Diaphragm ultrasound: watch the sniff

Question 1In a subcostal view, which way does a normal diaphragm move on inspiration?

1. aTowards the probe, up on the screen
2. bAway from the probe, down on the screen
3. cIt stays still
4. dSideways across the screen

Question 2On a sniff, the left hemidiaphragm moves away from the probe. What does this show?

1. aPoor patient effort
2. bA left pleural effusion
3. cParadoxical movement from left hemidiaphragm paralysis
4. dNormal movement

Question 3Which window do you use for the right hemidiaphragm?

1. aThe heart, from the parasternal view
2. bThe liver, from below the right costal margin
3. cThe spleen
4. dThe bladder

Question 4Why is diaphragm movement during a ventilator breath unreliable?

1. aThe ventilator stops all diaphragm movement
2. bM-mode cannot be used in ventilated patients
3. cThe diaphragm cannot be seen in ventilated patients
4. dThe ventilator pushes the diaphragm passively, so movement does not prove the muscle works

Question 5A patient is breathless after an interscalene block on the right. What is the most likely diaphragm finding?

1. aA normal diaphragm on both sides
2. bReduced movement of the left hemidiaphragm
3. cReduced or paradoxical movement of the right hemidiaphragm
4. dIncreased movement on both sides