FAMILY MEDICINE POCUS SPECIALIST CURRICULUM

Please note: Beside POCUS curriculum for Family medicine (which can be used in general practice and in internal medicine), our organization is also developing curriculum for emergency medicine (EM), and for ICU & Anesthesia specialist. These curriculums shall be posted here soon.

1. BASIC THEORY

Physics of ultrasound
Different transducers and their application
B mode, M mode, Doppler - application; BART mnemonic
Interaction of US waves with tissue (reflexion, refraction, diffraction) - Artifacts (reverberation, ring-down, mirror image, enhancement, attenuation)
Knobology of ultrasound machines, manipulative skills (sliding, rotating and tilting)

2. NECK

Regional echo-anathomy
Thyroid gland: size evaluation, echogenicity, vascular activity;
Most common pathological findings of thyroid gland (changes in size and echogenicity, nodes, cysts, calcification)
Neck lymph nodes - size, shape, hilus, echogenicity
Salivary glands evaluation and common pathology (tumors, cysts, stones)
Carotid arteries - CCA, ICA, ECA - size, position, recognizing ICA from ECA (position, resistance, waveform, branches) intima-media thickness, plaques (size, surface, fibrous vs. calcificated...), stenosis % measurement (area, flow speed - Vmax); RI measurement; kinking, coiling.
Vertebral arteries - position, flow evaluation

3. BREAST

Scanning methods - Normal tissue, evaluation of glandular development, evaluation of lactiferous ducts diameter.
Most common pathological findings (fibrosis, cysts, fibroadenoma, fluid collections, lipoma, lymph nodes, suspect malignant changes)
Axillar lymph nodes evaluation
BI RADS system

4. HEART

Views and anatomical structures: Apical view, substernal view, PLAX, PSAX
Apical four chamber and two chamber view: PW for diastolic LV function (E/A ratio); MAPSE, TAPSE; Doppler assessment of MV and TV; Doppler inspection for ASD and VSD. CW of AV.
Substernal view: crux cordis, re-assessment of MV, TV; pericard
PLAX: MSS, MV re-assessment, chamber sizes (RVOT, LA), aorta (diameter, separation, regurgitation?); walls measurement (IVS, PW), LVEDD, LVESD, EF.
PSAX: Aorta, pulmonary valve assessment, LV eyeballing for wall kinetics.

5. ABDOMEN AND PELVIS

Liver size, echogenicity, criteria for steatosis; Focal changes: haemangioma, cysts, deposits...
CBD, hepatic artery and portal vein - "Mickey Mouse" sign.
Hepatic veins and IVC - "Playboy bunny" sign
Gall bladder size, shape, wall thickness, stones; pancreas - size, shape, echogenicity; spleen - size, focal changes
Abdominal aorta - diameter, plaques or thrombus inside aneurysm...
Paraaortic and parailial lymph nodes
Kidneys. length, parenchim thickness and color, calculosis, hydronephrosis, cysts, angiomyolypoma, tumors;
Urine bladder: volume, neurotic bladder assessment, walls - cancer, stones, diverticulum.
Prostate: size/volume, shape, focal changes,
Uterus: position, size, myometrium evaluation, endometrium thickness, ovarian size and cysts; Measuring accidental pregnancy (CRL. BPD, FL), spotting cardiac action.
Douglas pouch, Morisson pouch

6. LEGS DOPPLER

Anatomy of legs vascular system
Waveform and Vmax inside AF, AP, ATA, ATP, ARM and ADP.
VSM: compressibility, varicose changes, reverse blood flow during inspirium
Deep femoral vein, polpiteal vein and deep crural veins - compressibillity, dilatation, stress test.
Perforant veins of crurual and perimalleolar region - diameter, compressibility, stress test.

7. MUSCULOSKELETAL US AND SOFT TISSUES

Principles of muscular and tendon scanning, signs of fresh and old lesions; Tendosinovitis
Achilles tendon rupture
Joint hydrops; Baker's cyst
Ostephytosis in OA; Signs oh chondritis, entensitis, bursitis; fractures under US
Soft tissues scanning: lipoma, atheroms, lymph nodes, vascularity of skin and subcutaneous changes, scanning collections of fluid (abscesses etc.).

8. LUNG ULTRASOUND

Scanning positions
Normal pleural sliding
Normal A lines
Pneumothorax, lung point
B lines: interstitial syndrom
Hepatisation of lungs
C lines: infiltration
Pleural effusion