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Final review
CVT-243-01 - Non-Invasive Cardiology III
| Question | Answer |
|---|---|
| How can you apply the ALARA concept? use the min receiver gain to obtain quality images use an unlimited amount of time to obtain quality images use ultrasound to identify fetal sex for friend use the min output power to obtain quality images | use the minimum output power to obtain quality images |
| Which of the following increases contrast on an image? increased receiver gain Increased output power Increased compression Increased time gain compensation Increased demodulation | Increased compression |
| How can you reduce swirling artifact when performing a microbubble contrast study? administer contrast at a slower rate decrease the mechanical index place the focus at the mid left ventricle level turn off harmonics | decrease the mechanical index |
| Harmonic imaging will: Create side and grating lobes Widen the beam diameter Improve axial resolution Improve penetration of the transmitted beam | Improve penetration of the transmitted beam |
| Which of the following would be used on an adult patient with a small body habitus during a TTE? 3 MHz 5 MHz 7 MHz 2 MHz | 5 MHz |
| A patient with Marfans syndrome presents to the emergency room with severe chest pain. What do you need to interrogate carefully? the TV for regurgitation the AV for stenosis the aortic root for possible dissection the MV for stenosis | the aortic root for possible dissection |
| What happens to tricuspid valve in flow during inspiration? no change with inspiration increases slightly decreases significantly increases by 30% or more | increases slightly |
| Which of the following represents a vasovagal response during a pericardiocentesis? heart rate of 130bpm, BP 180/100, erythema heart rate of 50bpm, BP 90/50, pallor, near syncope high BP and dizziness tachycardia and feelings of impending doom | heart rate of 50bpm, blood pressure 90/50, pallor, near syncope |
| Which of the following begins with the end of the electrocardiogram T wave and ends with the onset of the QRS complex? ventricular systole atrial systole isovolumic relaxation time ventricular diastole | ventricular diastole |
| What hemodynamic response occurs with inspiration? increased venous return to the heart and decreased venous flow in the legs increased venous return to the heart and increased venous flow in the legs | increased venous return to the heart and decreased venous flow in the legs |
| A STAT order is placed in the emergency room on a patient with shortness of breath, hypotension, and pulsus paradoxus. What do you think the physician is trying to prove with the echo images? | cardiac tamponade |
| What part of the cardiac cycle is from semilunar valve closure to atrioventricular valve opening? diastole isovolumic contraction time isovolumic relaxation time systole | isovolumic relaxation time |
| Which of following will decrease venous return? valsalva squatting inspiration walking | valsalva |
| Which of the following vessels carry oxygenated blood? superior vena cava coronary sinus hepatic veins pulmonary veins | pulmonary veins |
| An inpatient has the following symptoms peripheral edema, jugular vein distention, and pulmonary rales/edema. Which of the following diseases would be suspected prior to the echocardiogram? | dilated cardiomyopathy |
| Which of the following must be confirmed before bringing an inpatient to the lab for a TEE? NPO status if they are on do not resuscitate orders if they are on contact precautions if they can ambulate | NPO status (nothing by mouth; refers to the medical instruction to abstain from all food and drink before a medical procedure or test) |
| How can you reduce swirling artifact when performing a microbubble contrast study? administer contrast at a slower rate decrease the mechanical index place the focus at the mid left ventricle level turn off harmonics | decrease the mechanical index |
| What grade of diastolic function does 48 year old patient have if their left atrial volume is 30ml/m squared, E/A wave ratio is 0.8, E/e' ratio is 8, medial E' is 12cm/sec, and the TR velocity is 2m/sec? | normal |
| A patient comes in for a stress echo. Which of the following would cause the technologist to reschedule the exam? Patient has occasional PVC's Patient had a MI 2 years ago Patient took atenolol the morning of the exam Patients BP is 125/75 at rest | the patient took atenolol the morning of the exam ;medication prevents your heart rate from increasing, which is necessary for an accurate evaluation of your heart's response to exercise or stress. |
| Which of the following is the hearts normal response to exercise/stress? EF of 65%, larger diastolic wall dimensions, systolic wall thickening EF of 72%, systolic wall thickening, smaller systolic dimensions | EF of 72%, systolic wall thickening, smaller systolic dimensions |
| The ordering physician hears a diastolic rumble with an opening snap on auscultation? What should you thoroughly interrogate? | mitral valve for stenosis |
| Harmonic imaging will: Improve axial resolution Create side and grating lobes Improve penetration of the transmitted beam Widen the beam diameter | Improve penetration of the transmitted beam |
| A patient is admitted to the hospital with sepsis. Upon admission, the hospitalist identifies a new holosystolic murmur. Which of the following should you evaluate for? | infective endocarditis with significant mitral regurg |
| A patient presents to the emergency room with an ST elevation on EKG, elevated troponin and regional wall motion abnormalities that correlate to the left anterior descending territory. What is your most likely next course of action? | perfluorocarbon microbubble to check for apical thrombus |
| Which of the following describes how to obtain systemic diastolic blood pressure? record the pressure level when the last pulsation is heard at the brachial artery record the pressure level when the first pulsation is heard at the pulmonary artery | record the pressure level when the last pulsation is heard at the brachial artery |
| What layer of the pericardium adheres to the myocardium? fibrous pericardium parietal layer visceral layer endocardial layer | visceral layer |
| Which of the following increases contrast on an image? Increased output power Increased demodulation Increased compression increased receiver gain Increased time gain compensation | Increased compression |
| What spectral Doppler measurement provides the pressure gradient needed to grade the severity of mitral stenosis? mitral valve pressure half time E/A wave ratio mitral valve velocity time integral E wave Vmax | mitral valve velocity time integral |
| What sonographic window would you use to interrogate a Starr-Edwards mitral valve with spectral Doppler? | apical |
| How can you confirm you are Dopplering the aortic stenosis waveform in the presence of mitral regurg when using pedof? AS includes IVCT and IVRT giving it a rounder shape AS does not include IVCT or IVRT making it more V-shaped | aortic stenosis does not include IVCT or IVRT making it more V-shaped |
| What is the first parameter to consider when assessing a patient for diastolic function? E/e' ratio Ejection fraction LA volume E/A ratio | Ejection fraction |
| What is the cardiac response of amyl nitrite and/or Valsalva on a patient with HOCM? Decrease in systolic anterior motion Increase in venous return to the heart Increased septal thickening Increased LVOT pressure gradient | Increased LVOT pressure gradient |
| What is the most accurate method to obtain mitral valve area status post balloon valvuloplasty? E/A wave ratio velocity time integral planimetry pressure half time | pressure half time |
| What echo view will give the most accurate Doppler evaluation of the tricuspid valve? | apical 4 chamber view |
| What is normal fractional shortening of the left ventricle? | greater than 25% |
| What is the best two-dimensional view for diagnosing mitral valve prolapse? | parasternal long axis |
| What should the sweep speed be set on when measuring units of time? (ie. decel time, IVRT, pressure half time, ect.) | 100 mm/sec |
| What view is best for identifying subaortic membranes? | apical 5 chamber provides a clear view of the LVOT where the membrane is located |
| If you are scanning the apical four chamber view, how will you manipulate the transducer to obtain coronary sinus view? slide inferior tilt slightly anterior slide superior tilt slightly posterior | tilt slightly posterior |
| How is pulmonic valve acceleration time measured? from the onset of systole to the end of systole from the peak of systole to the end of systole from the onset of systole to peak systole from the onset of diastole to peak diastole | from the onset of systole to peak systole |
| Which of the following console adjustments must be made before freezing the image when performing PISA on mitral regurgitation during TTE? Shift the color baseline up to between 30 – 40 cm/sec Shift the color baseline down to between 30 – 40 cm/sec | Shift the color baseline down to between 30 – 40 cm/sec |
| Which of the following is used to evaluate right ventricular systolic function? IVRT a' s' e' | s' |
| What happens when the right atrial pressure exceeds the right ventricular pressure? | tricuspid valve opens |
| Do not measure spectral Doppler waveforms the first beat following: long P-P intervals long R-R intervals long Q-T intervals long P-R intervals | long R-R intervals ;the prolonged diastolic filling time leads to an uncharacteristically high velocity and volume of blood |
| Which of the following vessels would you assess with PW Doppler if you are trying to grade MR severity? pulmonary artery hepatic vein inferior vena cava pulmonary vein | pulmonary vein |
| How can you identify the right ventricle? contains two papillary muscles connects to the aorta contains the moderator band thick walled | contains the moderator band |
| What is the mitral valve area if the pressure half time is 220 msec? 1.5 cm squared 0.5 cm squared 1 cm squared 1.25 cm squared | 1 cm squared MVA= 220/PHT |
| What is the right ventricular systolic pressure normally equal to? Left ventricular systolic pressure Pulmonary artery systolic pressure Right atrial pressure Pulmonary artery diastolic pressure | Pulmonary artery systolic pressure |
| What is the echocardiographer looking for when performing serial echoes on patients with aortic insufficiency? any changes in LV wall thickness the measurement of the aortic root the amount of MV flutter any changes in LV size or function | any changes in left ventricular size or function |
| What part of the cardiac cycle do you measure the aortic root diameters such as sinus of valsalva and sinotubular junction? end-diastole end-systole mid-systole onset of diastole | end-diastole |
| What is the best sonographic window to best detect mitral regurgitation when a patient has a Starr-Edwards valve in both the mitral and aortic positions? | subcostal |
| What is the best sample gate position for measuring left ventricular inflow with pulsed wave Doppler? | at the mitral valve leaflet tips in the apical 4 chamber view |
| What normally causes the mitral valve to close? | when left ventricular systolic pressure exceeds left atrial pressure |
| Which Doppler view is best for evaluating the severity of mitral stenosis? | apical 4 chamber |
| What is a significant restenosis by pressure half-time for a mitral prosthetic valve? 180 msec 150 msec 130 msec 220 msec | 220 msec |
| What can you do in the parasternal long-axis position when the interventricular septum and aortic root are forming a right angle to get an on axis image? rotate clockwise slide superiorly tilt inferiorly slide inferiorly | slide superiorly |
| What is an alternative window for evaluating the pulmonic valve with spectral Doppler? | subcostal short axis |
| What is the most accurate method to determine mitral valve area in cases of stenosis? | planimetry |
| What is an acceptable difference in left ventricular length measurements when using Simpson's biplane method? less than 1 cm between 4ch and 2ch less than 20% change between 4ch and 2ch less than 10% change between 4ch and 2ch | less than 10% change between 4ch and 2ch |
| What is pulmonary insufficiency end diastolic velocity used to calculate? peak systolic pulmonary artery pressure severity of pulmonic regurgitation pulmonary artery end diastolic pressure mean pulmonary artery pressure | pulmonary artery end diastolic pressure |
| What is the best view to detect a bicuspid aortic valve? | parasternal short axis in systole |
| When measuring mitral orifice size by planimetry in cases of mitral stenosis, care must be taken to: measure the opening during systole measure the opening at the leaflet tips use high gain settings measure in parasternal long axis | measure the opening at the leaflet tips |
| What part of the cardiac cycle do you measure the left atrium? | end-systole |
| Which two cardiac diseases require the interrogation of mitral and tricuspid inflow with pulsed wave Doppler to check for respiratory variations? acute percarditis and cardiac tamponade constrictive pericarditis and restrictive cardiomyopathy | constrictive percarditis and cardiac tamponade |
| What spectral Doppler measurement is used to grade the severity of aortic regurgitation? | pressure half time |
| When would the severity of aortic stenosis be overestimated? spectral Doppler undergained LVOT measured to small 2D image undergained LVOT measured to large | LVOT measured to small |
| What spectral Doppler measurement is used to calculate the mitral valve area needed to grade the severity of mitral stenosis? | mitral valve pressure half time |
| Which of the following is an expected finding of chronic moderate mitral regurg? Enlarged left ventricle Decreased ejection fraction Normal ejection fraction Normal left atrial size | Enlarged left ventricle |
| Which of the following complications is most often associated with an inferior MI that may result in mitral regurgitation? Papillary muscle dysfunction Left ventricular pseudoaneurysm Ventricular septal defect Left ventricular true aneurysm | Papillary muscle dysfunction |
| All three struts of the aortic or mitral bioprosthesis can be seen when imaged from which of the following views? Parasternal long axis Parasternal short axis Apical window Subcostal 4-chamber | Parasternal short axis |
| A patient has a pressure half time of 180 msec through the aortic valve. What is the disease and severity | severe aortic regurg |
| Which of the following is most likely to occur post MI in patients with an akinetic regional wall motion? Papillary muscle dysfunction Thrombus True aneurysm Pseudoaneurym | Thrombus |
| Systolic anterior motion of the mitral valve with mitral valve thickening is seen with which one of the following: IHSS Restrictive CMO Mid-ventricular HCM Apical HCM | IHSS Idiopathic Hypertrophic Subaortic Stenosis (IHSS) IHSS is a condition where the left ventricle of the heart becomes abnormally thick, narrowing the outflow tract and obstructing blood flow from the heart to the aorta |
| Which tumor is usually located in the right atrium, often associated with pericardial effusion, and is the most common primary malignant tumor? Angiosarcoma Papillary fibroelastoma Rhabdomyoma Sarcoma | Angiosarcoma |
| What is the most likely diagnosis if the echo shows a restrictive mitral inflow pattern , significant respiratory variations, and an interventricular septal bounce with no significant effusions? | Constrictive pericarditis |
| What is the most common ventricular septal defect and what view confirms the type? membraneous/5 chamber trabecular/any view inlet/4 chamber supracristal/short axis | membraneous/5 chamber |
| What is m-mode used to rule out while scanning a patient with suspected cardiac tamponade? To confirm associated MVP Diastolic collapse of the RV free wall Systolic collapse of the RV free wall Respiratory variations of greater than 25% | Diastolic collapse of the right ventricular free wall |
| What acyanotic defect would be suspected if there is a fixed split S2 murmur? atrioventricular canal defect patent ductus arteriosus atrial septal defect ventricular septal defect | atrial septal defect |
| Which is most accurate for determining aortic valve area in aortic stenosis cases when the patient has a low ejection fraction? mean gradient cusp separation continuity equation planimetry pressure half time | continuity equation |
| What post-operative changes would you expect to see after a mitral valve replacement for mitral regurgitation? | LA size reduction, pulmonary artery pressure reduction, LV systolic function improvement |
| A left ventricular outflow tract to jet height ratio of 50% suggests: | moderate AI |
| What describes viable myocardium that continues to display wall motion abnormalities after reperfusion of the affected coronary artery? stunned hibernating calcified scarred | stunned |
| Which of the following most likely would present with a left atrial thrombus? mitral regurg myocardial infarction mitral stenosis metastatic heart disease | mitral stenosis |
| Which of the following is a known complication of bioprosthetic heart valve? Thrombus formation Pannus formation Mechanical failure Thrombocytopenia | Pannus formation |
| Which of the following occurs first in the setting of severe mitral regurgitation due to a flail leaflet? Dilated left atrium Dilated left ventricle Dilated right atrium Dilated right ventricle | Dilated right ventricle |
| What is the right ventricular systolic pressure if the patients’ blood pressure is 120/70 and the velocity across the ventricular septal defect is 3.5 m/sec? | 71 mmHg RVSP= LVSP- 4(v)^2 |
| What is the most common valvular tumor? | Fibroelastoma |
| While performing the Doppler study, you detect tricuspid regurgitation with a peak velocity of 4 m/sec. The IVC measures 2.5m and collapses 75%. What is the right ventricular systolic pressure? | 72 mmHg |
| What is the most common benign tumor that is usually found in the left atrium and attached to the interatrial septum? Papillary fibroelastoma Lipoma Myxoma Rhabdomyoma | Myxoma |
| A patient presents with hemoptysis, left atrial enlargement, right ventricular hypertrophy, and a flattened interventricular septum. What disease are you most likely to find? | mitral stenosis |
| Which of the following is associated with Ebstein's anomaly? large right ventricle superiorly shifted tricuspid valve ventricular septal defects atrial septal defects | atrial septal defects |
| What grade of diastolic dysfunction is usually identified on patients with left ventricular hypertrophy secondary to systemic hypertension? Restrictive irreversible Impaired relaxation Pseudonormalization Restrictive reversible | Impaired relaxation |
| Which of the following complications of MI is represented by a bulge in the left ventricular wall that enlarges during systole and that has a wide base with walls composed of myocardium? | Left ventricular true aneurysm |
| What does pulmonary vein systolic reversal indicate? restrictive cardiomyopathy severe tricuspid regurg severe mitral regurg severe mitral stenosis | severe mitral regurg |
| What respiratory variations suggest cardiac tamponade on echo? | >25% increase in MV velocity during expiration |
| Which is characterized by non-ischemic bulging of the LV apex at end-systole with the base of the ventricle being hypercontractile related to emotional stress? Takayasu’s arteritis LV true aneurysm LV non-compaction Takotsubo cardiomyopathy | Takotsubo cardiomyopathy |
| The anteroseptal wall of the left ventricle is supplied by which coronary artery? | left anterior descending |
| Grade the diastolic function. EF 40%; E/A ratio > 2; LA enlarged 40 ml/m2 | Grade 3 |
| Partial mid-systolic closure of the aortic valve due to a sudden decrease in cardiac output may be seen in m-mode with what disease? | Hypertrophic obstructive cardiomyopathy |
| A patient presents with dyspnea and chest pain. The right ventricular apex is still contracting, but the mid to basal right ventricular wall is not. What do these findings indicate? | Acute pulmonary embolus |
| What complication could you expect to find post-MI in a patient with a new harsh holosystolic murmur? Dressler's syndrome Left ventricular pseudoaneurysm Ventricular septal rupture Left ventricular true aneurysm | Ventricular septal rupture |
| Which will most likely have an incidental finding of thrombus? Restrictive cardiomyopathy Acute pericarditis Mitral regurgitation Dilated cardiomyopathy | Dilated cardiomyopathy |
| What grade of aortic stenosis does a patient have with a pressure gradient of 30 mmHg, aortic valve area of 1.3, and left ventricular wall thickness of 1.4cm? | moderate |
| What four components make up Tetralology of Fallot? | large overriding aorta, ventricular septal defect, pulmonic stenosis, and right ventricular hypertrophy |
| A Down syndrome patient presents with a common atrioventricular valve, an atrial septal defect, and a ventricular septal defect. What congenital anomaly do they have? | Endocardial cushion defect |
| What dysrhythmia is associated with Ebstein's anomaly? Wolff Parkinson White ventricular tachycardia atrial fibrillation ]bundle branch block | Wolff Parkinson White |
| What is the most common cause for tricuspid stenosis in a 65 year old patient? rheumatic fever carcinoid heart disease congenital stenosis tricuspid annular calcification | rheumatic fever |
| The TR Vmax is 4m/sec. The BP is 120/70 mmHg. The IVC is 2.6cm and collapses 25%. What is the severity of pulmonary hypertension, if any? | severe |
| Which of the following can cause false positive mitral valve prolapse on m-mode evaluation? probe placed too high on the chest systolic anterior motion pleural effusion mitral stenosis | probe placed too high on the chest |
| What is the normal mitral valve area? | 4-6 cm squared |
| What chamber most commonly receives blood from a sinus of valsalva aneurysm? | right atrium |
| Which of the following represents the last event to occur during a stress echo according to the ischemic cascade? angina systolic dysfunction diastolic dysfunction perfusion abnormality ischemic ECG abnormalities | angina |
| Grade the diastolic function on this 35 year old female using the following criteria: EF 60%, E/A 2.2, E/e’ 13.5, Septal e’ velocity 5 cm/sec, lateral e’ velocity 8 cm/sec, TR velocity 2.0 m/s, LA volume index 24 ml/m2. | Normal |
| What is a perimembraneous ventricular septal defect commonly associated with? aortic coarctations aortic stenosis bicuspid aortic valve aortic regurgitation | aortic regurgitation |
| Which chamber would most likely be affected by a blunt force trauma to the chest? left ventricle right atrium left atrium right ventricle | right ventricle |
| Which coronary artery is most likely abnormal if the inferoseptal wall is hypokinetic? Right coronary Left circumflex Left anterior descending Acute marginal | Right coronary |
| Grade the diastolic function on this 65 year old male using the following criteria: EF 45%, E/A 1.5, E/e’ 13.5, TR velocity 3.0 m/s, LA volume index 44 ml/m2. | Grade 2 |
| What does a negative contrast area in the right atrium indicate on an agitated saline study? pulmonary arteriovenous malformation irrelevant finding left to right shunt right to left shunt | left to right shunt |
| What wall motion score would be given to a hyperdynamic wall segment during a stress echo? | 1 |
| In the normal circulation, what is the value of the QP/QS ratio? | 1 |
| What dilates due to patent ductus arteriosus? left atrium and left ventricle aorta and pulmonary artery right atrium and right ventricle aortic arch and descending aorta | left atrium and left ventricle |
| Which direction would the mitral regurgitation jet be directed if there is isolated anterior mitral valve leaflet prolapse? | posteriorly |
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