E-learning Acute Care : EGLS – Echo Guided Life Support

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Section 00: Introduction (part 1)

1- What probe movement is demonstrated here*

Watch the video below (Video 1)

A Tilting

B. Rotating

C. Rocking

D. Sliding

2- Why can we say that this image was done with cardiology convention ?

A Because the heart is at the centre of the screen

B. Because this is a subcostal view

C. Because the indicator is on the upper right side of the screen

D. Because this is a phased array probe

3- True or False*

Phased array probes make good images of the heart, but are not useful for lung ultrasound.

True

False

4- Which mode is used the most in the EGLS course?*

A- A-mode

B- B-mode

C- C-mode

D- D-mode

5- True or False*

In M-mode, we can see the IVC length variation over time.

True

False

Section 01: Introduction (part 2) - artifacts

6- Your subcostal view of the heart is scattered. What is the most probable cause ?*

A- Air in the lungs

B- Rib under the probe

C- EKG sticker under the probe

D- Air in the stomach

7- What is the mechanism by which reverberation artifacts happen?*

A- The probe sends multiple sound waves that hit a highly reflective surface

B- Sound waves are distorted after hitting a highly reflective surface

C- Sound waves repeatedly bounce between the probe and a highly reflective surface

D- The probe receives less sound waves than what it sent to the highly reflective surface

Section 02: Lungs (pneumothorax)

8- Which ultrasound finding does not rule out a pneumothorax under the probe?*

A- Lung sliding

B- Lung pulse

C- Bar code sign

D- Seashore sign

9- Which one is true about lung pulse?*

A- It represents the pulsation of the arteries near the pleura

B- It will beat at the same rate than the heart

C- It will still be seen even if there is air between pleural layers

D- It will be abolished in status asthmaticus patients

10- Where would be the lung point in a patient with tension pneumothorax ?*

A- Over the lateral side of the chest

B- Over the anterior chest, 2nd intercostal space

C- Lateral or medial, it will depend on how big the tension pneumothorax is

D- Don’t lose precious time looking for a lung point because there is no lung in contact with the chest wall

11- This can be seen with each of these diagnoses, except one. Which one?*

Watch the video below (Video 2)

A- Tension pneumothorax

B- Pleurodesis

C- Acute pulmonary edema

D- ARDS

E- Right mainstem intubation

12- True or False*

I see a lung point : I’m 100 % sure this patient has a pneumothorax

True

False

Section 03: Lungs (interstitial syndrome)

13- True or False*

I’m using a linear probe for lung ultrasound and I see a lot of B lines: I can be sure that my patient has an interstitial syndrome.

True

False

14- True or False*

My patient is short of breath and has a lot of B lines: I can be sure that he will be improved by IV furosemide.

True

False

15- Your patient received 2 L of crystalloids. Where would you first put the probe if you were looking for mild cardiogenic pulmonary edema in this supinated patient?*

A- Anterior chest, 2nd intercostal space

B- Lateral chest, with the beam aimed posteriorly

C- Antero lateral chest, 5th intercostal space

D- Anterior chest, 5th intercostal space

Section 04: Lungs (pleural effusions)

16- While looking for a pleural effusion, which structure should first be identified?*

A- Lung

B- Diaphragm

C- Diaphragm

D- Liver

17- True or False*

My patient has a simple pleural effusion. I’m sure it’s a transudate

True

False

18- What do these hyperechoic signals represent in a lung consolidation? **

Watch the video below (Video 3)

A- Air in a bronchus with scattering artifact

B- Calcifications in a bronchus with shadowing artifact

C- This is not a lung consolidation, this is an ultrasound image of the liver

D- None of the above

Section 05: Cardiac Subcostal

19- In a systematic focused cardiac ultrasound, which structure should be assessed first?*

A- Right ventricle

B- Pericardium

C- Left ventricle

D- Interventricular septum

20- Which finding is not associated with severe left ventricular dysfunction?*

A- Decreased fractional shortening

B- EPSS more than 7 mm

C- Left ventricle diameter more than 5 cm in diastole

D- Increased left ventricle wall thickening in systole

21- Which condition is not associated with a hyperdynamic left ventricle ?*

A- Severe mitral regurgitation

B- Early septic shock in a 60 year-old healthy patient

C- Extended anterior STEMI Killip 4

D- Splenic rupture in a 20 year-old trauma patient

22- What does the horizontal axis represent on the Frank-Starling curve ?*

A- Preload

B- Contractility

C- Afterload

D- None of the above

23- Your patient is in shock. Your focused cardiac ultrasound show the following. How would expect the slope of this patient’s Frank-Starling curve will be?*

Watch the video below (Video 4)

A- Steep

B- Flat

C- None of the above

Section 06: IVC

24- True or False*

In a patient in shock, an isolated assessment of the IVC is often enough to guide resuscitation.

True

False

25- IVC diameter variability at the level of hepatic vein depends on:*

A- Venous return

B- Intrahepatic vascular resistance

C- Right atrial pressure

D- A and C

E- A,B and C

26- True or False*

IVC and lung ultrasound can help understand where the patient stands on his Starling curve.

True

False

Section 07: Parasternal Long Axis

27- What is the structure indicated by the question mark?

A- Right ventricle

B- Descending aorta

C- Right atrium

D- Ascending aorta

E- Pulmonary trunk

28- What should you ask your supinated patient to do if you want to obtain a good parasternal long axis view?*

A- Ask him to turn 90° on his left side

B- Ask him to take a deep breath and hold it for 30 seconds

C- Ask him to turn 45° on his left side

D- Ask him to do a Valsalva manoeuvre

E- Ask him to turn 90° on his right side

29- How should you move the probe to aim the ultrasound beam in the middle of the LV cavity?*

A- Rotate the probe 15° counterclockwise

B- Tilt the probe side to side to get the best view of the valves

C- Rotate the probe 15° clockwise

D- Rock the probe to get a better view of the apex

30- Which finding is not associated with a normal LV in long axis view ?*

A- The diameter of the cavity is decreasing by a third in systole

B- The mitral valve slaps the septum in diastole

C- LV diameter is more than 5 cm in diastole

D- There is LV wall thickening in systole

Section 08: Parasternal Short Axis

31- Here is a patient with severe LV dilation. What is the structure indicated by the question mark?

A- Left ventricle

B- Right ventricle

C- Right atrium

D- Left atrium

E- Ascending aorta

32- You’ve got a good short axis view of the LV at the level of the mitral valve. How should you manipulate the probe to get the ultrasound beam at the level of the papillary muscles?*

A- Rotate the probe 15° clockwise

B- Tilt the probe in order to aim the ultrasound beam toward the feet

C- Tilt the probe in order to aim the ultrasound beam toward the head

D- Rock the probe toward the patient left side

33- Select the false affirmation regarding paradoxical motion of the septum.*

A- Can be observed when there is volume or pressure overload of the LV

B- Is a concentric motion of the septum in systole

C- Is a concentric motion of the septum in diastole

D- Can be seen in chronic conditions

Section 09: Apical 4 chamber

34- Name the structure indicated by the arrow?

A- Tricuspid valve

B- Mitral valve

C- Aortic valve

D- Moderator band

35- Which statement is false about the apical 4 chamber view?*

A- It’s a good view to look for s pericardial effusion

B- It’s a good view to assess right ventricular size and function

C- The apex is centred in the near field

D- It’s easier to obtain if the patient turns 45 ° on his left side

36- In the apical view, severe RV dilation is diagnosed when the ratio of RV to LV area is:*

A- <0.6

B- >1

C- 1

D- 0.6-1

Section 10: Wrap up cardiac US

37- Which ultrasound finding is not expected in a patient with tamponade?*

A- Swinging heart

B- Collapse of the right chambers in diastole

C - Compliant IVC

D- Fixed and dilated IVC

E- Small pericardial effusion in a trauma patient

38- Which ultrasound finding is not expected in a patient with acute RV strain?*

A- Fixed and dilated IVC

B- Paradoxical septum

C- RV dilation

D- Width of RV free wall = width of LV free wall

E- Decreased TAPSE

Section 11: EGLS algorithm (part 1)

39- Your intubated patient is crashing. The oxygen saturation was 92% few minutes ago. It’s now 81%. You put the probe on left anterior chest and you see no lung sliding. Before using a needle for a suspected tension pneumothorax, what else should you look for with ultrasound?*

A- Lung point

B- Lung pulse

C- Dilated IVC

D- Pericardial effusion

40- Your trauma patient has low blood pressure and skin mottling. With ultrasound, you see bilateral lung sliding, pericardial effusion and a collapsible IVC. What is the next step in the management of this patient?*

A- Perform an ultrasound guided pericardiocentesis

B- Search for severe left ventricular dysfunction

C- Give blood and look for a bleeding site

D- Search for right ventricle collapse

Section 12: EGLS algorithm (part 2)

41- Your patient looks very sick and you suspect a cardiogenic shock. There are bilateral lung sliding but no B lines on lung ultrasound. What should you do next?*

A- Consider another shock etiology

B- Start dopamine infusion at 5 mcg/kg/min

C- Call a cardiologist

D- Take your stethoscope and listen for a cardiac systolic murmur

42- True or False*

Your patient in septic shock has a good LV contractility before his first fluid bolus. Therefore, you can consider that he doesn’t suffer from septic cardiomyopathy.

True

False

43- These findings are part of the sonographic signature of massive pulmonary embolism, except:*

A- Dilated RV

B- Fixed and dilated IVC

C- Bilateral B lines

D- D shaped LV

E- Paradoxical septum

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