ABEM ultrasound cases, explained
An ultrasound case gives you a patient, names the area to scan, and puts an image in front of you. Here is what it is testing and how to practice it.
What the case looks like
You are told which area to scan
The case opens with a short clinical picture and vital signs, and then the examiner names the region: the lungs, the right upper quadrant, the abdominal aorta, the heart. You are not asked to choose the study. You are asked whether you can obtain it and read it.
The first question is the probe
Before any image appears, you say which probe you want and roughly what frequency. Phased array for the heart and the lungs, curvilinear for the abdomen, linear for vessels and soft tissue. Naming a range rather than one number shows you understand why a low frequency buys depth and a high frequency buys detail.
Then you read the image out loud
A still or a moving clip goes up, and you describe it: the structures you can name, what is normal, what is abnormal, and which of the bright and dark lines are artifact rather than anatomy. An organized read beats a lucky guess — the examiner is listening for a system, not a single word.
Artifact is part of the answer, not a distraction
A lines, mirror image above the diaphragm, shadowing behind bone, enhancement behind fluid — these are the machine, not the patient. Being able to say which is which is a large part of what the case is checking.
Then you commit to a diagnosis
The last question for each image asks what it shows, with the picture taken away. A hedge is not an answer. Say what it is, and say plainly what the image cannot tell you.
Two areas, one patient
A case usually scans two regions on the same patient, because that is what the complaint demands — lungs and leg veins for shortness of breath, a FAST and the heart in trauma, kidney and aorta for flank pain. The second scan is often the one that changes the disposition.
Common traps
- Naming a probe without a frequency, or reaching for the wrong one — a linear probe will never reach an abdominal aorta.
- Jumping to the diagnosis without describing the image, so the examiner never hears your reasoning.
- Calling an artifact a finding, or a finding an artifact.
- Reading a single frame when the answer is in the movement — sliding, compression, wall motion.
- Stopping after the first area when the complaint clearly calls for the second.
- Hedging on the final question instead of committing to what the image shows.
How to practice it
Read images out loud in the same order every time — structures, normal, abnormal, artifact, diagnosis — until the order is automatic. Scrolling through saved clips in silence builds pattern recognition but not the narration the exam actually scores. PrepEM’s ultrasound cases give you a printed parameters sheet and a timer, ask for the probe before any image appears, put a still or a moving clip in front of you, and then take it away when they ask for your diagnosis.
See also the procedure case guide, the clinical decision-making guide, and the full exam format guide.