All of the following conditions can lead to difficulty in auscultating breath sounds in a
critically ill patient except?
 A.
Pulmonary edema

B.
Pneumonia

C.
Pneumothorax

D.
Chronic obstructive pulmonary disease

E.
None of the above Correct
The visceral and parietal pleura within the thoracic cavity __________.
 A.
line the lungs and inner thoracic cavity, respectively
Correct

B.
are adherent in a majority of locations

C.
are both primarily found lining the lungs

D.
are found exclusively along the heart

E.
have an anechoic appearance on ultrasound
When confirming tracheal intubation by scanning the chest anteriorly, absence of
lung sliding along one hemithorax indicates __________.
 A.
the patient has a pneumothorax

B.
the need for more information (i.e., scanning the contralateral chest cavity)
Correct

C.
a pneumothorax is ruled out

D.
a lung pulse is present

E.
a small pleural effusion is present
Detecting an esophageal intubation during the course of upper airway sonography
__________.
 A.
is dependent upon the compressibility of the esophagus

B.
can occur by noting a foreign-body artifact (emanating from the misplaced
endotracheal tube) within the esophagus
Correct

C.
is exclusively dependent upon visualizing air bubbles moving through the
esophagus

D.
is dependent upon identifying the tracheal tube anterior to the trachea
ntubation of the left mainstem bronchus __________.
 A.
is impossible without a bronchoscope

B.
is undetectable by ultrasound and CXR must be used

C.
can be identified by ultrasound and differentiated from a pneumothorax
Correct

D.
is a common occurrence in critically ill patients

E.
will cause paradoxical lung sliding on the right at end-expiration
A patient is experiencing progressively dropping oxygen saturations following a
rapid sequence intubation attempt. Sonography of the patient's right and left
anterior chest regions reveals bilateral lung pulses, but no lung sliding. This implies
__________.
 A.
the patient has emphysema

B.
the esophagus has been intubated
Correct

C.
the patient has had successful endotracheal intubation

D.
the patient is suffering from bilateral pneumothoraces

E.
there is no need for plain radiography
Which of the following statements best characterizes the use of ultrasonography for
pneumothorax detection?
 A.
Detection of pneumothorax typically involves scanning the anterior chest in supine
patients.
Correct

B.
Pneumothorax detection primarily occurs by scanning the mid- and infrascapular
regions of the posterior thorax in upright patients.

C.
The presence of lung sliding in a lung definitively excludes the presence of
ipsilateral pneumothorax.

D.
The absence of lung sliding definitively establishes the presence of ipsilateral
pneumothorax.
A patient with advanced pulmonary fibrosis presents in severe respiratory distress.
The clinician attempts to perform endotracheal intubation following rapid sequence
induction with a paralytic agent. Upon securing the endotracheal tube, ultrasound
examination of the chest reveals symmetric bilateral lung sliding that corresponds
with bag-valve mask ventilations. Which of the following choices best describes the
location of the endotracheal tube?
 A.
Right mainstem bronchus

B.
Left mainstem bronchus

C.
Trachea
Correct

D.
Esophagus
A difficult-intubation patient is found to have a lung pulse along his left anterior
chest and lung sliding along his right anterior chest. These findings indicate __________.
 A.
right mainstem intubation
Correct

B.
left mainstem intubation

C.
tracheal intubation

D.
esophageal intubation

E.
pneumothorax
Documentation of diaphragmatic excursion may be accomplished by using __________.
 A.
a video clip

B.
M-mode image recordings

C.
one still image of each hemidiaphragm

D.
A and B only
Correct

E.
All of the above
When scanning a patient's hemidiaphragm for confirmation of tracheal tube
positioning, __________.
 A.
the patient must be spontaneously breathing to ensure a reliable result

B.
a pneumothorax can concurrently be reliably excluded

C.
power Doppler-mode imaging is not a useful adjunct

D.
both left and right sides should be imaged
Correct

E.
movement of either hemidiaphragm confirms endotracheal tube positioning
A patient with severe pulmonary fibrosis presents in severe respiratory distress. The
clinician attempts to perform endotracheal intubation following rapid sequence
induction with succinylcholine as the paralytic agent. Upon securing the
endotracheal tube, ultrasound examination of the chest reveals the absence of lung
sliding in both the right and left sides of the chest despite bag-valve mask ventilatory
support. Which of the following choices best describes the location of the
endotracheal tube?
 A.
Right mainstem bronchus

B.
Left mainstem bronchus

C.
Trachea

D.
Esophagus
Lung sliding as a method of detecting esophageal and mainstem bronchus intubation
has been studied in a variety of settings, including __________.
 A.
cadaveric models

B.
hospital-based live patients

C.
cardiac arrest patients

D.
All of the above
Correct

E.
None of the above
Sonographic evaluation of the anterior neck reveals that the trachea __________.
 A.
has a characteristic appearance and acoustic shadowing pattern
Correct

B.
has an anechoic appearance

C.
is located posterior to the esophagus

D.
is similar in size to the esophagus

E.
is always directly anterior to the esophagus
Which of the following statements best characterizes the role of Doppler imaging in
examining the lungs and pleura with sonography?
 A.
Pulsed-wave Doppler is the primary Doppler imaging mode used for detecting lung
sliding.

B.
Power Doppler imaging may be used to detect and document lung sliding.
Correct

C.
M-mode has been replaced by spectral Doppler imaging as the principal method for
detecting lung sliding.

D.
Color-flow Doppler is the only mode of Doppler imaging that can be used to detect
lung sliding.
Which of the following statements regarding the presence of a lung pulse is correct?
 A.
It is created by adhesions between the visceral and parietal pleura.

B.
The visceral and parietal pleura do not contribute towards a lung pulse.

C.
A lung pulse occurs when no pleural movement occurs.

D.
A lung pulse represents pulsation of the pleura in concert with the heart.
Correct

E.
A lung pulse is always a pathologic finding.
Studies that analyzed sonographic visualization of diaphragmatic motion as an
adjunctive method for determining tracheal tube positioning revealed that __________.
 A.
chest radiography was the only method to detect tracheal tube location

B.
this method reliably identified endotracheal tube positioning
Correct

C.
this method had a sensitivity of less than 10 percent

D.
esophageal intubation was undetectable by this method
Published studies analyzing the use of lung sliding as a method for determining
tracheal tube positioning __________.
 A.
include both live patients and cadavers
Correct

B.
are limited to several case reports

C.
have not been performed

D.
show disappointingly low sensitivity and specificity
The ribs __________.
 A.
provide a good reference point when the transducer is oriented parallel to them

B.
are located deep (or posterior) to the pleural line on the ultrasound screen

C.
provide a good reference point for locating the pleural surfaces when the transducer
is oriented perpendicular to them
Correct

D.
prevent pleural sliding on ultrasound

E.
magnify the underlying lung tissue
Which of the following methods should not be relied upon as the sole method for
confirming endotracheal intubation?
 A.
Lung auscultation

B.
Condensation of the endotracheal tube

C.
Chest percussion

D.
End-tidal CO2 colorimetry

E.
All of the above