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medical CCI

CCI exam

QuestionAnswer
Sound waves are described as? Longitudinal, Mechanical. Since a sound wave is a disturbance that is transported through a medium via the mechanism of particle-to-particle interaction, a sound wave is characterized as a mechanical wave. Longitudinal waves are waves in which the motio
Vagal stimulation of the heart will? Vagal stimulation of the heart will Decrease the SA Node rate. Parasympathetic innervation of the heart is controlled by the vagus nerve. To be specific, the vagus nerve acts to lower the heart rate. The right vagus innervates the sinoatrial node. Paras
What does each prefix mean? ab, acro, epi, cyan, intra, supra, brady, peri, leuk, end, auto ab- away from, acro-extremities, epi-outer, cyan-blue, intra-within, supra-above/over, brady-slow, peri-around/about, leuk-white, end-inside, auto-self
ASD surgery is mainly considered when the Qp/Qs exceeds? What is Qp/Qs? ASD surgery is mainly considered when the Qp/Qs >1.5 The size of an atrial septal defect is typically described in terms of the ratio between pulmonary blood flow(Qp) and systolic blood flow(Qs)
How many Lung lobes are there typically on the left and right sides of the sternum? The lungs are divided into lobes: The left lung has only two lobes(located on the left side of the sternum), upper and lower lobes. The right of the sternum has the right lungs having three lobes.
What is the average speed of sound in soft tissue, bone and air? Soft tissue 1,540m/s, Bone 3,500m/s, Air 330m/s
What does each root word mean? athro, cardio, hemo, neuro, rhin, thromb, viscer, myco, laparo, path athro-joint, cardio-heart, hemo-blood, neuro-nerve, rhin-nose, thromb-clot, viscer-organ, myco-fungus, laparo-abdomen, path-disease
What is the frequency of ultrasound? What is the frequency of Infrasound? Ultrasound is >20,000 Hz, Infrasound <20Hz.
Can you describe the myocardium? The myocardium is the basic muscle that makes up the heart. This muscle is involuntary and, this is striated in nature. The cardiac muscle structure consists of basic units of cardiac muscle cells known as myocytes. Coordinated contraction of the cardia
The RV is approximately how many times thinner than the LV? Three
What is a specular reflector? What is a nonspecular reflector? Specular reflector=Large smooth structure in comparison to the wavelength like a diaphragm. A nonspecular reflector(also known as Rayleigh scatter) is a smaller reflector like a red blood cell
What layer of the heart makes the heart contract? What is the thick middle layer of the heart called? Myocardium-a thick contractile middle layer of uniquely constructed and arranged muscle cells that forms the bulk of the heart wall. The myocardium contains a minimum of other tissue, except blood vessels, and is covered interiorly by the endocardium. T
What does each suffix mean? algia, centisis, desis, ectomy, itis, ostomy, plasty, oma, scopy, & megaly. algia-pain, centesis-surgical puncture, desis-surgical union, ectomy-removal, itis-inflammation, ostomy-opening into, plasty-surgical repair, oma-tumor, scopy-view, megaly-enlargement.
What is harmonic imaging? If your harmonic frequency is 6MHz what is the initial transmit frequency? Transmit a certain frequency which is the first harmonic and then processes the next harmonic at twice the frequency. 3MHz because, the first frequency was 3MHz the second higher frequency would be 6MHz.
Name the two major types of harmonic imaging? Tissue and Contrast
What are these measurements of? 1)mm 2)cc 3)cm squared mm=distance, cc=volume, cm squared=area
How many centimeters are in a meter? How many cubic centimeters in 3.56 cubic meters? What is 3/8 converted to a decimal? How many centimeters are in 2 meters? 100, 3,560,000, 3/8 is 0.375, Centi means hundredth, so there are 200 centimeters in 2 meters
How many elements does a CW transducer need to operate? Two. One sending and one receiving.
What is a common murmur heard with mitral valve prolapse? Mid systolic click
Are these prefixes in increasing order? micro,centi,milli,deci,kilo,hecto What do the prefixes "kilo", "Giga" and "mega" mean? No, here is the correct increasing order: micro, milli, centi, deci, hecto, kilo. Kilo=1000, Giga=Billion, mega=million
What abnormality is often associated with a high pitched friction rub murmur? Pericarditis
What is collateral circulation? Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge an
What is the damping material used for in a transducer? How does damping influence the bandwidth and Q factor? Damping material is placed behind the element to reduce the number of cycles in each pulse. This also increases the bandwidth and decreases the Q factor.
Can you describe the Endocardium? The endocarium is the innermost, thin and smooth layer of epithelial tissue that lines the inner surface of all the heart chambers and valves. This layer is made of thin and flat cells that are in direct contact with the blood that flows in and out of t
How do you convert Fahrenheit to Celsius? How do you convert Celsius to Fahrenheit? Normal oral body temperature is 98.6F, What is the equivalent in Celsius? To convert a Fahrenheit to Celsius, subtract 32 from the Fahrenheit reading and multiply by 5/9. Example: 5/9(98.6-32)= 37.0. Celsius to Fahrenheit- multiply Celsius reading by 9/5 and add 32. Example: 9/5100+ 32 = 212. 37.0C
What is a common murmur heard in patients with constrictive pericarditis? Pericardial knock
What is the Doppler effect? What is the Doppler shift? Effect- Change in frequency of sound relative to the movement of the source. Shift-Is the difference between the transmitted and received frequency
A patient with a PDA may have what type of murmur? Continuous murmur
Can aliasing occur with normal blood flow using color flow doppler? Yes, high velocities can alias
Describe the layers of a normal arterial wall? The wall of a normal artery is made up of three parts. The external part, called the tunica adventitia or externa, is thin and very strong. The middle part, called the tunica media, is thick and contains muscle fibers. The inner part, called the tunica
The Centers for Disease Control and Prevention categorizes various diseases in levels of biohazard, Level 1 -4. What are they? L1: Bacteria/ viruses including Bacillus subtilis, hepatitis, E coli, precautions in question are minimal, most likely involving gloves/ facial protection.L2: Bacteria/ viruses that cause only mild disease to humans, or are difficult to contract via aer
What is the decimal form of 44%? 8 is 2 and 1/2% of what number? What is 2/3 divided by 5? What is the product of 2/3,1/5,3/6? 44%=.44, 8 is 2.5% of 320, 2/3 divided by 5 is 2/15, the product of 2/3,1/5,3/6 is 1/15
T/F A mobile mass typically moves into the left atrium during systole and moves to the left ventricle during diastole? True
What factor involving the wavelength and frequency will improve axial resolution? Increasing the frequency will decrease the wavelength and improve axial resolution
What is 40% of 200? What is 1.0x10 to the 5th power? If it takes 5 hours to clean 2/3 of a large boat, how long will it take to clean the whole boat? 40% of 200 is 80. 1.0x10 to the 5th power is 100,000. To clean the whole boat will take 7 and 1/2 hours.
List two common findings in a patient with the connective tissue disorder Marfans Syndrome. What valvular jet is often observed? Mitral valve prolapse, Aortic dilatation/dissection. MR and AI
What are the 3 main arteries viewed in this picture that arise from the aortic arch? Although not pictured, what is the purpose of the common carotid artery? Although not pictured what part of the body does the internal carotid artery supply blood to The Brachiocephalic artery, Left common carotid and Left subclavian arises from the aortic arch in the thoracic region. The common carotid artery is often used in measuring the pulse, especially in patients who are in shock and who lack a detectable pu
What are three common sense principles of transporting patients? 1-Always get adequate assistance when needed. 2-Use lower body strength(legs) they are strongest. 3-When moving an ambulatory patient from wheelchair to bed- bend knees, and put one foot between the patient's legs and the other close to the bed. Turn yo
What is axial resolution? What is lateral resolution? Axial-Able to resolve two closely spaced structures that are parallel to the direction sound is traveling. Lateral-Resolve closely spaced structures that are perpendicular to the beam
What is the first artery from the arch of the aorta? The brachiocephalic artery (or brachiocephalic trunk or innominate artery) is an artery of the mediastinum that supplies blood to the right arm and the head and neck. It is the first branch of the aortic arch, and soon after it is emerges, the brachioce
How do you transport patients involving wheelchairs? When entering an elevator with a patient in a wheel chair you should? Lock big wheels using the wheel locks. The foot rests must be moved aside or removed completely to prevent tripping. Back into the elevator so you can make a quick and safe exit
Ultrasound bioeffects are not confirmed below what number? 100 mW/cm2 SPTA (Spatial Peak Temporal average)
What is the disease also known as "Aortic arch syndrome" that occurs more in women in Asia and Africa? Takayasu's arteritis (also known as "Aortic arch syndrome," and "Pulseless disease") is an inflammatory disease with an unknown cause. It affects the aorta, the main blood vessels that attach to it. Inflammation of the aorta and major derivative branche
What is the purpose of Isometric exercises like the hand grip? Isometric exercises can also be used at the bedside to differentiate various heart murmurs; the murmur of mitral regurgitation gets louder as compared to the quieter murmur of aortic stenosis
What are the three main methods of oxygen administration used in a medical setting? Nasal cannula, Nasal Prongs, Tent
What are the three planes that are used to describe the body in relation to anatomic structures? What direction will correlate with these four anatomical structures listed? Dorsal, ventral, cranial, caudal? Coronal plane separates front and back of the body. Transverse plane divides upper and lower body. Sagittal plane divides the body into right and left sides. Dorsal= Posterior, Ventral=Anterior, Cranial=Superior, Caudal=Inferior
What is stable cavitation? What is transient cavitation? Expansion and contraction of micro bubbles which may cause tissue damage. Stable is the safe cavitation. Transient is a more violent form which is bad
What is the most common mechanical prosthetic valve? St.Jude(bi-leaflet tilting disc). The design (using two disks, a hinge mechanism, and a low profile) was found to be very durable when constructed of an appropriate material (usually carbon pyrolite) and has enjoyed low thrombogenicity and superior hemo
Why do abnormal heart rhythms occur? The vagal stimulation of the parasympathetic nervous system can cause a decrease in the rate at the SA node and can also decrease the excitability of the AV junction fibers. This causes a slowing of the heart rate, and in severe cases a complete blockag
What are the precordial leads? What is the location of the 10 electrode (12 Lead) placement of the precordial leads? Precordial views V1-V6 (Chest views) make up a cross section view of the heart in a transverse horizontal plane. V1 - fourth intercostal, right sternal border. V2 - fourth intercostal, left sternal border. V3 - equal distance between V2 and V4. V4 -
What is TGC and what does it do? Time Gain Compensation. It helps to compensate for attenuation of the sound waves
What system is the liver, pancreas, endocrine glands, thymus gland and gallbladder part of? The Digestive system
What type of valves is the Hancock? What type of valve is the Ionescu-Shiley? They are both bioprosthetic valves. Hancock-most commonly from the pig, Ione-from the cow
What % of accuracy is a standard TM (treadmill)? Standard Treadmill examinations are usually 60%-80% accurate. Usually a 85% HR is the target HR. A treadmill test or exercise stress test, helps to find out how well your heart handles work. The test can show if the blood supply is reduced in the arteri
What is the advantage and disadvantage of a mechanical valve vs. a bioprosthetic valve? Mechanical valves typically are more durable but require anticoagulant therapy. Bio prosthetic valves usually don't require anticoagulation and have low thrombic risk
What is the unit for attenuation? Name three causes of attenuation in soft tissue? Which is the most major cause of attenuation in soft tissue? Describe attenuation as it pertains to Decibel? Decibel(dB). Reflection, Absorption and Scatter. Absorption is the largest form of attenuation in soft tissue.(conversion of energy to heat) The loss of ultrasound energy as it travels through a medium (tissue) is called attenuation. The loss of ultraso
What term would correspond to the list of terms? 1.Toward midline 2. Away from midline 3.Close to a location 4.Farther away from the location 1. Medial 2. Lateral 3. Proximal 4. Distal
Name four acoustic variables? Temperature,density,particle motion and pressure
T/F A common inflammatory finding with post surgery bioprosthetic valve replacement is they usually are at least 2mm thick? False
What are the 5 areas of the electric conduction pathway? The heart is composed primarily of muscle tissue. A network of nerve fibers coordinates the contraction and relaxation of the cardiac muscle tissue to obtain an efficient, wave-like pumping action of the heart. 1. Sinoatrial Node(SA node or sinus node)
When a patient is in respiratory distress, what are a few ways in which they could be positioned to help with breathing? Upright in position(sitting 45 degree), Mid Fowlers position(semi-sitting 30 degree), Reverse Trendelenburg(lying down on back, head elevated higher than pelvis)
If a patient is in shock, what would be a good position to put them in? Trendelenburg(lying down with feet elevated above the pelvis)
What is the anatomy of the pulmonary circuit? Right heart-Oxygen-depleted blood from the body leaves the systemic circulation when it enters the right heart,(RA through the SVC and IVC). Then pumped through the TV, into the RV.Then pumped through the Pulmonic valve into the pulmonary artery. Arteri
What two factors influence propagation speed? Which has the largest effect? Place the following in order of increasing sound propagation speed: Liquid, Solid, Gas Bulk modulus(stiffness) and density. stiffness has the largest influence. Increasing sound propagation speed- Gas - Liquid - Solid
What type of graft transplant would demonstrate replacing the aortic valve in the heart with another persons aortic valve? Homographs (or allographs) in which the patient receives a replacement heart valve from a deceased donor. Because the delicate nature of the valve, surgeons must be careful to ensure the valve is the proper size and to take the utmost care during surger
According to Ohm’s law, resistance is the product of voltage divided by: a. Ergs b. Watts c. Power d. Current e. Ohms d. Current, The law stating that the direct current flowing in a conductor is directly proportional to the potential difference between its ends. It is usually formulated as V = IR, where V is the potential difference, or voltage, I is the current, and
At a fat-tissue/ muscle interface approximately what percent of the ultrasound beam would be transmitted? Why? 99%, There is a small acoustic mismatch
In performing CPR on an adult what is the recommended breath to compression ratio? What ratio for a child or infant? What is the chest landmarking? What guidline is used for AED use? Rescue Breaths and Chest Compressions One new method is in the area of rescue breaths and chest compressions. The old method of giving rescue breaths was deep breaths lasting two seconds. The new method is to give normal breaths in one-second spans unti
What are four sounds heard by using a stethoscope? What are the grades of a murmur? 1). Murmur-Heart sound. 2)Bruit-Blowing sound heard over a stenosis. 3)Rales-Abnormal sound due to fluid in the air passage. 4)Wheeze-High pitched buzzing or whistle of breath sounds. Thepurpose of the stethoscope is to amplifie sounds. Palpablesound or
What is a common symptom of a patient with endocarditis? What is the "classic" cardiac finding with endocarditis? Fever/chills. A patient with endocarditis is at risk of vegetations
1.Should IV bags be kept above, at level, or below the level of IV site? 2. If a patient has a Foley catheter in place, should the bag be placed above, level with, or below the waist? 1. Above infusion site 2. Below the waist
Approximately how much sound energy would be reflected at a soft-tissue(skin)/ air interface? Why? 99%, There is a large acoustic mismatch
What side of the mitral and tricuspid valves are vegetations most commonly seen? Atrial side
Are these sound velocities in order from lowest to highest? Air,fat,blood,muscle,liver,skin,bone? Yes
Staphylococcus Aureus is most commonly found in what type of patients? What side of the heart is most effected? IV Drug users. Right side of heart
What is Malpractice? What is Consent? What is the primary goal of the Code of Ethics? Malpractice is defined as bad or harmful practice that injures another person. Consent is permission granted by a person voluntarily and in sound mind. Code of Ethics is to determine what is moral, it is your obligation to do good.
What is the approximate equivalent of 16 ounces? a. 1.5 liter b. 1.0 kiloliters c. 0.5 microliters d. 500 milliliters d. 500 milliliters Here are the metric measurements of volume.The basic unit is the liter. A liter measures approximately a quart (1 liter = 1.056 qt.) There are 1000 liters in a kiloliter, and 1000 milliliters in a liter.Other units of volume and their
Name three reasons a pericardial effusion may occur? Infection, radiation therapy, metastatic disease
What is the frequency range for clinical imaging? What is the frequency range for clinical imaging?
Why is AC 60Hz current(wall current), a very dangerous current to the heart if you were to get shocked? It can produce Cardiac Fibrillation- a life threatening arrhythmia
A measure of the total opposition to current flow in an alternating current circuit, measured in ohms defines: a. Voltage b. Impedance c. Inductance d. Capacitance b. Impedance
As frequency increases, axial resolution will? Improve
What is Tamponade? A moderate to large pericardial fluid build up do to a rapid increase in venous pressure
What is the difference between negligence and liability? What is a purpose of a Quality Assurance Program? Liability means we are legally responsible for our actions toward patients. Negligence means to not do something we should or do something we should not. QAP's purpose it to monitor and help patients receive optimal care.
How does inspiration effect the mitral and tricuspid valve during a tamponade? Inspiratory velocity decrease across MV and an increased velocity across TV
Name three guidelines for charting health care records? 1). Records are kept on all clients receiving care or treatment. 2). The chart is considered the property of the facility. 3). Do not chart before the event occurs
What are the three layers of the heart? The heart consists of three tissue layers: endocardium, myocardium, and pericardium. The endocardium, the innermost layer, lines the hearts chambers and is bathed in blood. The myocardium is the thick middle layer of the heart. Its cells are unique in t
What unit is dynamic range measured in? What is dynamic Range? Decibels, The range of gray scale between the lowest and the highest magnitude signals the ultrasound system can detect
As frequency increases attenuation will? Are they both directly related? Increase. Frequency and attenuation are directly related meaning as frequency increases attenuation will also
If fibrin is seen in an effusion, what may this suggest? Long standing effusion
Name the government agency having the legal responsibility for enforcing proper drug manufacture and clinical use? Food and Drug Administration
Parasympathetic stimulation of the heart can? Parasympathetic stimulation of the heart can decrease the rate of the SA node and decrease the excitability of the AV junction, thereby slowing the heart rate
What describes Power/Area? Intensity
What is pulses paradoxus? >10mmHg decrease in systolic pressure gradient during inspiration
When documenting in a computer chart, is it ok to use general non specific statements? No, avoid using generalizations, use facts. These are things that can be visually observed, felt and heard
Which of the following may be caused by rapid accumulation of fluid in the pericardial sac? a. Subvalvular gradient b. Coarctation gradient c. Atrioventricular gradient d. Semilunar valve gradient c. Atrioventricular gradient
What are most hospital safety requirements for power cables and electronic equipment like EKG and Echo machines? What if sparks fly when you plug in a machine? They must be 3 wire conductor, with 3 prong plug. If sparks fly the machine may have been left on
What is the best reliable predictor for echo in a tamponade? What is a common way to treat a tamponade? RV wall diastolic collapse. Pericardial centesis(Tap) to drain the fluid
Which of the following doppler frequencies 18MHZ, 7MHZ, 2MHZ, 2.5MHZ would result in the shallowest penetration depth? 18MHZ
Which of the following will markedly elevate right ventricular systolic pressure? a. Infundibular stenosis b. Pulmonic insufficiency c. Constrictive pericarditis d. Patent ductus arteriosus a. Infundibular stenosis
a patient feels faint during a blood draw or IV insertion, what might help? Have the patient put there head between there knees
The label on a large aspirin bottle reads 1 tab, 5 grains. Dr. Jeffrey Lux Felbeet (JLF) prescription reads aspirin grains XV every 4 hours. How many tablets should be taken according to Dr. JLF? a. 2 b. 3 c. 4 d. 7 e. 1.5 f. 6 b. 3 tablets should be taken
The largest Doppler shift occurs when the beam strikes at what angle? 0 degree angle
What are the two classic findings(heart sound and m-mode)for constrictive pericarditis? 1)Pericardial knock sound 2)Atrial or spanish notch on m-mode
What is the BEST indicator of the exact moment the aortic and pulmonary valves open? a. R wave on the ECG b. C wave on the atrial pressure tracing c. Dicrotic notch on the atrial pressure waveform d. Beginning of systolic rise on the arterial pressur d. Beginning of systolic rise on the arterial pressure
A patient has a cardiac output of 5 L/min.and a heart rate of 75 bpm.If stroke volume remains constant,what will be the effect of an increase in heart rate to 150 beats per minute? Cardiac output would:a.Triple b.Increase to 10 L/min.c.Increase to 25 L/mi b. Increase to 10 L/min
Describe aliasing? Can aliasing only occur with pulsed doppler systems? When the PRF(pulse repetition frequency) is less than twice the doppler shift frequency. Yes
T/F With constrictive pericarditis the diastolic filling is impaired? True
What three factors influence resistance to blood flow? What vessel has the greatest influence on total vascular resistance? Radius of the vessel, Viscosity of fluid through the vessel and the length of the vessel all determine resistance to flow. Arterioles
Radius of the vessel, Viscosity of fluid through the vessel and the length of the vessel all determine resistance to flow. Arterioles a. Left atrium. Myxomas account for 40-50% of primary cardiac tumors. Approximately 90% are solitary and pedunculated, and 75-85% occur in the left atrial cavity. Up to 25% of cases are found in the right atrium.Myxomas are polypoid, round, or oval. The
The normal range for white blood cell count in adult males (per cubic millimeter) is approximately: a. 500 - 1,000 b. 5,000 - 10,000 c. 10,000 - 20,000 d. 50,000 - 100,000 e. 500,000-1,000,000 b. The normal range for white blood cell count in adult males (per cubic millimeter) is 5,000 - 10,000
What are three types of electrical injury involving hands and feet? Which of the three is considered the most deadly? Foot to Foot electric shock, Hand to Foot, Hand to Hand. The most deadly route is Hand to Hand, with a risk of going through the heart
What information does the spectral analysis provide? Amplitude, Time, Frequency
What is Pulmonary HTN? What side of the heart does Pulmonary HTN effect? What are three things associated with PHTN A pulmonary pressure greater than 30mmHg. Right heart(PHTN is typically secondary to left heart problems).RAE, RVE, TR, dilated IVC
Describe pH as it pertains to the following question? A patient is admitted to the cardiac department with the following ABGs: FiO2 = 40%, pH = 7.3, PCO2 = 50, HCO3 = 20. According to these blood gases, the patient is in:a. Metabolic acidosisb. Metabolic c. Respiratory acidosis- ABG Fio2= 40% (respiratory) also note the pH is in the acidic range. Respiratory acidosis is a medical condition in which decreased respiration (hypoventilation) causes increased blood carbon dioxide and decreased pH (a condit
If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect: a. LVH b. IV Strain c. Hyperkalemia d. Anterior Infarction a. LVH
T/F With PHTN there is a common finding- D shape "pancaking" of the septum in systole? T/F This is due to both volume overload and high pressure True, True
What does FFT (Fast Fourier Transform) do to ultrasound signals? Converts doppler signals to analog waveforms.
What is the reason heart valves open and close? What are the mean intracardiac pressures(mmHg) for each chamber? A change in intracardiac pressure. RA 2-8, RV 15-30/2-8, LV 80 to 130/3-12, LA 2-12, PA 15-30/4-12, AO 100-140/60-90
Define Left ventricular diastolic dysfunction (DD) ? Left ventricular diastolic dysfunction is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest
What is an Aneroid Sphygmomanometer? What is considered the normal value for blood pressure? It is an inflatable cuff that measures the blood pressure using air or mercury. Normal value is 120/80.
What is write magnification? Is this pre or post processing? It is a zoom feature to increase the size of the structure you want to look at. It is part of preprocessing
Which of the following typically increases to compensate for constrictive diseases which impede filling: a. SV b. Preload c. Afterload d. EDV, ESV b. Preload
Define the following key terms: Asepsis, Immunity, Sterile, Pathogen Asepsis- Freedom from infection. The methods used by health care workers to prevent spread of microorganisms.Immunity- High level of resistance to certain microorganisms. Sterile- Free from all living microorganisms. Pathogen-Microorganism that produces
Describe the pathophysiology of left ventricular diastolic dysfunction (DD)? DD is present when an elevated filling pressure is necessary to achieve normal ventricular filling. So, DD is related to abnormal left ventricular relaxation and filling during diastolic phase of cardiac cycle. During this phase there are four events:
In cardiac tamponade, venous pressures: a. fall and arterial pressures rise b. rise and arterial pressures fall c. remain steady and arterial pressures fall d. rise and arterial pressure remains steady b. rise and arterial pressures fall
What is pre processing? Name two pre processing functions? After data is acquired you may use the data before storage in the scan converter. TGC and rejection are both pre processing.
What is the normal dimension of the IVC? Does it collapse with inspiration? 1.2 to 2.3cm. Yes, it usually has some collapse upon inspiration
Define the following key terms: Infection, Isolation, Reverse-Isolation. Infection-Invasion and multiplication of microorganisms in the body tissues. Isolation- Separation from others(because they may have an infection) and want to prevent the spread of microorganisms. Reverse Isolation protects the patient from microorganisms
Describe a quick overview on how the heart works? The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to
In an aortic pressure recording, a gradual upstroke with a prominent low anacrotic notch is indicative of: a. Aortic stenosis b. Aortic insufficiency c. Left ventricular failure d. Congestive heart failure a. Aortic stenosis
Pathological filling is determined from transmitral flow pattern. Briefly describe the prolonged relaxation pattern, Pseudonormal pattern and the Restrictive pattern. 1) Prolonged relaxation pattern: characterized by prolonged isovolumetric relaxation time and deceleration time, low E and high A wave velocities with an E/A wave ratio typically 1. It is related to the remodeling process including hypertrophy or scar
What is post processing? Name three examples of post processing? Post processing is image processing after memory such as: assignment of gray shades, freeze frame and colorization
Describe the four heart chambers The heart has four chambers. The atria are the two upper chambers that collect blood as it comes into the heart. The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body
Protection from radiation may be maximized by all but which of the following:a. Significantly reducing kV setting b. Maximizing the distance to the sourcec .Minimizing the time near the radiation sourced .Placing absorbing material between yourself and a. Significantly reducing kV setting
What is a simplified view of the Krebs Cycle? Krebs Cycle(citric acid cycle), is basically many oxidation-reductions, involving various acids. During these reactions,O2 and H2 combine and energy is released. The cycle creates energy(ATP), by breaking the bonds in glucose(ADP to ATP). This is impo
What two things are a sound waves wavelength determined by? The medium and the source of sound
Describe the heart valves and their function? Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.The tricuspid valve is in the right side of the heart, between the right atrium and the right ventricle.
The major pathway of blood to the brain is through the: a. Femoral arteries b. Carotid arteries c. Coronary arteries d. Subclavian arteries e. Pulmonary arteries b. The major pathway of blood to the brain is through the Carotid arteries. The common carotid artery is an artery that supplies the head and neck with oxygenated blood; it divides in the neck to form the external and internal carotid arteries.
What are two ways to reduce bioeffects on an ultrasound system? Limit scan exposure time and reduce the transmit gain
What is MOST likely indicated by the following pressures? RV = 26/2, PA= 25/19, LA = mean of 18, LV = 142/8, AO = 145/75? a. Mitral stenosis b. Aortic stenosis c. Mitral insufficiency d. Aortic insufficiency a. Mitral stenosis will cause a high LA mean. 18 mmHg is elevated
What is the main organ responsible for regulating electrolyte and acid base balance in the body? Why is Echocardiography important in evaluating disease states of this organ? Kidney. Cardiovascular complications are the main cause of death in patients with chronic kidney disease (KCD) on renal replacement therapy. Individuals on dialysis treatment often have a form of pre-existing cardiovascular disease. Possibly influence
What is the number one cause of dilated cardiomyopathy in in the USA? What are other international causes? What type of EF usually is associated with a dilated cardiomyopathy? Alcohol is the number one cause. Other causes are infection, AIDS, ischemia. 10-25% EF
What are normal arterial blood gas values? Normal ABG's would be: PH 7.38-7.44, PC02 40mmHg,HC03(bicarbonate)24mEq/L
What do you call the memory or computer of the ultrasound machine? Digital scan converter
What is the number one valvular heart disease? What is the best 2-D view used for diagnosing Mitral valve prolapse? Mitral regurgitation is the number one valvular heart disease. Use the Parasternal long axis view (3 chamber) for diagnosing MVP.
When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope. What is the first heart sound caused from? The first sound—the"lub"is made by the mitral and tricuspid alves closing at beginning of systole. Systole is when the ventricles contract and pump blood out of the heart.The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at th
What are Arteries? The arteries are major blood vessels connected to your heart.The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen. The aorta is the main artery that carries oxygen-rich blood pumped f
What are five common findings associated with dilated cardiomyopathy? What is a common late complication associated with this type of cardiomyopathy? Increased EPSS, dilated LV, global hypokinesis with a low EF, decreased aortic root motion, LAE. Risk of systemic emboli or apical thrombus late in course
What is Metabolic Alkalosis? What is a normal bicarbonate level? Excessive bicarbonate (HCo3)in the blood. The normal level is 24-28mEq/L
Why is a Ultrasound transducer that is cracked considered unsafe? It may cause electric shock
Nuclear medicine studies are NOT useful in ... a) Quantifying intracardiac left to right shunts b) Assessing differential lung perfusion c) Diagnosing pulmonary AV malformations d) Aortic disease e) Assessing cardiac function Nuclear medicine studies are NOT useful in d) Aortic disease
What are Veins? The veins also are major blood vessels connected to your heart. The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body. The superior and inferior vena cava are large veins that carry ox
What is Chagas disease? Cardiomyopathy caused from a parasite bite(more common in South America)
What is respiratory acidosis and how is it treatable? What is respiratory alkalosis and how is it treatable? A patient is admitted to the cardiac department with the following ABGs: FiO2 = 40%, pH = 7.3, PCO2 = 50, HCO3 = 20. According to these blood ga Acidosis is a build up of carbon dioxide in the blood. (The PH level will be lower than the normal of 7.4)PH of7.3= acidosis. This may be treatable by giving oxygen. Alkalosis is a deficiency of carbon dioxide in the blood. PC02 is abnormally low(40mmHg
What is the formula for wavelength? Wavelength =c/f (speed divided by frequency)
Describe the artifact reverberation and name one? Multiple echos equally spaced and close to the transducer. Gas bubbles
In an emergency situation what body fluids may be considered infectious? How do you disinfect an area after a blood spill? All fluids may be infectious. After a blood spill put on your gloves, then use 1 part bleach with 10 parts water
What type of cardiomyopathy may be seen as a bright myocardium with a ground glass appearance? What causes this bright appearance? Amyloidosis. Starch like deposits of an abnormal protein (amyloid) in the heart tissue, which make it hard for the heart to work properly.Cardiac amyloidosis ("stiff heart syndrome") occurs when amyloid deposits take the place of normal heart muscle. It i
Why are microsphere ultrasound contrast agents such as Definity used in echocardiography? This is an Image of Definity perflutren lipid microsphere ultrasound contrast agent. Contrast echocardiography Transpulmonary contrast agents are used to fill the left heart chambers for enhancement of left ventricular endocardial border definition. Dif
If you are accidentally exposed to a patient's blood, what is the medical responsibility to the healthcare worker? Post exposure follow up must be made available and blood testing is free of charge
What are the three major types of cardiomyopathy? Hypertrophic (with or w/o obstruction), Dilated (congestive), Restrictive (infiltrative)
What artifact will occur to an object if the propagation speed is less than 1540 m/s when scanning? The object will be placed too far from the transducer
If there is a lack of oxygen in the blood stream for anaerobic glycolysis, what is one of the end products? Lactic Acid may build up in the body
What are two classic findings associated with hypertrophic cardiomyopathy using doppler and M-mode? Late peak dagger shape on doppler, Mid systolic notch of aov(double diamond appearance)on M Mode
What type of artifact may sclerotic valves and prosthetic valves produce? What type of artifact is associated with low amplitude signals? Shadowing artifact
What primary structures are seen in the PSLA? Parasternal long axis: place the transducer on the 3rd intercostal space left parasternal. The trans-ducer's index mark is directed towards the patient's right shoulder. The right (RV) and the left ventricle (LV), as well as the aortic bulb (Ao) and the (
How do you obtain the Parasternal short axis (papillary muscle level) view? What structures are seen in this view? Parasternal short axis (papillary muscle level): From the psax view tip the transducer to the level of the papillary muscles in the LV. The LV and the right ventricle RV and Papillary muscles aer seen
Oxidation of glucose is also known as? Why is this process important to the cell? Cellular respiration. This process produces the cells energy
What effect does the valsalva maneuver have on the aortic valve murmur Hypertrophic Cardiomyopathy (HCM)? It will increase or accentuate the murmur
What is Frequency? What is considered the audible sound range? Does the doppler shift occur in this range? Frequency refers to the number of cycles of compressions and rarefactions in a sound wave per second, with one cycle per second being 1 hertz. While the term ultrasound generally refers to sound waves with frequencies above 20,000 Hz (the frequency range
T/F Systolic anterior motion(SAM) of the mitral valve is associated with HCM? True. Hypertrophic cardiomyopathy (HCM) has various manifestations with respect to the localization of the hypertrophy, However, the prevalence of systolic anterior motion of anterior mitral leaflet (SAM) is an echocardiographic diagnostic hallmark in HOC
What are building blocks of proteins called? What part of a cell stores Genetic Nucleic Acids? Amino Acids, Deoxyribonucleic Acid (DNA)
What are two ways to improve temporal resolution? Will increasing the frame rate improve temporal resolution? Decrease the image depth, decrease the sector size of your scan. Yes
What structures can be seen in the MV short view? Parasternal short axis (mitral valve level): A cross section of the left ventricle (LV) at the level of the mitral valve and the right ventricle (RV) can be displayed
The heart rate and respirations are controlled in what part of the brain? Medulla Oblongata
What does Amyl nitrite do to the heart? What murmurs are increased by Amyl nitrite and which are decreased? Amyl nitrite is a vasodilator which causes a decrease in BP and venous return. Murmurs such as AS, AO sclerosis and HOCM are increased. Also a murmur with MVP may be more prevalent, However murmurs associated with MR, AR and VSD's will typically decrease
Amyl nitrite is a vasodilator which causes a decrease in BP and venous return. Murmurs such as AS, AO sclerosis and HOCM are increased. Also a murmur with MVP may be more prevalent, However murmurs associated with MR, AR and VSD's will typically decreas Fresnel-Near field of the sound beam. The region between the transducer face and the focal point. Fraunhofer- Far field. After the focal point where there is beam divergence
Which of the following vessels have the greatest influence on total vascular resistance? a. Veins b. Venules c. Arterioles d. Capillaries c.Arterioles, Vascular resistance is a term used to define the resistance to flow that must be overcome to push blood through the circulatory system. The resistance offered by the peripheral circulation is known as the systemic ascular resistance, while t
(T/F) The memory of the ultrasound machine uses binary numbers? True
How do you obtain the Apical four-chamber view? What structures can be seen in this view? Apical four-chamber view: place transducer on the 5th inter- costal space, approx. left midclavicular. The transducer's index mark is directed towards the patient's left side. The left (LV) and the right ventricle (RV) ,as well as the left (LA) and the ri
T/F With hypertrophic cardiomyopathy common findings are LVE,LVH,LAE False, LVH,LAE and normal to decreased LV size
What does the Valsalva maneuver do to intrathoracic pressure? What murmurs will increase during the Valsalva maneuver? The strain phase of the Valsalva maneuver increases intrathoracic pressure and will decrease venous return,stroke volume and cardiac output. All murmurs will decrease (Mitral, Tricuspid, Aortic and Pulmonic) except for murmurs specific to Hypertrophic obs
Mosaic color may depict what type of blood flow? Turbulent
What is the main brain stimulus used to control breathing? What nerve controls the breathing by the diaphragm? The C02 level in the body is what the brain uses to regulate breathing. The Phrenic Nerve controls breathing by the diaphragm
What type of ventricular aneurysm involves only two layers of the heart muscle? What are the two layers? Pseudoaneurysm. Epicardium and pericardium
What walls are seen in apical 2 chamber view? Apical two-chamber view: The left ventricle (LV) and the left atrium (LA) can be displayed. In the two chamber view you can see the (septal side) which is called the Inferior Wall. Also, the Anterior Wall can be seen
T/F A true ventricular aneurysm occurs more frequently than a pseudo aneurysm? T/F Aneurysm formation is the most common complication of an myocardial infarction? False. True
What type of transducer can beam steer and focus from a small time delay in the elements firing mechanism? Sector phased array transducer
What structures are seen in the apical 3 chamber view? Apical three-chamber view: The left ventricle (Inferolateral wall and septum), the left atrium (LA) and the aortic bulb (Ao) can be displayed
Where is insulin produced? Is the pancreas located in the abdominal cavity? Pancreas. Yes. The pancreas is a small organ, approximately six inches long, located in the upper abdomen,and adjacent to the small intestine.The Pancreas completes the job of breaking down protein, carbohydrates, and fats using digestive juices of pancre
T/F True ventricular aneurysms have the mouth wider than the body and involve the endo,myo and epicardial ventricular walls? True
What is the simplest carbohydrate group? What are the three classified groups of carbohydrates? Monosaccharide, the simplest group, and is a single sugar molecule such as glucose or fructose. Disaccharide,Polysaccharide and monosaccharide
What type of transducer does not have beam steering and produces a rectangle shape? Linear sequenced array transducer
Are lipids soluble in water? What are the three major groups of lipids? No. The three groups are: Triglycerides (fats, oils and waxes), Phospholipids, and Steroids
How do you obtain the Subcostal view? What structures are seen? What is the normal diameter for the IVC? Subcostal view:place the transducer on the subxyphoid region.The transducers index mark is directed towards the patient's head.The inferior vena cava (VCI) can be displayed.Turn the transducer clockwise slightly to display the right and left ventricle, as
In continuous wave ultrasound what is the maximum duty factor value? What is the minimum value? Maximum is 1 or 100% when the CW is on. Minimum is 0 or 0.0% when CW is off.
What is the number one benign cardiac tumor that is made of connective tissue cells? LA myxoma, Cardiac myxomas are benign tumors of the heart. Eighty-five percent are located in the left atrium (LA), the remaining 15% in the right atrium (RA), in both atria, or occasionally in the ventricles. Clinical symptoms are related to embolic ev
Describe peak to peak pressure gradient compared to a peak instantaneous pressure gradient. Which is used in doppler echocardiography? Peak to Peak used in cath, compares the peak systolic right or left ventricular pressure to the peak systolic pulmonary artery or aorta.(2 measurements) while, Peak Instantaneous is just one measurement obtaining the instantaneous peak between the 2 c
In the ultrasound beam spatial resolution determines the degree of image clarity. Where is lateral resolution best? Where is axial resolution best? Spatial resolution determines the degree of image clarity. resolution is the ability of the ultrasound machine to distinguish two structures (reflectors or scatterers) that are close together as separate. Spatial resolution is influenced by axial and lat
What is the number one malignant cardiac tumor? Sarcoma- It is the most common malignant tumor of the heart, and occurs in the right atrium. Here it can cause right-sided heart failure, arrhythmias, pericardial effusion, and cardiac tamponade
What Structures can be seen in the suprasternal view? Suprasternal view: place the transducer on the suprasternal region. The transducer's index mark is directed towards the patient's head and turned approx. 45° to the right. The aortic arch(*), the neck arteries (TB, CL, SL) and the right pulmonary artery (
What are the three parts that make up the respiratory system? Respiratory system includes the Trachea, Bronchi and Lungs
What is the most common VSD including adult population? Perimembraneous VSD
What is the name of the most common electronic cardiac transducer? Sector phased array is a multi-element ultrasonic transducer (typically with 16, 32, or 64 elements) used to generate steered beams by means of phased pulsing and receiving. This is the most common electronic cardiac transducer
What are the four major types of ASD's? What is the most common ASD? There are four types of ASD- nSecundum ASD- 75%Primum ASD- 20% Sinus venosus ASD- 5%Coronary sinus ASD- 1%Secundum ASD is sometimes called secondary ASD as it develops over the existing foramen ovale while the others are called primary ASD.Embryology •S
What is Amarosis Fugax? What is Syncope? Temporary loss of sight or blindness in one eye (monocular) caused from decreased blood flow to the retina.Syncope is the medical term for fainting, a sudden, usually temporary, loss of consciousness generally caused by insufficient oxygen in the brain ei
What is Attenuation as it relates to Decibel (dB)? Attenuation is loss of energy, expressed as change in intensity, as the energy travels through a medium. Ultrasound intensity is measured in watts per square centimeter. Decibels are used to express difference between ultrasound intensities.For ei., when
T/F Most ASD's are low velocity with left to right shunting? T/F Longer standing ASD shunts commonly cause RV volume overload? True, True
What does the nervous system consist of? The paired vegas nerves, and paired sympathetic chains
What percent does a -3dB loss of original intensity represent? 50% loss of the original intensity
What are the three components for valvular regurgitation? All valvular regurgitations have three components: PISA (proximal isovelocity surface area), vena contracta and regurgitation jet. PISA can be spontaneously seen when regurgitation is already significant. Vena contracta plays a more important role for ass
What body cavity contains the lungs, heart, esophagus, trachea, major blood vessels, endocrine glands nervous system and lymphatics? Thoracic Cavity
What law is considered the law of refraction? Will refraction occur if there is perpendicular incidence? Snell's law, No
Explain the Continuity Equation? What is the formula for the Simplified Continuity of flow equation? Continuity Equation:Standard method to calculate valvular opening area. Systolic velocities in (LVOT) and on the AV, as well as LVOT area must be assessed. A2 = aortic stenosis area, V2 =aortic stenosis velocity time integral (VTI, obtained with CW-Dopple
What is Persistent Left SVC? What is a one common Echo finding? Congenital malformation where the left arm drains into the coronary sinus instead of the SVC. A dilated coronary sinus
What is the most common man made piezoelectric transducer is made of? Why? Lead Zirconate Titanate(PZT). Crystals which acquire a charge when compressed are said to be piezoelectric. This provides a convenient transducer effect between electrical and mechanical oscillations. Barium titanate, lead zirconate, and lead titanate are
What structure separates the thoracic cavity from the abdominal cavity? What purpose does the diaphragm serve? The Diaphragm has several purposes 1. Respiration: the diaphragm contracts during inhalation, leading to entrance of air from the environment; the diaphragm relaxes during exhalation, leading to exit of air to the environment.2. Retaining of Food: the di
The frequency of a CW transducer is determined by what factor? The frequency of a CW transducer is determined by what factor?
What cavity contains the stomach, gallbladder, pancreas, intestines, liver, spleen, adrenal glands and kidneys? Abdominal cavity
What is Eisenmenger's Syndrome? What is a common complication associated with this disorder? A long standing left to right ASD or VSD the shunt reverses and becomes right to left. Severe pulmonary HTN
The pressure gradient through a tube is inversely proportional to which of the following: a. Length of the tube b. Flow rate of the fluid c. Radius of the tube to the fourth power d. Radius of the tube to the sixteenth power c. Radius of the tube to the fourth power
What does plasma consist of? Plasma is 90% water(liquid portion of blood), 8% proteins, nutrients, waste products such as uric acid and creatinine, electrolytes,(various ions such as sodium calcium chloride and bicarbonate), respiratory gases(O2 and CO2).
What is Ebstein's Anomaly? What are three common findings in patients with this anomaly? Apical displacement of the TV leaflets. TV abnormal, RVVO, ASD
What is in vitro? What is in vivo? What is epidemiology? Vitro-Studies performed in a glass tube. Vivo-performed on animals or plants. Epidemiology is the study of the prevalence of disease.
How do we assess pulmonary artery pressure (PA-pressure)? Assessment of PA-pressure is an important part of a echo exam. Assessment of pulmonary artery systolic pressure (PASP) can be carried out by measuring maximal tricuspid regurgitation velocity, and applying the modified Bernoulli equation to convert this
What function do platelets and thrombocytes have? Platelets and thrombocytes adhere to damaged blood vessel walls and release enzymes that activate hemostasis which stops bleeding.
What is the basic value of attenuation in soft tissue? .5-1db/cm/MHz
What type of aortic dissection is the most common? What is the location? Type one. Ascending aorta to the aortic arch
T/F With Trunkus Arteriosus the RV has no RV outflow tract and no pulmonic valve? True
What is the most common protein and it's function? Name a few other proteins and function? Albumin. It is produced by the liver and helps to keep osmotic pressure between blood and tissue. Other proteins are hormones, alpha and beta globulins(transport lipids), gamma globulins(antibodies), fibrogen and prothrombin(clotting proteins).
What is Thermal index(TI)? What is mechanical index(MI)? MI-Is the potential of cavitation (The higher the MI the larger the potential) TI-Estimates temperature rise from ultrasound exposure
If there is a propagation speed error what might occur? The echo may be improperly located
In the PSLAX view what two aortic valves can be seen? Which valve is closest to the MV in this view? Right and non coronary. Non coronary
What are the main functions of blood? What is anemia? What is erythrocytosis? Transport nutrients, oxygen, and hormones, remove metabolic waste and C02, provide immunity through antibodies, maintain body temperature, electrolyte balance and clotting. Anemia is low RBC count and erythrocytosis is a high RBC count
Where can Pulmonary venous flow velocities best be assessed with PW-Doppler? Pulmonary venous flow velocities can be assessed with PW-Doppler. Localization of pulmonary veins with color Doppler is relatively easy, and allows to place sample volume at the right position. (3-4 mm into the pulmonary veins for a good signal)
T/F Does the MV have premature closer when acute severe AI is present? Is the MV effected with loss of Sinus Rhythm or a when a First Degree AVB present? True, True-premature MV closure can occur
What are the four major blood types? Which is the universal donor? A,B,AB,& O. Type AB is the universal recipient. Type O- is considered the universal donor because it has no antibodies to clump with the antigens of other blood types
What is associated with Huygens principle? All points on a wave can be considered for secondary smaller waves
Blood and lymph can be checked by chemical tests and coagulation studies. What are the five common tests used for direct examination of blood? 1. Hemoglobin test- Measures the oxygen-carrying ability of blood. 2. Hematocrit -Measures volume of erythrocytes. 3- Sedimentation rates- How long it takes the erythrocytes to settle in the bottom of a container.4.Blood cell counts(CBC,WBC, RBC)- to ev
What are three other names that lateral resolution may be called? What factor determines lateral resolution? Transverse, Azimuthal, Angular. Beam diameter determines lateral resolution
What does fine diastolic flutter of the mitral valve represent on mode? What type of murmur is associated with Austin Flint? AI is present. Austin Flint murmur is a low pitched diastolic rumble present with severe AI.
Can slow wall Mitral annular velocities be assessed with Tissue Doppler? Mitral annular velocities examination.Slow wall velocities can be assessed with Tissue Doppler Imaging (TDI). The sample volume, when placed at the medial mitral annulus, shows slower velocities as when placed at the lateral annulus. The E/E' relationsh
In statistics, the most commonly used measure of the variability or dispersion of data is the: a. Chi square b. SDSS-test c. Quartile deviation d. Standard deviation e. Statistical mean d. Standard deviation
Name the three layers of a Vessels wall? Define the vasa vasorum? Tunica Intima- inner most,Tunica Media- middle, and Tunica Adventia or Tunica externa- outer layer. The vasa vasorum are tiny vessels that cary blood to the walls of large arteries. They feed the adventitial layer as well as some of the medial layer
What are three other names axial resolution may be called? What factors determine axial resolution? Longitudinal, Range, Depth. Spatial pulse length and the frequency determine axial resolution
Which has a longer ejection time AS or MR? MR
How can AI effect the LV size and wall motion? LV dilatation, hyperkinesis of the IVS and LV wall
What are the arteries that act as a control valves through which blood is metered to the capillaries? What are capillaries and why are they considered microvessels? Arterioles. Capillaries are the smallest of a body's blood vessels and are part of the microcirculation. They are only 1 cell thick.(microvessels) they connect arterioles and venules, and enable the exchange of water, oxygen, carbon dioxide, and many ot
What is the function of the matching layer on a transducer? The matching layer decreases the impedance difference between the piezo crystal and soft tissue. This improves transmission and reception
Refraction may often cause artifact known as? Side lobe artifact
What vessel contains deoxygenated blood from peripheral tissue? Veins
Which occurs first with AS, LVH or LVE? LVH
What are the three distinct layers of the heart? What is the pericardium? Epicardium- Thin outer layer, Myocardium- Thick middle muscle, Endocardium- Inner layer composed of endothelial cells which line the heart valves. Pericardium is the protective sac that surrounds the heart, fibrous parietal and great vessels
What is the log of 1000 equal to? 3. The log of any number represents the number of times 10 must be multiplied together to create the original number. What is the log of 1000? We have to multiply 10 by itself 3 times to make 1000. So, the log of 1000 is 3.(10x10x10)
What murmur typically has a mid systolic upper right sternal border? What murmur has a crescendo decrescendo right sternal S4 sound? Aortic stenosis murmur. AS murmur
What are three classic symptoms with AS? Angina pectoris, CHF, syncope
What determines the resonant frequency of the transducer? Crystal thickness
What is the function of the left atrium and the right atrium? What vessels carry O2 rich blood from the lungs to the left atrium? What three vessels carry CO2 to the right atrium? They both act as temporary storage chambers so that blood will be readily available for ventricular filling. O2 rich Blood enters the left atrium from the four pulmonary veins. Oxygen depleted blood(CO2) enters the right atrium from the IVC,SVC and Coron
Name two mechanisms of bioeffects and describe them? Thermal-Localized heat is produced with ultrasound. Cavitation-Small micro bubbles are produced as a result of violent agitation
T/F AS often times may be overestimated if a bad angle or low cardiac output states are present? False -Underestimated
What are the functions of the right and left ventricle? The ventricles are the main pumping chambers for the systemic(oxygen rich LV) and (oxygen depleted RV) pulmonary circulation
Can color shift information be determined by color flow doppler if blood flow is 90 degrees (perpendicular) to flow? No, a colorless region may be present
If a patient has chest pain and is given morphine, what effect would it typically have? It should dull the chest pain and is known for it ability to increase vascular resistance and decrease systemic resistance
What 2-D findings are seen with Aortic Stenosis? What Doppler finding are associated with AS? Decreased AOV mobility with thickened leaflets, LVH, Possible AO root dilatation. Increased AOV velocities and turbulence
What is Marfans Syndrome? What are some of the physical abnormalities present with this disorder? What are some common echo findings? A connective tissue disease. Patients may have long bones and eye problems. MVP, ascending aorta dilatation, and aortic aneurism
T/F Rheumatic heart disease has been known to effect these three valves with MS, AS and TS? True
What is the function of a Beta blocker? Name some common beta blockers? What are some side effects? Beta blockers slow the sinus rate,depress AV conduction,reduce BP (by blocking part of the sympathetic nervous system). Beta blockers have multiple beneficial effects (including prolonged life) in patients with coronary artery disease, patients who have h
What is the normal Aortic vavle velocity? How do you assess the severity of Aortic Stenosis? Normal velocity is 1.4 m/s.( with a range of .9 to 1.8 m/sec)The aortic valve area can be calculated non-invasively using echocardiographic flow velocities. Using the velocity of the blood through the valve, the pressure gradient across can be calculated
What type of transducer has elements that are energized sequentially from inside out and create a circular beam? Annular array
What are four common findings with TR? Is the LA effected typically with TR? RAE, RVE(volume overload), flattened septum, Vena cava enlargement. No, the LA is not effected
What is the Foramen Ovale and the Ductus Arteriosus function? Foramen ovale is a opening across the interatrial septum which allows blood to pass from the RA to LA while the lungs develop during fetal development. The Ductus Arteriosus is a connection between the Pulmonary trunk and Aorta.
What type of information does color flow doppler come from? Multi-gate pulsed wave doppler
(T/F) Low transmit output and high receiver gain is safer than high transmit out put low receiver gain? True
What are three common findings with stenotic valves? Thickened leaflets, valvular doming, reduced cusp separation
What is the function of calcium channel blockers? What are two common Ca++ channel blockers? Calcium channel blockers block inward movement of calcium to slow impulse conduction(particularly through the AV node). They also relax smooth muscle contraction of the vessels. Diltiazem and Verapamil are two common calcium channel blockers
Autorhythmic activity of the heart can be modified by what branch of the nervous system? Autonomic nervous system
What is the propagation of sound inversely proportional to? The mediums density
What type of flow is AI and PI? Are these typically seen above or below the baseline with doppler interrogation? Diastolic flow. Seen typically above the baseline
(T/F) As the density of the medium increases, the speed increases? False
What does the Cardiovascular system consist of? What are the three main functions? The heart, blood vessels and blood. 1)Transport of nutrients, oxygen and metabolic waste removal. 2)Protection by WBC's, and antibodies. 3)Regulation of body temperature, fluid PH and H2O content in cells.
What type of flow is MR and TR? Systolic flow
What are two common early stage findings with MR? What are three late stage findings? LAE,LVE. Late-RVE,RVH,HTN
What type of Valve is seen in this photo? Starr-Edwards Silastic ball valve mitral Model.
What will happen to the speed of sound through tissue if the stiffness of the medium increases? The speed will increase
Where is the highest O2 saturation in the fetal circulation found? Umbilical Vein
Name one thing that you could do to increase the frame rate? Decrease the size of the image sector
Pauses can be seen on an EKG following a PVC or PAC. What are these pauses called? What is an interpolated PVC? PVC-Compensatory pause, PAC-Non-Compensatory pause. PVC's that don't have a compensatory pauses are called interpolated PVC's.
What are six common findings with mitral stenosis? Is the LV commonly effected with mitral stenosis? LAE,HTN,RAE,RVE,LA thrombus,A-fib. No, the LV is not usually effected unless MR is present.
Which is the most commonly implanted mechanical valve in the United States? Bileaflet valves include the St. Jude, shown in the image. This is the most commonly implanted valve in the United States
If blood travels away from the transducer the doppler shift will be? Negative doppler shift
List four findings with AS? Why is there sometimes post stenotic dilatation of the aortic valve with AS? Is the RV usually effected with AS? LVH then LVE,LAE,decreased LV contractility. Post dilatation may occur because of the high pressure/velocity jet hitting the aortic walls. No effect on RV
List some Bioprosthetic (xenograft) valves are made from porcine valves or bovine pericardium? Bioprosthetic (xenograft) valves are made from porcine valves or bovine pericardium. Porcine models include the Carpentier-Edwards valves and Hancock II and Mosaic valves. Pericardial valves include the Perimount series valves,Ionescu-Shiley pericardial
What are the basic four heart sounds? S1-Closure of mitral and tricuspid valves(Systolic contraction), S2-Closure of the aortic and pulmonic valves(dicrotic notch), S3-Rapid filling of blood into the left ventricle, S4-atria contracting, pushing blood into the LV and RV-(final rush of b
T/F AI may effect the great vessels and sometimes cause aortic dilatation? What are three common findings with AI? False. LVE,LAE,hyperdynamic LV.
What artifact is typical of Multi-element transducers? Grating lobe artifact
What is a common chronotropic drug and a common inotropic drug? Chronotropic= Atropine, Inotropic= Dobutamine
What equation should be used to determine AVA? Does AI effect this equation for an accurate peak velocity? What value area is considered severe aortic stenosis? Continuity of flow equation A2=A1xV1/V2. AI does not effect the V1/V2 equation. Values are: Mild: 1.5-2.0cm2, Moderate: 1.0-1.5 cm2, Severe: <1.0cm2
What function on the ultrasound machine would eliminate smaller amplitude voltages produced by weaker echos to to reduce unwanted noise? Reject function
What is a False Positive test? What is a False Negative Test? What is True positive? What is True negative? FP=a positive test,but the patient does not have the disease state.FN=The test shows a negative result, but the patient does have a disease state that has been missed.True positive means the study is positive and disease is detected. True negative means
What is Intra-Cardiac Echo (ICE)? Intracardiac echocardiography ICE).The application of miniaturized transducers and techniques that create images. These images can then be displayed as M and B modes, with Doppler Effect (pulsed wave, continuous wave, or color flow imaging),and as three-d
What are the ACC/AHA Aortic Valve Area(AVA) guidelines for grading an aortic valve stenosis? Assessment of valvular morphology is the first step to a Correct diagnosis of valvular heart disease and should be seen in multiple views when possible. The aortic valve is thickened, calcified and with severely reduced leaflet separation. AVA guidelines
What are the inherent fire rates of the SA, AV, and Perkinje fibers? SA=60-100, AV=40-60,Perkinje=20-40 beats per minute
What heart valve is location most superior? On M-mode what abnormality is a common finding with a deep "a" dip of the posterior leaflet >7mm? Pulmonic. Pulmonic Stenosis
Which transducer will avoid aliasing better? 2.5MHz or 3.5MHz? 2.5MHz
What are three common findings with PS? T/F The LV and LA are typically effected with pulmonic stenosis? T/F The most common cause of PS is congenital(non- RHD)? RVH then RVE over time, also possible RAE. False. True
What effect does the Valsalva maneuver have on the cardiovascular system? How many phases of the Valsalva maneuver are there? What are they? Decreases venous return.There are four phases during the Valsalva maneuver. Phase one is the onset of straining with increased intrathoracic pressure. The heart rate does not change but blood pressure rises.Phase two is marked by the decreased venous ret
What percentage of time is a pulsed ultrasound system receiving sound? 99.9%
Describe normal aortic valve anatomy? Describe the Sinus of Valsalva? There are three cusps, the right, left and the non coronary cusp. Behind each leaflet the wall dilates to form a sinus of valsalva. The L and RT sinus fill with blood during diastole. Respectively-RT Ao cusp to the RT coronary artery and Left Ao cusp to t
In which of the following patients would an enteric isolation technique be used? a. Influenza b. Draining wounds c. Respiratory disease d. Diseases spread by fecal contamination d. Diseases spread by fecal contamination
Looking at the monitor, approximately how many shades of gray can the organic human eyeball see? One Hundred
What effect is there on the cardiovascular system with isometric exercise? (sustained handgrip type of exercise) Increased peripheral resistance,CO,BP,HR are some of the effects
A change in direction of a sound beam at a interface with two different impedances is called? A change in direction of a sound beam at a interface with two different impedances is called Refraction. Refraction and is determined by Snell’s law
How does PI effect the right ventricle? T/F The very most common cause of PI is valvular ring dilatation? RVE with paradoxyl septal motion, possible fine diastolic flutter of the TV leaflets. True
How many weeks does it take for the heart to be completely formed? Seven
In the fetal heart what does the Bulbus Cordis form? LV and RV, The bulbus cordis (also known as the conotruncus) lies ventral to the primitive ventricle after the developing heart assumes its S-shaped form. Together, the bulbus cordis and the primitive ventricle give rise to the ventricle of the formed hea
What are three causes of TR? T/F Carcinoid is a TV disease where the valves are thickened and fixed in a closed position? RHD, Carcinoid syndrome, Ebsteins anomaly. False-fixed in an open position
What determines the brightness of an echo signal? Amplitude
What are three common findings with ASD's? PA enlargement, RAE, RVE
What is pectus carinatum? A protrusion of the chest over the sternum which gives the chest a bowed-out appearance
What is the unit of frequency? Hz
The time it takes for one cycle to occur is called? Period
What are two common findings with VSD's? What is a classic m-mode finding with ASD's? Which direction is the blood flow across the VSD usually? LAE, LVE. RVVO. Left to Right (higher pressure to lower)
(T/F) Wavelength increases as frequency increases? False, higher frequency equals a shorter wavelength. A lower frequency will produce a longer wavelength
In relation to the EKG what normally occurs with the S2 murmur? End of the T wave
T/F Aortic Coarctation is strongly associated with Bicuspid aortic valve? What is Coarctation of the Aorta? True. The aortic arch is the part of the aorta which curves to connect the ascending and descending aorta.Narrowing of the aortic arch is termed coarctation of the aorta.This causes elevation of BP in the arteries before the point of narrowing and reducti
Can respiratory inspiration cause a delay in the interval between aortic and pulmonic valve closure? Yes
What does a sound wave carry? Energy
(In statistics) What is the greatest common variability of data? What is the statistical Mean of 1,2,3? (In statistics) What is the greatest common variability of data? What is the statistical Mean of 1,2,3?
How many cycles are there in one second in a 7MHz transducer? Seven million
If there is high O2 sats in the IVC what abnormality may be present? ASD
Is attenuation higher in soft tissue or bone? Soft tissue
Name two common radioisotopes used in a nuclear myocardial scan? Thallium 201, Technetium (99m Tc) referred to as Sestamibi
T/F On pulsed wave doppler an E/A ratio of 2:1 is a normal diastolic value? False 1.0-1.5 to 1 ratio is normal
What is one of the most common protocols used during the treadmill exam? Bruce protocol.The Bruce protocol is a stress test performed on a treadmill to evaluate patients with potential heart disease. The function of the heart and lungs is assessed before, during and after the administration of the stress test with a progressiv
What term is used to describe when pressure changes a crystals shape from electric voltage hitting it? Piezoelectric effect
The SA and AV node receive oxygenated blood from which coronary artery? Right
What are the five wall motion assignments? What do the segments define in regard to function of wall motion? T/F? Number 1 is normal so 2 would be akinetic? The 5 wall motion segments define the wall motion of the heart as follows:1.Normal=no obvious abnormality 2.Hypokinetic =lower than normal movement 3.Akinetic= no movement 4.Diskinesis =opposite motion 5.Aneurysmal=a tear or ripping of wall. False- segmen
What is the bandwidth? A range of frequencies that occur with a pulse of sound
T/F? Doming of a valve is usually caused by valvular regurgitation rather than valvular stenosis? False- Valvular doming is associated with stenosis rather than regurgitation. Valve thickening, decreased leaflet excursion and doming (tethering) may all occur in a valvular stenosis
What is the crux of the heart? Where all four heart chambers come together
What type of modality is 2D imaging? B mode
Is color flow angle dependent? Yes
What is automaticity? The ability of the heart to start and maintain rhythmic activity without the use of the nervous system
While performing echo,you discover what appears to be a large thrombus in the LV.The patient states that she just can’t wait to speak with DR. Checkers and that any information you could supply would be the biggest relief to her. You should inform the pat d. You cannot interpret her Echocardiogram, but assure her that doctor Checkers will be reviewing it soon.
If standing, venous return and ventricular filling will? Decrease
Name the two basic ways to focus the ultrasound beam? Mechanical and electronic
Which would Endocarditis most likely cause, PI or PS? Which is a better role in evaluation of Infective endocarditis Transthoracic or Transesophageal Echo, Why? PI.Transthoracic echocardiography has proven to be useful for the diagnosis of infective endocarditis.However,suboptimal images in up to 20% of patients, limited image resolution, reduced ability to detect perivalvular abscesses in both native and prosth
What is the formula Z=pv used to describe? Acoustic impedance
What type of aneurysm is Kawasakis Disease? Coronary artery aneurysm
What type of EKG signal is produced when the the heart depolarizes toward a positive electrode? R wave
High frequency transducers will have what type of wavelength and penetration? Short wavelength and poor depth of penetration
What effect does Inspiration have on Preload? What effect does the Valsalva Maneuver have on venous return and BP? Inspiration results in increased preload and increased RV stroke volume. The Valsalva maneuver(bearing down) causes decreased BP and decreased Venous return
What is myocardial Ischemia? What is the number one cause of myocardial Ischemia? What is CHF? MI, also called cardiac ischemia, can damage your heart muscle, reducing its ability to pump efficiently.Sudden,severe blockage of a coronary artery may lead to a heart attack. (Lack of oxygen to the myocardium) MI may also cause serious abnormal heart r
What happens when a annular array transducer malfunctions? There will be a horizontal blank space on the CRT
What is Dresslers syndrome? Dressler's syndrome is a post myocardial infarction pericardial effusion. This disease state very rarely leads to pericardial tamponade. The syndrome consists of a persistent low-grade fever, chest pain,a pericardial friction rub,and /or a pericardial eff
Which cardiac valve is the first to open and the last to close in ventricular systole? Pulmonic Valve
How does Poiseuille's Law demonstrate the changes in pressure related to the radius of a blood vessel? Which factor has the largest effect on resistance to laminar flow through a vessel? Inversely proportional to the the 4th power. The vessels radius
Name three things that ultrasound systems require periodic testing? Depth calibration, Axial resolution, Lateral resolution
What are the two most common congenital abnormalities found in adults? Atrial septal defect and Bicuspid aortic valve are the two most common congenital abnormalities found in adults. However, the most common congenital cardiac anomaly is ventricular septal defect which is involved in 20%-30% of all congenital defects
Atrial septal defect and Bicuspid aortic valve are the two most common congenital abnormalities found in adults. However, the most common congenital cardiac anomaly is ventricular septal defect which is involved in 20%-30% of all congenital defects It decreases the AV conduction time, which will increase heart rate and contractility
What is the number one cause of mitral stenosis? What is considered a significant stenosis? What three measurements should you get in a MS study? Rheumatic heart disease. <1cm2. MVA, P1/2, PAP
What ratio does maximum amplitude to minimum amplitude describe? Dynamic range
What is contrast commonly used for in an echo study? Where does peripheral contrast appear first? To determine LV function, also helpful in ASD, TR and VSD studies. Appears in the RA first
What is Primary Hypertension? What is the cause of PHTN? What are four major risk factors that can develop with high BP? An increase in peripheral vascular resistance (Usually-BP>140/90) The etiology of most HTN is unknown. Risk factors include heart attack, stroke, heart and kidney failure
What is Temporal resolution? What type of frame rate will help improve temporal resolution? Being able to determine the position of a moving structure at any given time on the ultrasound system. Higher frame rates improve temporal resolution
Name a common Test object used in quality assurance and its purpose? AIUM 100mm Test Object-Used to evaluate resolution and range performance.(non Attenuation).
T/F Plural effusion is commonly difficult to see in the presence of RVH? True
What is blood pressure? What is pulse pressure? Force of blood against the walls of the arteries.The systolic is when the heart contracts and is the highest number,the lowest number is in diastole when the heart relaxes.Normal pressure is 120/80. Pulse pressure is the difference between the top number
(T/F) Blood flow toward the transducer is above the baseline? True
In the 2 chamber apical view what 2 LV walls are seen? In the four chamber apical view what LV walls are seen? Inferior septal and Anterior wall. Anterior lateral and septal
Which percent stenosis is considered to be significant coronary artery disease? 70%
1)Which of the following coronary arteries provides blood to the anterior wall of the left ventricle? 2)Which to the right ventricle? 3)Which to the inferior septal walls in a right dominant system? 1)LAD-(Left anterior descending), 2)Right coronary, 3)Posterior descending
What type of MI involves the right ventricle? Inferior MI
With a stenosis, What location is there typically the most turbulent blood flow? Distal to the stenosis
A 97-year-old female is scheduled for a TEE.a preoperative measure, his doctorhas given him 25mg of Demeral.Upon entry to the lab, his breathing is shallow and he is unresponsive.After notifying the Cardiologist, which of the following medications would b b.Narcan (Naloxone) is an special narcotic drug that reverses the effects of other narcotic medicines.Naloxone is used to reverse the effects of narcotic drugs used during surgery or to treat pain. Naloxone may also be used to treat narcotic drug overdos
Cyanosis is often seen in what types of congenital abnormality? Eisenmenger's syndrome, and a number of congenital heart defects including atrial septal defects, ventricular septal defects, patent ductus arteriosus, and more complex types of acyanotic heart disease
What is the Absolute or Effective refractory period of the heart? When the heart is unable to respond to electrical stimulus
Will color flow doppler provide peak velocity blood flow information? No, Average velocity
List three findings with post operative cardiac patients? Paradoxyl septal motion, pericardial effusion, atrial enlargement in some cases
What EKG findings may be present with a patient with the electrolyte disorder Hypokalemia? Peaked P waves(lead 2) and a long QT interval, Large U waves, also flat T waves.
What type of doppler uses autocorrelation? Color flow doppler
(On a treadmill) What is the hearts largest response to myocardial work and increased oxygen demand? The heart adapts to work by vasodilatation of the myocardial arterioles. Arterioles share many of the properties of arteries – they are strong,have a relatively thick wall for their size, and contain a high percentage of smooth muscle.Arterioles are very
Peak instantaneous pressure gradient for a patient with aortic stenosis of 4.0 m/s is? 64 mmHg
What is the Curie point? In performing TEE Echo's you must keep all transducers sterilized, should you use autoclaving for this? A temperature 300-400 degrees C that will cause the piezoelectric crystals to a permanently lose effectiveness. No
If a person is walking, what is the main mechanism responsible to returning the venous blood to the heart? Skeletal Muscle
What does a darker color shade represent during aliasing? What does the color black represent? Lower frequency shifts will exhibit darker shades of color. Black represents no doppler shift (Zero baseline)
What is the B notch seen on the m mode? What does this indicate? It is the small notch between the AC point on the mitral valve m-mode, caused from prolongation of the AC interval. Indicates elevated LV diastolic pressure
Coronary artery perfusion occurs from? Epicardium to Endocardium.-The myocardium is supplied by two arteries that branch from the base of the aorta.These arteries are the Right and Left Coronary Arteries, (RCA and LCA). These arteries further branch into circumflex,anterior and posterior arte
How do the stenotic aortic and pulmonic valves effect the ventricle chamber first? Ventricular pressure overload
Name three functions that effect the frame rate of color gain? Sector size,Color size box,PRF
How are each of the following units used in ultrasound? Area, Circumference, Time, Volume Area-Distance squared, Circumference-Length or distance (inches or millimeters), Time-Seconds milliseconds (ms) or microseconds, Volume-Cubic units (cc)
How does a regurgitant mitral and tricuspid valve first effect the atrial chamber? MR first creates volume overload of the left heart and TR creates overload of the right heart
What vessel in the body contains the largest volume of blood? Veins and Venules
How does MS and TS effect the atria first? MS first creates pressure overload of the left atrium and TS creates pressure overload of the RA
What equation helps to keep the proper depth of a reflection? Range equation
What is hibernating myocardium? What is stunned myocardium? A living myocardial muscle that is nonfunctioning because of chronic ischemia-Perfusion may restore function. Ischemic muscle that is reperfused but still not functioning
How does AI and PI effect the ventricle first? Ventricular overload
How many pulses does it take to equal one scan line on the image frame? One
Which method is the most common right heart cath method used for predicting cardiac output? Which is the most accurate method? What is cardiac output? Thermodilution. Fick. Cardiac Output is the amount of blood pumped out of the heart per minute(SVxHR), Normal range is 4-8LPM
Loud S1, opening snap and late diastolic murmur often represent? Rheumatic mitral stenosis
What are the two major components of demodulation? Rectification, Smoothing
What is the amount of blood pumped out of the heart per beat called? What is normal range? Is the stroke volume of the LV equal to that of the RV? Stroke volume (EDV-ESV) The normal range is 70cc-100cc. Yes
Describe the mitral valve prolapse murmur? Is the 2-D 4 chamber view a good view to determine the presence of MVP? A MVP murmur is a mid-systolic and late systolic murmur at cardiac apex. NO, MVP may be falsely diagnosed in the 4 chamber
In a vessel, what is the number that determines when turbulent flow will occur? Reynolds number (number greater than 2000).
What is CRT? What format does CRT write in? TV screen or computer screen(Cathode ray tube), writes in a raster scan format up to 60HZ or 60 frames per minute
4. Splitting of S2 is best heard at the a. Apex b. Third left intercostal space c. Fourth left intercostal space d. Second right intercostal space b. Third left intercostal space
Frequency and wavelength are inversely related, what does this mean? As frequency increases wavelength decreases. As frequency decreases wavelength increases
PSAX at the apex the heart can be seen contracting in what direction? Counter clockwise
What are the normal left and right heart oxygen saturation levels? Right heart sats are 70% and left heart sats are 98%.
(In comparing the systemic circulation to the pulmonary circulation) Which has the higher pressure, higher resistance, higher oxygen content, thicker ventricular and vessel walls and lower CO2 level? Systemic Circulation
Anterior clear space is seen between the epicardium and myocardium, what is the most likely? Fat tissue (adipose tissue)
What does the term "BART" stand for in ultrasound? This is the standard direction of blood flow in orientation to the transducer.(Blue-away, red-toward)
Name the components of the pulmonary circulation? RV,main pulmonary artery and branches, pulmonary capillaries, pulmonary veins
What is the muscle bundle that attaches from the RV free wall to the IVS? Moderator band
With acoustic exposure, What type of ultrasound has the highest intensity levels? What has the lowest levels? Pulsed wave and color flow doppler have highest intensities. M-Mode and 2D imaging have the lowest intensities
80mm is the same as how many centimeters? 8cm
Name the components of the systemic circulation? LV, aorta, systemic capillary network, cerebra, peripheral and abdominal veins, SVC and IVC.
What is the subpulmonic area of the RV? Infundibulum
2 meters per second(m/s) can be written as how many cm per second? 200cm/s
How does tricuspid regurgitation affect the right atrium? How does it affect the right ventricle? Tricuspid regurgitation may cause right atrial enlargement due to volume overload.The RV may become dilated and present hyperdynamic wall motion. In cases of severe TR the volume overload can cause reversal of flow into the Hepatic Vein and cause IVC and
The length of of myocardial fibril stretch prior to it's next contraction is called? What 3 factors influence this? Preload, LV Preload occurs only during ventricular diastole and the 3 measurements that evaluate LV Preload are resting fiber length, End Diastolic Volume and End Diastolic Pressure
The resistance(pressure build up) the ventricles face as they eject blood is called? Blood Pressure is mainly determined by? Increasing the _____ will cause a decrease in Cardiac Output Afterload, Afterload, Afterload causes a decrease in CO do to the increase in resistance
Where is the tricuspid valve located? Name the three tricuspid valve leaflets(cusps) in relation to the right ventricle? List 4 conditions can cause obstruction of the native tricuspid valve? The tricuspid valve is located between the right atrium and right ventricle. The cusps are Anterior,posterior and medial or septal. (1) rheumatic heart disease, (2) congenital abnormalities, (3) metabolic or enzymatic abnormalities, and (4) active infec
Depolariziation of the ventricle occurs with the onset of which EKG complex? QRS
What pulmonic valve is normally seen on m mode? What is the most common cause of pulmonic stenosis? The posterior pulmonic valve is usually seen on m mode. Congenital abnormality is the most common cause of pulmonic stenosis
What will improve temporal resolution? Increase the number of images per second (increase PRF- by decreasing the depth
What 2d view is best for visualizing tricuspid regurgitation? What are two main echo findings with chronic tricuspid regurgitation? Apical four chamber is best for visualizing tricuspid regurgitation. Findings with chronic tricuspid reguritation are right ventricular volume overload and right ventricular dilatation
What effect does isometric handgrip exercise have on the mitral valve? Increases the murmur and regurgitation
T/F Aortic valve peak velocities can often be detected from the apical four chamber view? False (five chamber view)
When do the mitral and tricuspid valves close and open in relation to the EKG? Why do they open and close? MV and TV close with the onset of the QRS. The LV and RV pressure has exceeded the LA and RA pressure. The MV and TV open at the end of the T wave when LV and RV pressure falls below LA and RA pressure
According to M-mode measurement guidelines from the American Society of Echo, the LV should be measured at the level of the: a. Papillary muscles b. Chordae tendineae above the papillary muscles c. Mitral valve where only the anterior leaflet is seen b. Chordae tendineae above the papillary muscles
T/F Mapping is one of the most common used methods of quantitating the severity of a regurgitant jet? True
What are the 4 phases of the Action Potential Curve? Phase 0-1:Cardiac cell rapid depolarization(sodium rapidly enters cell and potassium leaves) Phase1:Early rapid repolarization (K+ reenters cell Na+ leaves) Phase 2:Plateau phase(coinsides w/the ST segment and is cardiac contraction)Phase 3:Final rapid r
What is 4v squared? The modified bernoulli equation
When do the aortic and pulmonic valves open and close? Why? In early ventricular systole the aortic and pulmonic valves open as the Left and right ventricle pressures exceed the aortic and pulmonic pressure. They close when the pressure in the ventricles fall below the aortic and pulmonic pressure
(T/F) Does the TV open before the MV? Does the MV close before the TV? (True, True
T/F Congenital bicuspid mitral valve typically has a larger anterior leaflet and a smaller posterior leaflet? True
Describe parachute MV? The Mitral valve consists of two valve leaflets (anterior and posterior), What other structures are part of the MV apparatus? Parachute MV is the abnormal condition in which LV papillary muscles are closer than normal or fused to create a single papillary muscle. The other structures of the normal MV include the LV walls, Mitral annulus and Papillary muscles.
Which semilunar valve opens first? Which semilunar valve closes first? Pulmonic, Aortic
What is a common ventricular finding with infundibular pulmonic stenosis? Hypertrophied portion of the RV outflow tract
What vessel has the lowest O2 saturation? Coronary Sinus
A 89 year old male with jugular venous distention and a pericardial knock; What might be the diagnosis? Constrictive pericarditis
What is the sequence of cardiac conduction? SA node-Internodal tracts-AV node(RA muscle then to the LA muscle)-His bundle- R and L Bundle branches(left has 2 sections the Anterior and Posterior)-Perkinje fibers
22 year old female seen in the ER with a severe ripping feeling; What might be two possible diagnosis? MI or aortic dissection
How do the layers of the heart muscle depolarize when ventricular depolarization occurs? Coronary artery perfusion occurs from? Endocardium to Epicardium. Epicardium to endocardium
What is aliasing? How can aliasing be corrected? Aliasing:Pulsed wave systems suffer from a fundamental limitation. When pulses are transmitted at a given sampling frequency (known as the pulse repetition frequency),the maximum Doppler frequency fd that can be measured unambiguously is half the pulse r
During the holding phase of the Valsalva maneuver, which of the following occurs? a. increased cardiac output b. decreased intrathoracic pressure c. increased venous return to the heart d. decreased venous return to the heart d. decreased venous return to the heart
In the PSAX -what wall can be seen at the top of the screen? Which is at the bottom? Top is the anterior wall. The bottom is the inferior wall
What is the medical term for headache? Cephalalgia
An incision into the gallbladder for removal is named? Cholecystectomy-A cholecystectomy is the surgical removal of the gallbladder. The two basic types of this procedure are open cholecystectomy and the laparoscopic approach. It is estimated that the laparoscopic procedure is currently used for approximately
What chamber is one of the best views used to see the LV lateral wall? Four chamber view- you can see the LV lateral wall
Breakdown of fat is called? Lipolysis
In mitral stenosis what is considered a severe p1/2 time and what is a severe MVA? >220 p1/2 time and MVA<1.0cm2
A common word for sternum is? Breast bone
What is the normal thickness of the IVSd? 7-11mm
What is "Under the skin" referred to? Hypodermic or Subcutaneous
What normally causes the patent foramen ovale (PFO) to close after birth? Although a PFO and PDA differ what echo view is best for evaluating a patient with a PDA anomaly? Higher LA pressure than RA pressure. The parasternal short axis view at the basal level is the best view for detecting the PDA. Usually blood flows in a left to right direction from aorta to the pulmonary artery during diastole with this abnormality
Higher LA pressure than RA pressure. The parasternal short axis view at the basal level is the best view for detecting the PDA. Usually blood flows in a left to right direction from aorta to the pulmonary artery during diastole with this abnormality Basal, Mid, Apical
What does the word Stetho mean? Chest
Before a medical procedure a patient should sign an informed consent. What are two general principles concerning informed consents? 1. Consent forms must be signed by the patient prior to preoperative medication administration(such as Demerol) 2. A patient that signs an informed consent- protects the medical staff from claims of unauthorized procedures.
What is the function of the Spleen? What is the function of the Hepatic Veins? The spleen filters plasma and dead RBC's and stores blood. The Hepatic Veins drain directly into the IVC to drain deoxygenated blood from the Liver
Breaches of patient's confidence may result in what law suit? Libel and Slander
23 year old patient comes to the non-invasive laboratory for an exercise stress test.While preparing him for the examination, she complains of left breast/chest pain that radiates down her left arm. The resting 12 lead ECG indicates ST segment elevation a. Begin CPR. Rescue Breaths and Chest Compressions One new method is in the area of rescue breaths and chest compressions. The old method of giving rescue breaths was deep breaths lasting two seconds. The new method is to give normal breaths in one-seco
Performing treatment without the patient's informed consent, the physician runs a risk of suit for? Performing treatment without the patient's informed consent, the physician runs a risk of suit for?
Pericardial effusions are commonly present with chronic renal failure? True
What statute generally protects a physician from civil liability in cases of rendering emergency care if done with good faith and due caution? Good Samaritan statutes
What is the factor you multiply red blood cells by if you are doing a RBC count? What is considered a normal white blood count? What could a WBC count of 22,000 indicate? Multiply by 10,000 for a RBC count. 5,000-10,000 is a normal WBC count. WBC of 22,000 indicates a systemic infection.
In RBC blood transfusions, What blood type is the universal donor? What is the universal acceptor? What blood types are compatible for the universal acceptor? O- is the universal donor, and they can only receive type O-. AB+ is the universal acceptor and they can receive A+ A-B+ B- O+ O- AB+ AB
What is another name for the RV outflow tract? Infundibulum
Describe Ebstein's anomaly and what echo view is best to assess this? A congenital defect where one or more of the tricuspid valves is displaced. The apical four chamber view or the subcostal view is best for viewing this tricuspid abnormality
What coronary artery delivers blood to the anterior and anterior septal wall of the heart? Left
Upon viewing the echo screen and obvserving the EKG- When does the aortic valve open in relation to the EKG? Aortic valve opens at the end of the QRS complex
What coronary artery usually supplies the anterior lateral and inferior lateral wall? The Left Main Coronary Artery which directs oxygenated blood to the left anterior descending artery and the left circumflex. The Left Anterior Descending Artery then supplies oxygenated blood to the ANTERIOR walls of the left ventricles and the left atri
What percentage is the normal right side heart pressure compared to that of the left side heart pressure? Right heart is approximately 20% of the left heart
What would be the first target of the echocardiography examination with Infective Endocarditis? The first target of the echo examination is the identification , characterization, and localization of masses consistent with valvular vegetation, the pathologic hallmark of endocarditis.This process consists of integrating circumstantial findings and epi
Which patients are at higher risk of Infective endocarditis? 1.Arrhythmia 2.CAD 3.Aneurysmal pericardium 4.Valvular disease 4.Valvular heart disease and prosthetic heart valves increase the risk for Infective endocarditis
What artery supplies the RV apex and the RV free wall? Right
What is the most common type of right ventricular outflow obstruction? Name three types of RV obstruction? At the valvular level is the most common type of RVO obstruction. Two other less common types may be subvalvular and supravalvular
What is the most common diagnostic modality used in a chest X-Ray? Name two possible cardiac related findings in X-Ray? Is X-ray able to detect coronary artery disease? PA (posterior- anterior) and Lateral. Cardiomegaly and increased pulmonary vascularity are two findings seen on X-Ray that may indicate cardiac abnormalities are present. No, there are no specific findings for CAD on X-Ray.
What is the most reliable M-mode finding for pulmonary hypertension? Notching or flying W appearance due to mid-systolic closure of the pulmonary valve
What is the first downward deflection on the EKG that follows the P wave? What does the QRS complex consist of? What does the QRS represent? What is the normal time duration for the QRS complex? Q Wave, The QRS consists of the Q wave, the R wave and the S wave. It is produced by ventricular depolarization and is associated with ventricular contraction. .06 to .12 seconds is the normal duration
What is the name of the most common restrictive cardiomyopathy in which a thickened bright shiny myocardium is present Amyloidosis
What is Infective Endocarditis? How do we diagnose Infective Endocarditis? Infection of the endocardium or lining layer of the heart can occur on valve leaflets, congenital defects, the walls or chordae of the chambers, paraprosthetic tissue, or the attachment of implanted shunts, conduits, and fistulae. The clinical diagnosis
What is the name of the hypertrophy describing an interatrial septum that has a primary appearance of a "dumbbell-shaped" (thick septum but thin at the level of the fossa ovalis)? Lipomatous hypertrophy
What percent of patients have a right dominant coronary artery supply? What does this mean? What 2-D view is best for visualizing the coronary arteries? 80-90%. This means the right coronary artery supplies the crux and the posterior descending artery.(PDCA-determines dominance). Parasternal Short Axis at the Aov level
What are the largest white blood cells called? Monocytes
What three vessels arise from the arch of the aorta? Which is the first artery that arises from the aortic arch? The three arteries are the brachiocephalic artery(innominate artery), left common carotid artery and left subclavian artery. The brachiocephalic artery is the first large branch of the aortic arch
How many pulmonary arteries are there? Does the pulmonary artery bifrucate? Describe the flow of blood through the pulmonary artery. What is the normal mean flow velocity across the pulmonic valve? There is 1 main pulmonary artery. Yes, it does bifrucate.- From the RV, blood is pumped through the pulmonic (semilunar valve) into the main pulmonary artery. This blood enters the two pulmonary arteries(and bifrucates one for each lung) and travels throu
What are the neurons that carry impulses toward the brain or spinal cord? Afferent Neurons
What is the basic description of Right Heart Catheterization? Are all of the following pressures measured in a Right Heart Cath? RA, RV systolic, RV end-diastolic, systolic pulm artery, end- diastolic pulm artery, mean and pulm artery wedge pressure A catheter is inserted in a femoral or antecubital vein and advanced to the SVC,IVC,RA,RV and main PA to obtain pressures and oxygen saturation levels. Yes
Sound travels through tissue at approximately: a. 154.0 m/sec b. 1,540.0 m/sec c. 15,400 m/sec d. 154,000 m/sec b. 1,540.0 m/sec
What is the only artery that carries deoxygenated blood? The pulmonary artery
What is present in the blood that causes red blood cells to appear red? Oxyhemoglobin
What nerves regulate the heartbeat? What happens when the parasympathetic nervous system is stimulated? Sympathetic and Parasympathetic nerves. There will be a decrease in HR if the parasympathetic nervous system is stimulated.
Difficulty in determining echo signs of tamponade may occur in the presence of: a. Right pleural effusion b. Systemic hypertension c. Left ventricular dysfunction d. Right ventricular hypertrophy e. Infundibular stenosis f. Coronary Sinus dilatation d. Right ventricular hypertrophy
Lying on the stomach is referred to as? Prone position
Why is it common for moderate AI to eventually cause left atrial enlargement? Moderate AI will cause LV volume overload, (then LVH over time) The LA enlargement is also common due to the volume of back flow blood
What abnormality is primarily seen with HCM (Hypertrophic Obstructive Cardiomyopathy)? Thickened ventricular walls, increased LV mass and a raised ventricular diastolic pressure. There are 2 types of HCM- either obstructive(HOCM) which can cause syncope and has been known to cause sudden death. Also Non-obstructive(HCM). Use of the valsalv
What is CAD directly associated with? Restricted blood flow to the heart muscle
What does the isles of Langerhans produce? Insulin
What abnormality is seen with a vena contracta color image? What is Vena contracta? What are the hallmarks of flow in mitral regurgitation? Vena contracta demonstrates mild mitral regurgitation.The hallmarks of flow in MR: 1.flow convergence that then narrows into an area called the 2. vena contracta (narrowest flow) and then expands into the area of 3. turbulence(what we currently call the
What do the following abbreviations mean? Qid, STAT Qid- medication given four times a day. STAT- Immediately
What do the following medications do? Analgesics, Antibiotics What do the following medications do? Analgesics, Antibiotics
Disinfectants destroy? Bacteria
How do you differentiate between a pericardial effusion and a plural effusion? mild pericardial effusion present.Note that the fluid is in the pericardial space (with adhesion),anterior to the descending aorta. A pericardial effusion is seen between the LA and the descending aorta, while a plural effusion isinferior and posterior t
The Polarized state of the heart is considered the? Resting state
Where does V1 go when placing an electrode on a patients chest? 4th intercostal space down from the right clavicle
T/F? The most amount of ventricular filling occurs in a phase of diastole called "Active filling"? False, The Passive (rapid) stage of diastolic filling accounts for approx 70% of filling. "Active filling" is when atrial contraction (a-kick) occurs, there is approx 30% of the remaining ventricular filling
What Precordial ECG lead is placed 5th intercostal down mid-axillary? V6
Name 2 other common names for the obstructive variant of hypertrophic cardiomyopathy (HOCM)? The obstructive variant of HCM, Hypertrophic obstructive cardiomyopathy (HOCM) has also historically been known as idiopathic hypertrophic subaortic stenosis (IHSS) and asymmetric septal hypertrophy (ASH).
What is pectus excavatum? A condition in which the "breast bone"(sternum) appears sunken in the chest, concave
Which of the following is most influenced by distance from the face of the transducer? a. Frequency b. Wavelength c. Axial resolution d. Lateral resolution e. Medium f. Niquist limit d. Lateral resolution, Lateral resolution is the minimum separation of two interfaces aligned along a direction perpendicular(objects that are side by side)to the ultrasound beam. The lateral or angular resolution directly relates with the collimation of
An extension cord running under a patients bed is likely to produce? AC interference
Where do you measure LVes and LVed to determine fractional shortening and Ejection Fraction on m-mode? What is the formula for EF? M-Mode examination of the LV is measurement of LV diameters (cm) :End-diastolic at Q wave of ECG and End-systolic at either: a) end-systolic notching of IVS or b) first wide component of II heart sound (phonocardiogram) or c) maximum anterior position of
Where is the U wave on the EKG? A small U wave may sometimes be seen between the T wave and P wave
How do we score pericardial effusion? Effusion size on Echocardiography 1.Small effusion: <0.5cm (roughly corresponds to <100cc) 2.Moderate effusion: 0.5cm-2cm (roughly corresponds to 100-500cc) 3.Large effusion: >2.0 cm (roughly corresponds to >500cc)
What does the T wave represent? Repolarization of the ventricles. The T wave represents the repolarization (or recovery) of the ventricles. The interval from the beginning of the QRS complex to the apex of the T wave is referred to as the absolute refractory period. The last half of the
Cardiac complications represent the most common cause of death in patients with Amyloidosis. What complications may occur? What is the most common visual abnormality seen on ultrasound imaging (echocardiography)? Amyloid deposits originally impair the heart muscle’s ability to relax, and ultimately impair the heart muscle’s ability to squeeze. In addition, amyloid deposits can cause abnormalities in the heart’s electrical system, causing the heart rate to be too f
What is the normal EKG paper speed? The EKG paper is made of a grid of big boxes and small boxes. Each big box is 10 mm in length has five small boxes and is 0.20 sec. Each small box is 1 mm and represents 0.04 sec. The EKG paper moves at a standard speed of 25 mm/sec.
What structure has the lowest oxygen saturation level of any structure in the body?What is the normal oxygen(02)saturation for the right heart?What is the 02 saturation level of the normal left heart?Do the pulmonary veins have high oxygen saturation lev The coronary sinus has the lowest 02 saturation in the body. Right heart chamber saturation is normally around 75%. Left heart saturation is normally around 98%. Yes, the pulmonary veins have the highest 02 saturation level.
What sensors are used for a 2 Lead ECG? R-arm(negative) and L-leg(positive)electrode placement
R-arm(negative) and L-leg(positive)electrode placement Six grades, The weakest would be 1/6, the strongest would be 6/6. A moderately loud murmur would be 3/6.
If the relative output of an ultrasound instrument is calibrated in decibels and the sonographer increases the output by 50 dB, how many times will the beam intensity increase? a. 2 b. 100 c. 100,000 d. 1,000,000 c 100,000
What are four reasons a patient may have a wandering baseline EKG? Bad prep, Bad sensor, Oily skin, Movement
What is Ejection Fraction? What is the normal value? Name three things Ejection Fraction(EF)can determine? The percentage of blood pumped out of the LV during systole. Normal percentage is 60-75%. Overall heart function, Cardiac output, Wall motion
What percent is the normal arterial O2 saturation level?(SaO2) 93-98%
How many pulmonary veins are there? How do the pulmonary veins connect to the systemic circulation? What echo view is best for viewing the pulmonary veins? There are 4 pulmonary veins. The oxygenated blood leaves the lungs through pulmonary veins, which returns it to the left heart, completing the pulmonary cycle. This blood then enters the left atrium, which pumps it through the bicuspid valve(MV), into th
What is Ejection Fraction? What is the normal value? The percentage of blood pumped out of the LV during systole. Normal percentage is 60-75%
Is Dobutamine a pharmacological agent that is considered a positive inotrope and chronotrope? Yes
When a person forcefully expires against a closed glottis, changes occur in intrathoracic pressure that dramatically affect venous return, cardiac output, arterial pressure, and heart rate. What is this forced expiratory effort is called The Valsalva maneuver, disturbances anywhere in the cardiovascular system that alter mean arterial pressure will elicit reflex changes in cardiovascular function. The Valsalva maneuver (increased intrathoracic pressure) decreases venous return and thus
Is Adenosine considered a coronary vasodilator? Why is Adenosine used in treatment for cardiac arrhythmias? Yes,Adenosine-Adenosine injection slows conduction time through the A-V node,can interrupt the reentry pathways through the A-V node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT ass
What is inotrope? What is chronotrope? Inotrope- Increases the contractility of the heart. Chronotrope-Increase the pacemaker firing rate of the heart.
What will nitrates (nitro) do to smooth muscle? Will this effect afterload? Why should you keep nitro in a dark bottle out of direct light? How are nitrates taken? How long do they last? Can you List some common nitrate medications? Nitro is a vasodilator and vasodilates smooth muscle. Yes, this will decrease afterload. Light will degrade the effect of the nitro, also avoid storage in moist places. Nitro is taken sub lingual - SL (disolves under the toung or in side of mouth) do not
In statistics, what is the most commonly occurring value out of many numbers? Mode. Example: Out of the numbers 1,2,7,5,5,3,5,9 the Mode would be 5 because it occurs the most.
Is it possible for a medication or lab specimen to slowly lose it's potency, or simply deteriorate as a result of aging? Yes
What is the refractory period? The time that immediately follows a stimulas to the cardiac muscle and will not respond to a new stimulus.
What is PAW? What does it reflect? Pulmonary Artery Wedge pressure. It reflects the LA and LV end diastolic pressure which is usually(3-8mmhg)
What is the pressure gradient of this MR jet at velocity of 4.0 m/s? Severe MR results in markedly increased flow across the mitral valve in diastole which accounts for the increased velocity and spectral filling.The peak velocity of the MR is only 4 mls which predicts a systolic gradient between the LV and LA of 64 mmHg
A ventricular wall motion abnormality that is reversible with nitroglycerine is associated with: a. Pericarditis b. Myocardial fibrosis c. Myocardial ischemia d. Myocardial infarction e. Stunned myocardium c. Myocardial ischemia
What effect does the Valsalva Manuever (sustained bearing down) have on the cardiovascular system? Decreased blood pressure and it also decreases the venus return
Decreased blood pressure and it also decreases the venus return The pulsed-Doppler cursor is positioned proximal to the entrance of the vein(approximately 3-4 mm into the vein) - from the left atrium. The beam of interrogation should be as parallel to flow as possible
Describe the components of the pulmonary vein waveform? The normal display has 3 components. These consist of systolic (S), early diastolic (D), and late diastolic (a) phases. Flow velocity is maximal during the S phase. Reversal of flow occurs in late diastole
What does inspiration have on the cardiovascular system? Increases right atrial venous return and the hearts stroke volume
What are the 3 different types of pacemakers? What patient position is often used when performing echo on a patient post Pacer/AICD placement? Single chamber pacemaker uses one lead in the upper chambers -atria or lower chambers -ventricles of the heart. Dual chamber pacemaker uses 1 lead in the atria and 1 lead in the ventricles of your heart. Biventricular pacemaker uses 3 leads: one placed in
What ion enters the heart in systole to make the heart contract? Ca++
What is the voltage of a resting cardiac muscle cell? -90mv
What are the three main coronary arteries? When does coronary blood flow occur? RCA,LAD,Circumflex. Diastole
Would a patient that spreads fecal contamination be a candidate for enteric isolation technique? What is enteric isolation? Yes, Enteric isolation refers to the avoidance of any contact with bodily fluids of a patient due to pathogens or chemotherapy treatment that can be transmitted via these fluids.
According to the American Society of Echocardiography, the left ventricle should be measured at the region of the Chordae tendineae above the papillary muscles
What is Streptokinase? What is Heparin? Streptokinase is a thrombolytic and dissolves clots. Heparin blocks clot formation, so blood clots won't get larger
During isovolumic contraction which cardiac valves are open? During isovolumic relaxation what valves are closed? The four valves(MV,TV,AOV,PV)are closed during both of the isometric stages
What is the first thing you should do according to the American Heart Association if an adult patient collapses and is unresponsive? Activate the local emergency medical services number
What is the most common life-threatening complication of myocardial infarction? Cardiac Arrhythmias
What is the normal cardiac valves function in regard to the direction of blood flow? In the case of a stenotic area of a vessel or valve, where typically is the highest velocity of blood flow found? One way or Uni directional flow. Proximal to the stenotic area is where the highest velocity will be found
Describe how cardiac muscle contracts when sarcoplasmic reticulum releases calcium? Myosin cross bridges form, then the calcium released by sarcoplasmic reticulum binds to troponin molecules on the actin helix this causes contraction
Name three things chest pain or angina may be caused by? Embolus, Tissue hypoxia, Plaque
What cardiac hemodynamics are involved in the heart and with valves? 3 main criteria when assessing the hemodynamic performance (proper blood flow)of a particular valve design. The valve in question should (1) function efficiently and present the minimum load to the heart, (2) be durable/maintain its efficiency for the pa
List the two causes of valvular heart disease? Valvular heart disease (VHD), a non-specific,all-encompassing name for various diseases affecting the heart valves,can be classified into two categories: congenital and acquired. congenital valvular heart disease is present from birth. It can be caused b
What is the first mechanical event in the cardiac cycle? What is the name for the amount of blood pumped from the ventricles in a solo systolic event? What is CO/HR called? Ventricular Systole. Stroke Volume. Stroke Volume=CO/HR
Describe the anatomy of the heart and valves? The heart has 4 chambers. The upper 2 are the right and LA; the lower 2, the right and LV. Deoxygenated blood is pumped from the body through the RA and RV to the lungs. From the lungs, oxygenated blood flows through the LA and LV. The blood then leaves
Name three things Ejection Fraction (EF) can determine? What is considered a normal EF? Overall heart function, Cardiac output, Wall motion. Normal EF is usually >60%
Name three factors that determine ventricular function? Which of the three factors are directly related to the Frank-Starling law of heart? Afterload, Preload, Contractility. Ventricular Preload will help determine the amount of stretch and force of contraction the heart will have (Frank Starling law of heart
One “heart beat” consists of two phases, the diastolic and the systolic phase describe this in relation to the valves opening and closing? 1 “heart beat”consists of 2 phases, the diastolic and the systolic. During the diastolic phase the heart muscles are “relaxed” and blood flows into the chambers from the body and lungs. The tricuspid and the bicuspid valves are open at this time, allowin
What arrhythmia has: wide QRS, regular rhythm, HR greater than 150 BPM? Is this considered a lethal arrhythmia? What is the inherent firing rate of AV junctional tissue? Heart rates between 60-100 BPM are considered? HR below 60 BPM are considered? Ventricular Tachycardia(VT) this is considered a lethal arrhythmia. AV Junctional tissue have a rate of 40-60 BPM. Sinus rhythm is 60-100 BPM, below 60 beats is Sinus Bradycardia
Rapid discharge of numerous irritable automaticity foci in the atrias describe what arrhythmia? Rapid discharge of numerous irritable automaticity foci in the atrias describe what arrhythmia?
What is a considered a normal amount of pericardial fluid? What layer in the heart is a pericardial effusion located? What is the oblique sinus and how is it used to differentiate between pericardial and plural effusions? 10-50cc. Visceral epicardium. A culdesac termed the oblique sinus, has little ability to expand due to its attachments to the pulmonary veins and so, although it forms a potential cavity, it rarely fills with fluid. This frequently is a helpful sign for d
Electrical alternans on a patient's ECG is often present with what cardiac abnormality? Large pericardial effusion
Why is agitated saline contrast injected into the right heart? Why would saline bubbles appear in the left heart after 3-5 heart beats? Agitated saline solution is often injected into the vein (through an IV port) to detect atrial shunts. also to document right sided masses and abnormal venous return. After injected bubbles (which are too large to pass through the pulmonary bed) go into
What is Systemic Hypertension? What primary side of the heart does systemic HTN effect? List three of the effects HTN has on the heart early in the course. What are three things late in course? Increased vascular resistance resulting in vasoconstriction of peripheral vessels. Left side. Early-LVH, increased LV mass, LAE. Late-Kidney disease, CHF, CVA
Which valvular cardiac event occurs between the end of the T wave and the onset of the QRS? Tricuspid valve opening
What is the cardiac output(CO) adjusted to body surface area(BSA) referred to? Cardiac Index
How will the screen appear on an ultrasound system if the overall gain or output gain is set too high? Overly bright with saturated echogenic signals everywhere
In fetal heart development what occurs around day 22 helping formation of the great arteries and ventricles? Cardiac Looping
From the fetal heart, Sinus Venosus becomes what in the adult heart? Coronary Sinus
If you see only shallow echos on the image screen(not deep reflectors) what control may need to be adjusted? Time Gain Compensation(TGC)
In the fetal aortic arch system, which of the arches persist in the adult heart? 3,4,6
Name the three channels of communication in the fetal circulation that close shortly after birth? Ductus Venosus,Ductus Arteriosus,Patent Foramen Ovale
During embryonic development, the pulmonic valve and the aortic valve are formed from which structure? What structure does the Truncus Arteriosus eventually form? What is truncus arteriosus? Truncus Arteriosus-TA. The TA eventually forms the AorticRoot. TA is a congenital (present at birth) defect that occurs due to abnormal development of the fetal heart during the first 8 weeks of pregnancy. The heart begins as a hollow tube, and the cham
What is cardiac tamponade? What hemodynamic effect does pericardial effusion and cardiac tamponade have on the heart? What is Pulsus paradoxus? Because the pericardium stretches , large effusions(> 1000 mL) that develop slowly may produce no hemodynamic effects. Smaller effusions that appear rapidly can cause tamponade. Tamponade is characterized by elevated intrapericardial pressure(> 15 mm Hg),
What is the term used to describe late diastolic equalization of aortic and ventricular pressures? Diastasis. Diastasis is the last stage of diastole in the heart, occurring just before contraction and during which little additional blood enters the ventricle
Can a standard chest X-ray be used to determine Cardiomegaly? Yes
What term describes how blood moves through a vessel at the center at a higher velocity than the blood along the vessel wall? Parabolic flow profile
What nerve supplies the SA Node and controls the HR? Right Vagus Nerve
Where is the aortic isthmus located? Descending aorta
T/F) Both diastolic blood pressure and auto regulation influence coronary blood flow? True
What is the term situs solitus? It describes the normal location of the heart in relation to the lungs and abdominal organs
What are three common EKG findings associated with a patient with LVH?(increased muscle mass) Changes in ST segment, T wave inversion, Pronounced Q wave
A person can go into shock if the cardiac index falls below what number? 2.0 liters/min/m2
What is the most important blood cell? What is Anemia? What blood cell percent would demonstrate Anemia on a hematocrit? Red blood cell(Oxygen transport cell). Anemia is a low amount of RBC in the blood stream. Hematocrit below 45% RBC
(T/F) With a Third Degree Heart Block there is still partial conduction of the atrium to the ventricle enabling the heart to contract? False
Name four common routes and description of drug administration methods 1)Inhalation: Breathing in the lungs.(useful for dilating the bronchial tubes) 2) Oral: Given by mouth,slow absorption.3)Sublingual: Under the tongue for rapid absorption. 4) Parenteral: Injection (under skin layer) or IV may be given for quick entry
Briefly describe the pulmonary circulation Briefly describe the pulmonary circulation
Does the right heart contain oxygen rich blood? Briefly describe the blood flow into the right heart No, Oxygen-depleted blood from the body leaves the systemic circulation when it enters the right heart (RA) through the superior vena cava and inferior vena cava. The blood is then pumped through the TV(right atrioventricular valve), into the RV
What occurs in the lungs during respiration? The pulmonary arteries carry blood to the lungs, where red blood cells release carbon dioxide and pick up oxygen during respiration (physiology)respiration.
What type of cardiac abnormalities do pacemakers treat? Pacemakers are used most commonly to treat brady arrhythmia's, which are slow heart rhythms that may arise from disease in the heart's electrical conduction system. (SA node, AV node, or HIS-Purkinje system).
When Cleaning a TEE probe in a enzymatic cleaner according to the soak times indicated, you must follow the manufacturer’s instructions and observe dilution rates. Name three of the enzymatic cleaning agents? Cidex, Klenzyme,Perasafe
Are rales(moist crackle in the lungs)considered a normal condition? No, breath sounds should be dry and clear
What are some of the endoscope/TEE Transducer Care & Safety Guidelines? •Prevent damage to transducers by placing them in the proper storage when not in use.•Do not drop or subject transducer to any type of mechanical shock.•Inspect transducer lens, cable & housing before each exam.•Do not use damaged transducers. Injury to t
How many pulmonary arteries are there? Does the pulmonary artery bifricate? Describe the flow of blood through the pulmonary artery There is 1 main PA. Yes, it does bifricate.- From the RV, blood is pumped through the pulmonic (semilunar valve) into the main pulmonary artery. This blood enters the two pulmonary arteries (and bifricates one for each lung) and travels through the lung
How many pulmonary veins are there? How do the pulmonary veins connect to the systemic circulation? Are 4 pulmonary veins. The oxygenated blood leaves the lungs through pulmonary veins, which returns it to the left heart, completing the pulmonary cycle. This blood then enters the LA, which pumps it through the bicuspid valve(MV), into the LV. The blood
In performing echocardiography, which of the following methods requires invasive introduction of the transducer? a. Stress echo b. Contrast echo c. Assisted pericardiocentesis d. Transesophageal echocardiography e. 3-D Echo f. Bubble study d. Transesophageal echocardiography
What three vessels arise from the arch of the aorta? Which is the first artery that arises from the aortic arch? The three arteries are the brachiocephalic artery(innominate artery), left common carotid artery and left subclavian artery. The brachiocephalic artery is the first large branch of the aortic arch.
What is Anaphylaxis? List four causes? What are common assessment findings? Anaphylaxis is a severe allergic reaction that occurs w/in minutes of exposure to substance.(latex, insect stings, foods,medications) May cause cardiac and respiratory distress, facial swelling, intercostal and suprasternal retractions, vomiting.
What is Urticaria? What is Pruritus? Urticaria is another name for hives. Pruritus is another name for itching.
What is Hypothermia? Name two primary areas of the body that are vulnerable in hypothermia? Hypothermia is a result of exposure to conditions resulting in excessive heat loss.(core body temperature <95 degrees F) The head and back of neck are two major areas of heat loss
What does Amyl nitrite do to the heart? What murmurs are increased by Amyl nitrite and which are decreased? Amyl nitrite is a vasodilator which causes a decrease in BP and venous return. Murmurs such as AS, AO sclerosis and HOCM are increased. Also a murmur with MVP may be more prevalent, However murmurs associated with MR, AR and VSD's will typically decre
What are the 6 phases of the Wiggers diagram? Which phase of Wiggers has the majority of blood filling? During Isometric relaxation on the pressure tracing what causes the Dicrotic Notch to appear? 1. Isometric contraction 2. Systolic ejection 3. Isometric relaxation 4. Rapid diastolic filling 5. Diastolic ventricular passive filling 6. Atrial contraction. The majority of blood fills during phase 4 (rapid filling). Aortic and Pulmonic Valve clos
What percentage of blood is pumped into the ventricle during the "A- Kick" or Atrial contraction? If a patient goes from sinus Bradycardia into Atrial Fibrillation and the HR remained the same, would the Cardiac Output (CO)increase or decrease?How much w 15-20%, Decrease CO, A decrease of 15-20%
What is PAW? What does PAW represent? What is the normal range for PAW pressure? Pulmonary Artery Wedge Pressure or PAW reflects the Left Atrial pressure of the heart and the LV end diastolic pressure. PAW=LA pressure and LVed pressure. 6-10 mmhg
Basic Cardiovascular Physiology Contractility: the intrinsic ability of cardiac muscle to develop force for a given muscle length.It is also referred to as inotropism.Preload:the muscle length prior to contractility, and it dependent of ventricular filling (or end diastolic volume.) Th
Which of the following conditions would be a contraindication to the administration of a transpulmonary contrast agent in Echo? a. VaIvular regurgitation b. Left ventricular dysfunction c. Elevated right heart pressures d. Complex congenital heart d d. Complex congenital heart disease
What is the Frank Starling Principle? The principle is based on the length-tension relationship within the ventricle. If ventricular end diastolic volume (preload) is increased-the ventricular fiber length is also increased, resulting in an increased ‘tension’ of the muscle.Cardiac output (
What are some determinants of cardiac performance when we discuss ventricular dysfunction? ventricular dysfunction,often in reference to the LV, however it is important to understand that the same basic principles apply to the RV.The L/R sides of the heart exist in a series,its interdependent;normal physiology , RV/LV will have the same output.
Cardiac function is the volume of blood pumped each minute, and is expressed by the following equation? CO = SV x HR Where: CO is cardiac output expressed in L/min (normal ~5 L/min) SV is stroke volume per beat HR is the number of beats per minute
What is Heart Rate (HR) directly proportional to? HR directly proportional to CO.HR x SV=CO) normal aduly HR 80-100 bpm.When CO increases in healthy individual , most of the increase can be attributed to an increase in HR.Change of posture, increased sympathetic nervous system activity, and decreased pa
What factors influence Stroke Volume (SV)? SV is determined by 3 factors: preload,afterload,and contractility. Preload gives the volume of blood that the ventricle has available to pump, as well as the end diastolic length of the muscle. Contractility is the force that the muscle can create at the
The statistical mean is commonly called the average: To find the mean of a group of numbers what must be done? What is the statistical mean of these numbers: 4,7,10,3,3,3 Add the numbers together Divide by how many numbers were added together The mean of 4,7,10,3,3,3 is 5.
The statistical mode is the number that occurs most frequently in a set of numbers. What is the "mode" of this group of numbers:2, 4, 5, 5, 5, 7, 8, 8, 9, 12 ?. Mode-Arrange the numbers in order by size.Determine the number of instances of each numerical value. The numerical value that has the most instances is the mode. There may be more than one mode when two or more numbers have an equal number of instances
How many colors can be displayed in a single pixel of color flow image? a. 1 b. 2 c. 3 d. 4 a. 1
What is the statistical median in a group of numbers? The statistical median is middle # of a group of numbers arranged in order by size.If there is an even number of terms,median is the mean of the 2 middle numbers: To find the median of a group of numbers:Arrange the numbers in order by size.If there is
What is 7% of 65? How much is 75% of 104? w = .7 x 65, 65 x .7= 4.55 We could write 75% as the decimal .75. Therefore we could multiply .75 × 104 or 75% of 104 is 78.
Which of the following Doppler frequencies would result in the shallowest penetration depth? a. 2 MHz b. 8 MHz c. 10 MHz d. 20 MHz d. 20 MHz
Which of the following frequency shifts would produce aliasing, when using a 5 MHz pulsed Doppler transducer, with a pulse repetition frequency of 15 kHz? a. 3 kHz b. 5 kHz c. 6 kHz d. 8 kHz d. 8 kHz
Why are patients requested to record time of bowel movements wearing Holter monitor?a. Valsalva Maneuver will cause a HR change b. To correlate the motion artifact on the recording c.For systematic recording of all pts activity d.Breathing rate delays co a. Valsalva Maneuver will cause a heart rate change
Which of the following is NOT increased secondary to exercise in a patient with a healthy heart? Increased: a. Stroke volume b. Ejection fraction c. End-systolic volume d. End-diastolic volume c. End-systolic volume
Which of the following is NOT considered an indicator of coronary artery disease, during the performance of exercise stress testing? a. Sinus tachycardia b. ST segment elevation c. ST segment depression d. Increased in R wave amplitude a. Sinus tachycardia
The first heart sound is associated with: a. preload b. afterload c. semilunar valve closure d. atrioventricular valve closure d. atrioventricular valve closure
What is Aortic Valve Area by Planimetry? Planimetry is the tracing out of the opening of the AV in a still image obtained during echo acquisition during ventricular systole, when the valve is supposed to be open. While this method directly measures the valve area, the image may be difficult to
Which coronary arteries supply these anatomic areas of the heart: 1.Inferior,2.Anteroseptal,3.Anteroapical,4.Anterolateral , 5.Posterior Anatomic Region of Heart Coronary Artery (most likely associated) Inferior- Right coronary Anteroseptal- Left anterior descending Anteroapical- Left anterior descending (distal) Anterolateral- Circumflex Posterior- Right coronary artery
When no ECG signal or a poor EKG signal is observed list a few things to be considered? Skin Preparation:Clean with alcohol or usual skin prep. If necessary shave hairy electrode areas.When no signal or a poor signal is observed the following should be considered:Make sure: the cables have been correctly connected, watch for external electri
What is a diuretic? List some commonly used diuretic medications? sometimes called "water pills." used to treat congestive heart failure, high BP or edema (water retention). they lower the amount of salt or sodium and water in your body,helps to lower your BP.ei. Lasix (furosemide), Aquatensen (methyclothiazide), Diuca
What is the purpose of a transducers backing material? backing material supporting the crystal has a great influence on the damping characteristics of a transducer.Using a backing material with an impedance similar to that of the active element will produce the most effective damping. Such a transducer will
What is the moderator band? What view is the best for imaging this with TEE? The moderator band of the right ventricle has been misinterpreted as an intracardiac mass. This specialized cardiac trabeculation runs from the right ventricular free wall to the interventricular septum. It is often best seen in the ME four-chamber view
What is Mitral valvuloplasty? Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Under local anesthetic, a catheter with a special balloon is passed from the right femoral vein, up the
T/F A Decreased EPS separation of the MV(m-mode) is usually associated with an increased ejection fraction? False. The separation is called E point septal separation (EPSS), which is less than 5 mm normally. In this case the separation is increased due to the left ventricular dysfunction and is over 9.5 mm.
How can contrast agents improve imaging? How are they introduced? can improve the image quality by decreasing the reflectivity of the undesired interfaces or by increasing the back scattered echoes from the desired regions. W/ CT and MRI the contrast agents are taken orally, and for Echo and nuclear testing the agent i
In formation of the fetal heart the heart tube appears by week? The Heart is completely formed by week? In formation of the fetal heart the heart tube appears by week 3. The Heart is completely formed by week 7.
The junction between the primitive ventricle(LV) and the bulbus cordis is called? The heart tube normally loops in what direction? What is this called? Bulboventricular loop or tube. The heart tube loops anterior and right ward and is known as "D" loop
What abnormality is present when the heart tube loops anterior and leftward? L-transposition or ventricular inversion.
What does the edocardial cushion divide? Failure of this endocardial cushion may result in what abnormality? The endocardial cushions divide the AV canal into R & L atrioventricular orifices, contributes the closure of the ostium primum and membranous septum and forms the anterior MV and septal TV leaflets. Failure of this endocardial cushion may result in AV c
What does the primitive ventricle form into? LV
What does the Bulbis cordis forms into? RV, Ventricular outflow tracts and Truncus arteriosus
RV, Ventricular outflow tracts and Truncus arteriosus The truncus arteriosis contributes to the formation of the aorta and pulmonary artery roots. Failure of the Truncus arterosis to divide may result in persistent truncus arteriosus
The ductus venosus after birth becomes? A.ligamentum venosum B.ligamentum teres C.ligamentim arteriosum D.Umbilical ligament A. ligamentum venosum. The ligamentum venosum is the fibrous remnant of the ductus venosus of the fetal circulation. Usually, it is attached to the left branch of the portal vein within the porta hepatis of the liver
The umbilical vein after birth becomes the? ligamentum teres is obliterated fibrous remnant of the left umbilical vein of the fetus. It originates at the umbilicus.It passes superiorly in the 3 margin of the falciform ligament. From the inferior margin of the liver, it may join the left branch of t
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