopefully you’ll have watched our lung ultrasound talk(s) and done the readings before hitting these questions. Some of them are basic concepts and anatomy, but some are more real-life cases. There are twenty questions in all, enjoy!!
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Nice job, you knocked that out. If you scored less than 80%, I’d suggest that you circle back and watch the lectures again.
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Question 1 of 17
1. Question
True or False: Chest X-ray has superior diagnostic accuracy in supine trauma patients when compared to lung ultrasound?
Correct
Yep. Lung ultrasound IS better than chest X-ray for identifying pneumothorax. With one exception – WE have to do it rather than clicking a box for someone else to do. Hence…slower uptake. If you’re interested you can check out this Cochrane review: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013031.pub2/full
Incorrect
Ohhhh, sorry, no! Lung ultrasound IS better than chest X-ray for identifying pneumothorax. With one exception – WE have to do it rather than clicking a box for someone else to do. Hence…slower uptake. If you’re interested you can check out this Cochrane review: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013031.pub2/full
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Question 2 of 17
2. Question
What are the implications of identifying lung sliding?
Correct
Lung sliding means that the visceral and parietal pleura are sliding against each other, you’re exactly correct!
Incorrect
Nope, sorry! Lung sliding means that the visceral and parietal pleura are sliding against each other. It excludes pneumothorax at the location of the probe. With effusion or hemothorax you’d see fluid between the layers.
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Question 3 of 17
3. Question
Which of the following can create the ABSENCE of lung sliding? (check all that apply)
Correct
Yep, they’re all correct! Keep ’em in mind.
Incorrect
Nope. These are ALL correct. Keep ’em in mind.
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Question 4 of 17
4. Question
What is indicated by the presence of a lung pulse?
Correct
Boom, you got it! Be careful not to mistake “hand-jiggles” for lung pulse, but otherwise it has similar implications to lung sliding in terms of excluding pneumothorax.
Incorrect
Lung pulse is essentially “mini lung sliding” and has similar implications with regard to exclusion of pneumothorax.
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Question 5 of 17
5. Question
Which is NOT true of B lines?
Correct
You got it, well done!
Incorrect
Take another look at this content, B-lines are not straightforward but this is important. Hang in there!
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Question 6 of 17
6. Question
How do we interpret the presence of an A-line on lung ultrasound?
Correct
You’re absolutely correct! This is an important one, so be sure you’re clear. An A-line is a normal finding, but it does not mean everything is normal. You should seek to create an A-line in your anterior and lateral lung imaging to ensure you’re perpendicular to the pleura. The A-line is a reverberation artifact from the pleura when there is air under the pleura, but it can be normal aerated lung or pneumothorax. To say that again, A-lines can co-exist with pneumothorax.
Incorrect
Not exactly. This is an important one, so be sure you’re clear. An A-line is a normal finding, but it does not mean everything is normal. You should seek to create an A-line in your anterior and lateral lung imaging to ensure you’re perpendicular to the pleura. The A-line is a reverberation artifact from the pleura when there is air under the pleura, but it can be normal aerated lung or pneumothorax. To say that again, A-lines can co-exist with pneumothorax.
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Question 7 of 17
7. Question
What is shown in this anterior lung image?
Correct
You’ve got it, well done! This is a basically-normal anterior lung image. You can clearly see a rib, so we know we’re seeing the pleura. We have pleura “horizontal” on the screen and we’re showing an A-line, so we’re nice and perpendicular to the pleura. Our gain is low and the clip is long enough to show a respiratory cycle. Make your anterior and lateral images like this!
Incorrect
Drat, you were so close. But this is a basically-normal image. We see good lung sliding, no evidence (in this clip, of course) of effusion or pnueumotorax.
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Question 8 of 17
8. Question
What conclusions can be made based on this image? (check all that apply)
Correct
Nicely done, you’re a rockstar! This image shows lung sliding with several B-lines. Both of those findings exclude pneumothorax at the location of the probe.
Incorrect
Double check this one, eh? This image shows lung sliding with several B-lines. Both of those findings exclude pneumothorax at the location of the probe.
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Question 9 of 17
9. Question
What is indicated by the arrow?
Correct
Yep, you got it! This is basic anatomy, but it’s important. Keep up the good work!!
Incorrect
Well…no, not exactly. This is the intercostal muscle. Basic stuff, you probably just mis-clicked, right?
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Question 10 of 17
10. Question
What is indicated by the arrow?
Correct
Absolutely! Because you see lung sliding, you know the pleural and visceral pleura are in apposition. But you knew that…
Incorrect
Maybe this question was a little unfair. The idea here is that we see lung sliding, so we know the visceral and parietal pleura are in apposition.
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Question 11 of 17
11. Question
What is indicated by the arrow?
Correct
Incorrect
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Question 12 of 17
12. Question
Which of the following are likely at the location of the ultrasound probe? (check all that apply)
Correct
You got it! This image shows clear evidence of pathological B-lines (more than 3 in this interspace.) B-lines suggest increased lung density, and do not co-exist with pneumothorax or effusion at the location of the probe.
Incorrect
Well. No. But these multiple-multiple questions can be hard. This image shows clear evidence of pathological B-lines (more than 3 in this interspace.) B-lines suggest increased lung density, and do not co-exist with pneumothorax or effusion at the location of the probe.
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Question 13 of 17
13. Question
Which of the following are likely at the location of the ultrasound probe? (check all that apply)
Correct
Very well done! B-lines (when 3+ at a space) suggest increased lung density, and do not co-exist with pneumothorax or effusion at the location of the probe.
Incorrect
Multiple-multiples are always hard, I’m sure you basically knew the answer. As a reminder…B-lines (when 3+ at a space) suggest increased lung density, and do not co-exist with pneumothorax or effusion at the location of the probe.
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Question 14 of 17
14. Question
What is demonstrated in this left lung-base image? (check all that apply)
Correct
Perfect, well done!
Incorrect
OK, that’s not quite right but I’m just certain you were close. This image shows both a curtain sign and absence of spine sign. Neither of those are consistent with pleural effusion. Also, the appearance “above” the diaphragm that looks a little like consolidated lung is actually a mirror-image artifact of the spleen (not consolidation.) It’s rare for consolidation to be right up against the diaphragm (there’s usually some amount of fluid in between) and consolidated lung would create a positive spine sign.
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Question 15 of 17
15. Question
Your patient is hypoxic in the PACU, whatcha gonna do? Yes, that’s correct, you do lung ultrasound. The question (ultimately) is what’s going on? The first image is right anterior lung.
The second image is left anterior lung.
The 3rd image is left lateral lung.
Correct
This is a great case, nice job! We see lung sliding in the right anterior lung field with no sliding in the anterior left. That’s concerning for pneumothorax, but not diagnostic. Moving the probe laterally, though, and demonstrating a left lateral lung point IS highly specific for pneumothorax. That’s what this was.
Incorrect
Give this one another look, it’s an important case. We see lung sliding in the right anterior lung field with no sliding in the anterior left. That’s concerning for pneumothorax, but not diagnostic. Moving the probe laterally, though, and demonstrating a left lateral lung point IS highly specific for pneumothorax. That’s what this was.
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Question 16 of 17
16. Question
The following images show one anterior and two lateral lung ultrasound images in a patient with unexplained dyspnea in a cancer preoperative clinic. An echo was also performed in clinic and showed normal global biventricular systolic and diastolic function. What diagnoses could explain these findings?
Correct
Excellent!! Nice job. This was an interesting case, and the diagnosis was NOT made with lung US (though it was helpful and frankly surprising.) The patient has diffuse B-lines, consistent with increased lung density. In the setting of a normal echo, cardiogenic pulmonary edema is unlikely and this is definitely not normal. No effusion is seen in any of the images (though you’d also look at the lung bases, of course.) I ultimately referred this patient to pulmonology where the patient was diagnosed with pulmonary fibrosis.
Incorrect
This was an interesting case, and the diagnosis was NOT made with lung US (though it was helpful and frankly surprising.) The patient has diffuse B-lines, consistent with increased lung density. In the setting of a normal echo, cardiogenic pulmonary edema is unlikely and this is definitely not normal. No effusion is seen in any of the images (though you’d also look at the lung bases, of course.) I ultimately referred this patient to pulmonology where the patient was diagnosed with pulmonary fibrosis.
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Question 17 of 17
17. Question
What is indicated by the arrow?
Correct
Boom, nailed it! This is an A line, and it is normal but neither diagnoses nor excludes pneumothorax.
Incorrect
This is an A line, and it is normal but neither diagnoses nor excludes pneumothorax.