CanPoCUS Pre-Course Assessment

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This introductory Point of Care Ultrasound (PoCUS) course has been designed for doctors, nurse practitioners, physician assistants who work in acute care. It provides the core knowledge and hands-on training required to start using point of care ultrasound in your practice.

This short pre-course assessment can help you identify any knowledge gap that you can address by reading the pre-course reading material and help you get the most out of this course.

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1) According to the type of exam, you will choose a transducer knowing that the following is TRUE: *

1 point

a. Curvilinear probe frequency range between 6-14 MHz and penetrate deeper.

b. Phased array transducer is used solely for cardiac scan.

c. Linear transducer is considered a higher frequency targeting higher depth.

d. Resolution of reflected image is inversely related to the penetration depth.

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2) Understanding the ultrasound physics, the TRUE statement is: *

1 point

a. Tissues have different reflectivity; highly resistant structure will appear black on B-mode.

b. Fluids are usually hyperechoic and appear black on B-mode.

c. Air scatter the ultrasound waves, so structure deeper to it won’t be visualized properly.

d. Fluid filled structure reflect the ultrasound waves and work as a good acoustic window.

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3) On using the ultrasound machine, the following statement is TRUE: *

1 point

a. The orientation marker is always set to the patient's right on the longitudinal plane.

b. Adjusting the gain will increase the reflected image brightness but not the resolution.

c. M-Mode represent the motion mode and record the moving structure with clips.

d. Doppler button is used solely for color doppler.

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4) In regard to the ultrasound artifact, the following statement is FALSE: *

1 point

a. Edge artifact is representing the refraction of ultrasound waves on the wall of circular structure.

b. Acoustic shadow formed by the reflection of ultrasound waves on a structure with high acoustic impedance.

c. Mirror artifact is caused by the reflection of ultrasound waves over the pleura causing A lines.

d. Acoustic enhancement will appear behind a fluid filled structure.

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5) During scanning the patient Aorta, the following is FALSE: *

1 point

a. The depth should be set to maximum and adjusted to patient body habitus.

b. The scan should start from the xiphoid to the umbilicus reaching the bifurcation.

c. The orientation of the transducer is to the patient right, So aorta will appear on the left side of the screen.

d. The internal land mark to be identified first is the anterior vertebral body.

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6) In regard to Aorta scan, the following statement is True: *

1 point

a. To rule out AAA, you must scan in both planes (transverse and longitudinal).

b. The depth should be increased when progressing with scan toward the umbilicus as the aorta become deeper.

c. If some parts of the Aorta were missed during the scan, you can not call it a determinate scan.

d. The measurement of the Aorta diameter should only include the lumen.

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7) In regard to Aorta Scan, the following statement is True: *

1 point

a. The ultrasound is highly sensitive to Rule out AAA and dissection.

b. The normal diameter of the Aorta during transverse view is < 3 cm.

c. Ultrasound can be used to definitely diagnose aortic rupture.

d. If a thrombus is present, it shouldn’t be included in the Aorta diameter measurement.

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8) In regard to the E-FAST scan, the following statement is True: *

1 point

a. The scan is used for trauma patient to identify solid organ injury by identification of free fluid close to it.

b. In the supine patient the most common place where fluids accumulation can be detected is the pouch of Douglas.

c. During the scan, the transducer is positioned more caudal and posterior on the LUQ compared to the RUQ.

d. During the scan, you must sweep through the interface to avoid false negative results.

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9) In regard to the E-FAST scan, the following statement is False: *

1 point

a. Pelvic scan is utilized to identify free fluids in the rectovesicular pouch in male and rectouterine pouch in female.

b. Fluid accumulation of 250 ml can be detected by ultrasound as anechoic, irregular shadow.

c. Filling the bladder can optimize imaging of free fluids in the pelvis

d. FAST scan can detect retroperitoneal fluid with some degree of difficulties

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10) In regard to the E-FAST scan, the following statement is False: *

1 point

a. Presence of lung sliding on one rib space on the anterior chest can rule out pneumothorax on that lung.

b. Ultrasound is more sensitive in detecting hemothorax compared to X-ray on a supine patient.

c. Identifying a lung point is a definite diagnosis of pneumothorax.

d. In pericardial effusion, fluids accumulate first in the posterior pericardium in a supine patient.

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11) In regard to E-FAST scan, the following is True: *

1 point

a. Absence of free fluid during scan can eliminate the need for CT scan.

b. Presence of free fluid in hemodynamically unstable patient will necessitate surgical intervention.

c. CT is the gold standard in trauma patient to define outcome regardless of patient hemodynamic status.

d. Serial E-FAST are not considered sensitive nor specific in detecting free fluid with alteration in hemodynamic.

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12) Using PoCUS in life support and resuscitation, the following is False: *

1 point

a. Cardiac tamponade is a clinical diagnosis that visualized as right ventricular diastolic collapse. .

b. Pericardium normally contain about 50 ml of physiological fluids.

c. Cardiac tamponade is correlated with the amount of fluids not the rate of accumulation.

d. Pericardial fat pad can be falsely diagnosed as pericardial effusion.

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13) Using PoCUS in life support and resuscitation, the following is False: *

1 point

a. Cardiac standstill can be used as prognostication tool in cardiac arrest to determine futility of resuscitation.

b. Left ventricular function can be estimated using eyeballing method where the left ventricle collapse by 50% of its size.

c. PoCUS can be used to rule out pulmonary embolism by identification of normal right ventricle size and function.

d. Volume responsiveness can be assessed by the variation in IVC size during a passive leg raise test

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14) Using PoCUS in life support and resuscitation, the following is False: *

1 point

a. In a subxiphoid view the near field is representing the liver.

b. In the apical 4 chamber the right ventricle is 2/3 the size of the left ventricle.

c. The pericardial fat pad is circumferential compared to fluid that accumulate in one place.

d. In the parasternal long axis the right ventricle, left ventricle outlet tract, and left atrium are having almost the same size.

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15) Using PoCUS in life support and resuscitation, the following is False: *

1 point

a. IVC size can range between 1.5-2.5 cm best measured 1 cm from the hepatic vein.

b. IVC measurement and volume status assessment are more helpful when its at the extreme of its size.

c. IVC physiologically will collapse during expiration and expand with inspiration.

d. The physiological variation in IVC is reversed in intubated ventilated patient.

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16) In using PoCUS for assessment of early pregnancy, the following is True: *

1 point

a. Curvilinear probe to be used in longitudinal plane oriented caudally then rotated 90 degree to patient right.

b. Full bladder is an acoustic window in transabdominal and transvaginal scan for intrauterine pregnancy

c. Fetal heart rate can be detected by doppler to confirm viable pregnancy.

d. In transvaginal scan, the probe is considered a high frequency with higher image resolution.

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17) In using PoCUS for assessment of early pregnancy, the following is False: *

1 point

a. The area of interest during scanning is the endometrial stripe.

b. Bladder-uterine juxtaposition must be confirmed to identify an intrauterine pregnancy (IUP).

c. Juxtaposition, decidual reaction and gestational sac are the requirements to define an IUP.

d. Fetal heart rate must be >100 to be identified as a live IUP.

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18) In using PoCUS for assessment of early pregnancy, the following is False: *

1 point

a. Most ectopic pregnancy is diagnosed by visualization of a gestational sac outside the uterus.

b. Cardiac activity should always be detected if the fetal pole exceeds 5 mm by TV or 10 mm by TA ultrasound.

c. Presence of intrauterine empty gestational sac > 25mm is considered anembryonic pregnancy.

d. Absence of IUP with a B-HCG on the discriminatory zone (1500-5000) is an indicator of ectopic pregnancy.

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19) Using Ultrasound for vascular access, the following statement is False: *

1 point

a. Using ultrasound carries a higher success rate in vascular access compared to anatomical land mark.

b. Ultrasound can be used in assisted or dynamic guidance of vascular access.

c. For vascular access the linear probe with higher frequency is used and should be properly sterilized for the procedure.

d. A sterile gel is used for the procedure and its applied inside the sterile probe cover and outside as well.

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20) Using Ultrasound for vascular access, the following statement is False: *

1 point

a. The in-plane technique is requiring the direct continuous visualization of the whole needle.

b. In out-of-plane technique, the needle is guided by visualizing the tip of the needle during cannulation.

c. In out-of-plane technique, the needle enter parallel to the ultrasound beam.

d. The out-of-plane technique is easier to utilize but carries the risk of mistaken the needle tip with the shaft.

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