EM Ultrasound Post-Test

Instructions

How to complete this post-test

Enter your name and rotation date in the fields below before starting.
Answer all questions — multiple choice and true/false are auto-graded instantly.
For short answer and image questions, type your response then click "Reveal Answer" to check your work and lock in your response.
When finished, click "🖨️ Generate Score Sheet" at the bottom to create a printable PDF summary.
Print to PDF and email your score sheet to [email protected].

Before You Begin

Enter your details before starting

Rotator Name

Rotation Date

Physics & Principles

Question 1

All of the following are true about ultrasound waves EXCEPT:

Question 2

Which of the following is/are true?
1. Ultrasound images are based on the depth and direction of the returning echoes
2. Depth is determined by the time elapsed between the signal and the received echo
3. The returning intensity is proportional to the grayscale assignment on the screen
4. 1 & 2
5. All of the above

Question 3

True / False: The amount of reflection is proportional to the difference in the acoustic impedance between the two media.

Question 4

Attenuation is:

Question 5

Which of the following is true about ultrasound and "gain"?
1. The gain amplifies the returning echoes from all parts of the screen
2. Returning echoes, by nature, are weaker than ultrasound pulses
3. Distant structures tend to appear less echogenic
4. 1 & 2
5. All of the above

Question 6

What ultrasound setting allows you to adjust gain at a particular level/depth?

Answer Time Gain Compensation (TGC)

Question 7

Identify the specific artifacts from the accompanying video and still images:

Artifacts — Identify Each

$Artifact D$

Answer A. Acoustic Shadowing | B. Posterior Acoustic Enhancement | C. Reverberation Artifact | D. Edge Artifact / Lateral Cystic Shadowing

Question 8

In a FAST exam, the absence of "mirror artifact" in the right or left upper quadrant might be helpful in identifying what pathology (be specific)?

Answer Fluid in the pleural space (pleural effusion / hemothorax)

Question 9

M-mode:
1. Represents time on the horizontal axis
2. Produces red color with flow towards the probe, and blue color with flow away from the probe
3. Depicts the motion or deflection of the tissue relative to the transducer
4. 1 & 3
5. All of the above

Question 10

True / False: The FAST exam readily identifies around 50 mL of intraperitoneal blood.

FAST Exam

Question 11

Free fluid in trauma:
1. Is initially anechoic
2. Appears "pointy"
3. Appears "rounded"
4. Is difficult to distinguish from ascites
5. 1, 2 & 4
6. All of the above

Question 12

The FAST exam:
1. Is more sensitive in obese patients
2. Is used to identify free intraperitoneal or pericardial fluid in the setting of trauma
3. Is sensitive for intra-abdominal organ injury
4. Free fluid is most commonly found in the left upper quadrant
5. 1 & 2
6. All of the above

Question 13

Identify the structures in the subxiphoid cardiac view (A, B, C):

$Question 13 - SX Cardiac View$

📄 q13_cardiac.png (embedded)

Answer A. Liver | B. Right Ventricle (RV) | C. Left Ventricle (LV)

Question 14

Name the four windows to evaluate for "free fluid," circling the most sensitive location for identifying free fluid in a FAST exam:

Answer 1. RUQ / Morrison's Pouch ✓ (most sensitive) | 2. LUQ | 3. Subxiphoid (SX) | 4. Suprapubic

Question 15

True / False: The Suprapubic view is obtained just below (caudal) the level of the prostate in men, and the vaginal stripe in women.

Question 16

In the RUQ (Perihepatic) view:
1. Perinephric fat is typically hyperechoic, and does not shift with movement
2. Duodenal fluid, the gallbladder, and the IVC are all mimics for free fluid
3. Perinephric fat tends to be even thickness
4. Pleural fluid may present as an anechoic stripe above the diaphragm
5. All of the above

Question 17

Identify the structures/areas on the LUQ view and state what is missing (inadequate) on the image (a–e, Missing):

📄 q17_luq_fast.png (embedded)

Question 18

In the LUQ view:
1. The phrenicocolic ligament restricts the flow of free fluid to the LUQ
2. Blood preferentially flows between the left paracolic gutter to the LUQ
3. The LUQ view is typically found more anterior and inferior as compared to the RUQ view
4. The LUQ is the most easily visualized of the FAST views
5. All of the above

Question 19

In the Pelvic (Suprapubic) view:
1. Seminal vesicles may be incorrectly identified as free fluid
2. Gain artifact is a major issue in this view
3. The probe should be angled to just below (caudal to) the prostate or vaginal stripe
4. The probe should be placed in a periumbilical location
5. 1 & 2
6. All of the above

Question 20

In the subxiphoid (subcostal) cardiac view:
1. RV or RA collapse may occur in an otherwise normal patient
2. A little pericardial fluid may be completely normal
3. Scans may be enhanced by obesity and pneumoperitoneum
4. Imaging typically worsens when the patient takes a deep breath
5. None of the above

Pneumothorax

Question 21

Pneumothorax is "ruled-out" (in the location under the probe) by either of the following two ultrasound findings. Name them:

Answer 1. Pleural sliding (lung sliding) | 2. Comet tail artifact (B-lines)

Question 22

In the Pneumothorax study with ultrasound:
1. Between two rib shadows, there is a notable echogenic line composed of the visceral and parietal pleura
2. The transducer is placed longitudinally (pointed cranially) in the midclavicular line
3. The transducer is moved inferiorly in a systematic fashion
4. 1 & 3
5. All of the above
6. None of the above

Question 23A

Is this pneumothorax clip positive (pneumothorax present) or negative (pneumothorax absent)?

Question 23B

Is this pneumothorax clip positive (pneumothorax present) or negative (pneumothorax absent)?

Question 23C

Is this pneumothorax clip positive (pneumothorax present) or negative (pneumothorax absent)?

Question 24

Which of the following can't typically be ruled out by a FAST exam?
1. Viscus perforation | 2. Bowel wall contusion | 3. Pancreatic trauma
4. Renal pedicle injuries | 5. Retroperitoneal hemorrhage | 6. All of the above

OB / GYN Ultrasound

Question 25

With regard to ectopic pregnancy:
1. Typically occur in the ovaries
2. The β-hCG always rises less than 50% every 2 days
3. If a patient has a β-hCG of <500, then an ultrasound is not helpful to evaluate for ectopic
4. The incidence of heterotopic pregnancy is around 1 in 400
5. None of the above

Question 26

Simple ovarian cysts are:
1. Thin-walled | 2. Anechoic | 3. Spherical | 4. No loculations | 5. All of the above

Question 27

Arrange the following sonographic findings based on the order in which they appear during pregnancy (first to last):
1. Fetal pole | 2. Double decidual sign | 3. Fetal heart tones | 4. Yolk sac | 5. Thickened endometrium

Answer 5 → 2 → 4 → 1 → 3
(Thickened endometrium → Double decidual sign → Yolk sac → Fetal pole → Fetal heart tones)

Question 28

What is the primary objective in 1st Trimester OB scans?

Answer To document an intrauterine pregnancy (IUP)

Question 29

True / False: Crown-rump length measurements exclude the yolk sac.

Question 30

Bleeding between the endometrium and chorionic membrane is called ___________.

Answer Subchorionic Hemorrhage

Question 31

True / False: A full bladder is necessary for an adequate transvaginal ultrasound.

Question 32

___________ are found just lateral and posterior to the body of the uterus.

Answer Ovaries

Question 33

Identify the structures on the still image from a transvaginal ultrasound (a–d):

📄 Slide14.jpeg (embedded)

Answer a. Uterus | b. Gestational sac | c. Fetal pole | d. Yolk sac

Question 34

Identify the pathology in the transvaginal OB scan:

▶ Accompanying Video

Answer Subchorionic Hemorrhage

Question 35

Identify the likely pathology in the transvaginal OB scan:

▶ Accompanying Video

Answer Ectopic pregnancy

Question 36

___________ may cause shadowing in the uterus due to internal fibrotic changes and calcifications.

Answer Fibroids (Uterine leiomyomas)

Aorta / AAA

Question 37

Identify the following structures on transverse view of the upper midline abdomen (a–e):

📄 question_37.jpg (embedded)

Answer a. Aorta | b. IVC | c. SMA | d. Splenic vein | e. Vertebral body

Question 38

The aorta:
1. Is approximately 2cm as it enters the abdomen and then gradually increases in size distally
2. Gives off, in the following order, the celiac trunk, the superior mesenteric artery, the inferior gastric artery
3. Bifurcates into the common iliac arteries at approximately the level of the umbilicus (L4 level)
4. 2 & 3
5. All of the above

Question 39

AAAs:
1. Are defined as an abnormal focal dilation of the vessel wall that measures greater than 5cm
2. Expand at an average rate of 2–3 cm per year
3. When ruptured, tend to do so intraperitoneally
4. An intervention is often recommended if the aneurysm grows more than 1 cm per year or it is bigger than 5.5cm
5. None of the above

Question 40

Ultrasonography for AAA:
1. Has been reported to be nearly 100% sensitive for detecting AAA, assuming the study is adequate
2. Has a high sensitivity for detecting extraluminal blood from a ruptured AAA
3. Usually incorporates a 2.5–5 MHz curved array probe
4. 1 & 3
5. All of the above

Question 41

True / False: The aorta diameter should be measured in transverse from inside wall to inside wall.

Soft Tissue

Question 42

In soft tissue ultrasound:
1. Fascial planes are hyperechoic
2. Muscle has a characteristic striated appearance
3. Lymph nodes have echogenic centers with hypoechoic rims
4. 1 & 2
5. All of the above

Question 43

Name 2 sonographic findings in abscesses:

Answer (any 2 of the following) 1. Fluid collection | 2. Posterior acoustic enhancement | 3. Squish sign (swirling internal echoes with compression)

Question 44

Name the sonographic "sign" in the soft tissue scan below:

▶ Accompanying Video

Answer Cobblestoning

Question 45

What sonographic "sign" demonstrated in the soft tissue scan confirms the presence of an abscess?

▶ Accompanying Video

Answer Squish sign

Question 46

What is the finding/structure in this soft tissue ultrasound of the upper thigh and inguinal region?

▶ Accompanying Video

Answer Lymph node

Question 47

Diagnosis in this axillary ultrasound:

▶ Accompanying Video

Answer Abscess

Vascular Access & DVT

Question 48

With ultrasound-guided vascular access:
1. The transverse approach is typically easier to learn
2. A disadvantage of the longitudinal approach is that you must scan back and forth to locate the needle tip as you advance
3. The one person technique is preferable in a busy ED
4. 1 & 3
5. All of the above

Question 49

Sonographically, arteries tend to be:
1. Pulsatile | 2. Collapsible | 3. Thin-walled | 4. All of the above | 5. None of the above

Question 50

True / False: Low frequency, high penetration is ideal for vascular access.

Question 51

True / False: In ultrasound-guided venous access, a flash of blood is adequate to confirm that the catheter can be advanced into the lumen.

Question 52

Answer the following from the DVT video: (1) Location of study — Common femoral vein OR Popliteal vein? (2) Is a thrombus present?

▶ Accompanying Video

Answer 1. Popliteal vein | 2. No (thrombus absent)

Question 53

Answer the following from the DVT video: (1) Location of study — Common femoral vein OR Popliteal vein? (2) Is a thrombus present?

▶ Accompanying Video

Answer 1. Common femoral vein | 2. Yes (thrombus present)

Question 54

Diagnosis in this patient with a red, painful calf (see video):

▶ Accompanying Video

Answer DVT (Deep Vein Thrombosis)

Question 55

What is the definition of a DVT by ultrasound (with regard to compressibility)?

Answer Vein noncompressibility despite arterial wall deformation (i.e., the vein does not fully collapse with probe pressure)

Question 56

In emergency venous compression ultrasonography:
1. The linear probe is typically used
2. The patient is maintained (if possible) in Trendelenburg
3. Augmentation, spontaneity, and respiratory variation are documented for an Emergency Ultrasound DVT exam
4. 1 & 2
5. None of the above

Question 57

Name 3 ways to position the patient for the popliteal evaluation:

Answer 1. Prone with a towel under the ankle | 2. Lateral decubitus | 3. Sitting with knee flexed over the bed

Question 58

True / False: The popliteal vein is deep to the popliteal artery.

Gallbladder & RUQ

Question 59

Name 4 sonographic findings in acute cholecystitis:

Question 60

What is the rule for common bile duct size based on age?

Answer Age ÷ 10 (or 1 mm per decade of life). For example, a 60-year-old may have up to 6 mm CBD and be normal.

Question 61

Identify the three structures in the Portal triad (A, B, C):

📄 portal_triad.png (embedded)

Answer A. Common Bile Duct | B. Hepatic Artery | C. Portal Vein

Question 62

With regard to RUQ ultrasound:
1. A contracted gallbladder is common in acute cholecystitis
2. Normal gallbladder wall thickness is <7mm
3. The most common cause of gallbladder wall thickening is acute cholecystitis
4. Ultrasound has a high sensitivity for detecting common bile duct stones
5. None of the above

Question 63

Describe the criteria for a true sonographic Murphy's sign:

Answer Pain over the gallbladder specifically, without pain elsewhere in the abdomen (maximal tenderness directly under the probe when positioned over the GB)

Question 64

True / False: Sludge has a low-level echogenicity (less echoic than stones) and fails to cause acoustic shadowing.

Question 65

Describe the pathologic findings on the ultrasound:

▶ Accompanying Video

Answer 1. Gallstone | 2. Sludge

Question 66

What is the diagnosis in this patient with RUQ pain and the following ultrasound?

▶ Accompanying Video

Answer Cholecystitis

Renal Ultrasound

Question 67

Choose the primary indication(s) for emergency renal ultrasound:
1. Rule out renal tumors | 2. Evaluate for painless hematuria | 3. Search for an etiology of acute renal failure
4. Evaluate patients with a clinical suspicion of ureteral colic | 5. Look for urinary retention | 6. 3, 4 and 5 | 7. All of the above

Question 68

In renal ultrasound, the following is/are correct:
1. Views may be improved by angling the probe indicator posteriorly in the orientation of the ribs
2. Perinephric fat is commonly seen between the kidney and the adjacent liver or spleen
3. The normal ureter is not visualized
4. Bladder volume may be estimated by taking 3 dimensions (in cm) and multiplying them together
5. The left kidney is often more difficult to visualize due to a smaller sonographic window
6. 1 and 4 | 7. All of the above

Question 69

With regard to hydronephrosis:
1. Calyceal dilation is reflected as hyperechoic areas in the renal sinus
2. Ureteral stones are commonly visualized in the mid-ureter
3. Color flow may be placed over the kidney to differentiate vascular structures versus hydronephrosis
4. 2 and 3 | 5. None of the above

Question 70

Watch the ultrasound clip of the kidney and classify the renal cyst as either simple or complex:

▶ Accompanying Video

Answer Simple

Question 71

Indicate the degree of hydronephrosis in the following video (MILD, MODERATE, or SEVERE):

▶ Accompanying Video

Answer Mild

Question 72

What is the sonographic finding and its clinical significance, as seen in the video?

▶ Accompanying Video

Answer Finding: Ureteral jet (color Doppler showing urine squirting from the ureter into the bladder) | Significance: Patency of the ureter — rules out complete obstruction

Cardiac Ultrasound

Question 73

Name the 4 basic views for a limited echo exam:

Answer 1. Subxiphoid (SX) | 2. Parasternal Long Axis (PSLA) | 3. Parasternal Short Axis (PSSA) | 4. Apical 4-Chamber

Question 74

Name the cardiac view and the labeled structures (A–D):

▶ Accompanying Video

Answer View: Parasternal Long Axis (PSLA) | A. Left Ventricle (LV) | B. Right Ventricle (RV) | C. Aortic Outflow Tract | D. Left Atrium (LA)

Question 75

Name the cardiac view and the labeled chambers (A–D):

▶ Accompanying Video

Answer View: Apical 4-Chamber | A. Right Ventricle (RV) | B. Left Ventricle (LV) | C. Right Atrium (RA) | D. Left Atrium (LA)

Question 76

What is the normal RV/LV size ratio?

Answer 0.5–0.6 : 1 (approximately 1:2, meaning the RV is about half the size of the LV)

Question 77

True / False: The IVC is dilated in tamponade.

Question 78

Name the 2 specific echocardiographic findings in this patient with pleuritic chest pain:

▶ Accompanying Video

Answer 1. Dilated RV | 2. Septal bowing / D-sign (interventricular septum bowing toward the LV)

Question 79

Are the following patients hypovolemic, euvolemic, or hypervolemic? (Patient #1 and Patient #2)

▶ Accompanying Video

Answer Patient #1: Hypovolemic | Patient #2: Hypervolemic

Question 80

Estimate the ejection fraction (EF%) from the cardiac video (AP4 view):

▶ Accompanying Video

Question 81

Estimate the ejection fraction (EF%) from the cardiac video:

▶ Accompanying Video

Question 82

What positioning maneuver can be used when a supine patient has poor cardiac windows?

Answer Lateral decubitus (left lateral decubitus) position

Question 83

From the video, identify the view, the diagnosis, and 2 ultrasonographic findings that support your diagnosis:

▶ Accompanying Video

Answer View: Parasternal Long Axis (PSLA) | Diagnosis: Cardiac Tamponade | 1. RV collapse | 2. Pericardial effusion

Knobology & Settings

Question 84

Fill in the blank with the correct ultrasound term (Depth, Focus, Gain, Zoom, Frequency):
1. ________ narrows the US beam at the depth of interest.
2. ________ adjusts the number of centimeters to the bottom of the screen.
3. ________ expands the area of interest on the viewing screen.
4. ________ improves resolution.
5. ________ augments the ultrasound signal on the viewing screen.

Answer 1. Focus | 2. Depth | 3. Zoom | 4. Frequency | 5. Gain

Question 85

True / False: Anisotropic tissue varies in appearance from bright to black based on the scanning angle (angle of insonation).

Quiz Complete!

—

Auto-graded questions only. Image/video and short-answer questions are included in your submission for instructor review.

Generate Score Sheet

Creates a printable PDF summary of your answers. Print to PDF and email to your instructor at [email protected].