Adult Echocardiography Review Questions Correct Answers

Adult Echocardiography Review Questions Correct Answers The PLAX view allows ID of all of the following wall segments EXCEPT: A. Basal and mid-interventricular septum B. Basal and mid-posterior wall of the LV C. Infero-lateral wall of the LV D. LV apex -Answer- D Wall segments that are visualized in the PSAX view of LV at papillary muscle level include all of the following EXCEPT: A. Anterior septum B. Anterior wall C. Antero-inferior wall D. Antero-lateral wall -Answer- C LV wall segments that may be visualized in the apical 2C view include all of the following EXCEPT: A. Anterior wall of LV B. Apex C. Interventricular septumza D. Lateral wall of LV -Answer- A Wall segments and structures that may be visualized in the apical 2C view include all of the following EXCEPT: A. Anterior wall of the LV B. Coronary sinus C. Free wall if the RV D. Inferior wall of the LV -Answer- C The boundaries of the functional LVOT are best described as extending from: A. Anterior AoV annulus to the posterior AoV annulus B. Anteromedial position of the TV annulus to the PV annulus C. Free edge of the AMVL to the AoV annulus D. Tips of the LV papillary muscles to the edge of the AMVL -Answer- C Landmarks used to ID the anatomic and functional RVOT are the: A. AMVL to the left edge of the IVS B. AoV annulus to the TV annulus C. TV annulus to the AoV annulus D. TV annulus to the PV annulus -Answer- D All of the following are considered AV valves EXCEPT: A. Aortic B. MitralC. Bicuspid D. Tricuspid -Answer- A All of the following are names of PVL EXCEPT: A. Anterior B. Left C. Non-coronary D. Posterior -Answer- C All of the following events are considered to occur in late diastole EXCEPT: A. A-dip of the PVL on M-mode B. A-point of AMVL on M-mode C. A-point of MV Doppler waveform D. E-point of the AMVL on M-mode -Answer- D The MVL is continuous with the aortic root, while the is continuous with the aortic root. A. Anterior, anterior, PMVL, posterior B. Anterior, posterior, IVS, anterior C. Posterior, anterior, IVS, posterior D. Posterior, posterior, AMVL, anterior -Answer- B Structures of the MV apparatus include all of the following EXCEPT: A. Mitral annulus B. Sinuses of valsalva C. LV walls D. Papillary muscles -Answer- B Normal MVA is: A. 1-3 B. 3-5 C. 4-6 D. 7-9 -Answer- C All of the following are considered pulmonary vessels EXCEPT: A. Main PA B. Pulmonary capillaries C. PV4 D. Vena Cava -Answer- D Upper limit of normal for the Ao Root diameter in adults measured by M-mode ranges from: A. 1.3-2.4 cm B. 2.2-2.5 cm C. 25-32 mm D. 33-37 mm -Answer- DThe 3 branches that normally originate from the Ao Arch include all of the following EXCEPT: A. Brachiocephalic artery B. Left CCA C. Left subclavian artery D. Right CCA -Answer- D Point at which the descending Ao and the Ao Arch join is called the Ao: A. Bifurcation B. Bulb C. Isthmus D. Sinus -Answer- C Thickest layer of an arterial wall is the tunica: A. Adventitia B. Intima C. Media D. Vasorum -Answer- C Anatomic landmark that demarcates the end section of the descending thoracic Ao and the beginning of the abdominal Ao: A. Ao isthmus B. Diaphragm C. Ligamentum arteriosum D. Renal arteries -Answer- B Section of the Ao that is located between the diaphragm and the iliac arteries is called the: A. Abdominal aorta B. Ao isthmus C. Descending thoracic Ao D. Transverse Ao -Answer- A Correct order for the branches of the Ao Arch: A. Left subclavian, right subclavian, left CCA B. Right brachiocephalic, left brachiocephalic, left CCA C. Right brachiocephalic, left CCA, left subclavian D. Sinus of valsalva, right innominate, left innominate -Answer- C Normal fetal vascular channel that connects the DAO and the main PA is: A. Ductus venosus B. Ductus arteriosus C. Ligamentum venosum D. Ligamentum arteriosum -Answer- BThe coronary artery that has a branch called the circumflex artery is the: A. Left anterior descending coronary artery B. Left coronary artery C. Posterior descending coronary artery D. Right coronary artery -Answer- B Coronary artery that predominantly supplies blood to the RV is: A. Acute marginal branch B. Anterior descending coronary artery C. Circumflex coronary artery D. Left main coronary artery -Answer- A Normal pressure values in the mmHg for the listed cardiac chambers or great vessels include all of the following EXCEPT: A. RA: 0-5 mean B. RV: 25 systolic, 0-5 diastolic C. PA: 25 systolic, 10-15 diastolic D. LV: 120 systolic, 80 diastolic -Answer- D The moderator band is found in the: A. RA B. RV C. LA D. LV -Answer- B The Eustachian valve is found in the: A. RA B. RV C. LA D. LV -Answer- A The chiari network is found in the: A. RA B. RV C. LA D. LV -Answer- A Normal volume of clear serous fluid in the pericardial sac is: A. 20-50 cc B. 20-50 L C. 200-500 cc D. 200-500 L -Answer- A Potential space behind the LA where the pericardial effusion could accumulate is the: A. Sinus of valsalva B. Pleural potential spaceC. Oblique sinus D. Coronary sinus -Answer- C Normal LA to the RA ratio is: A. 1:1 B. 1.3:1 C. 2:1 D. 3:1 -Answer- A Volume pressure that exists in the ventricle at ED is called: A. Preload B. Afterload C. No-load D. Sumload -Answer- A Resistance to ejection of blood encouraged by the contracting ventricles is called: A. Preload B. Afterload C. No-load D. Sumload -Answer- B In general, and outside certain disease states, the greater the stretch of the muscle cell, the greater the force of contraction: A. Frank's law of the heart B. Frank-Starling law of the heart C. Force-velocity relationship D. Interval-length relationship -Answer- B The percentage of blood pumped out of the heart per beat is called: A. Stroke volume B. Cardiac output C. Cardiac index D. Ejection fraction -Answer- D Failed fusion of the superior and inferior endocardial cushions is associated with all of the following EXCEPT: A. Partial AV canal defect B. Complete AV canal defect C. Isolated inlet VSD D. Isolated supracristal VSD -Answer- D The imaginary boundaries that defined the mid-left ventricle are the: A. Mitral annulus to the tip of the papillary muscles B. Base of the papillary muscles to the cardiac apex C. Tip of the papillary muscles to the base of the papillary muscles D. Ao annulus to the edge of the MV -Answer- CCoronary sinus can be differentiated from the DAO with pulsed wave Doppler because the coronary sinus flow is predominantly diastolic, while aortic flow is: A. Equiphasic B. Phasic C. Predominantly diastolic D. Predominantly systolic -Answer- D In standard imaging (m-mode and 2D), the control that determines the amount of electrical energy transmitted to the transducer from the pulser is: A. Overall gain B. Radiofrequency gain C. TGC D. Transmit power -Answer- D Amplification of received signals is controlled by: A. Output power B. Overall gain C. Pulser power D. Transmit power -Answer- B Method used to compensate for the attenuation of signals as a function of time/depth along the US beam is: A. Overall gain B. Pulser power C. TGC D. Transmit power -Answer- C Control that selects the minimum signal amplitude to be displayed is: A. Depth B. Far gain C. Output power D. Reject -Answer- D Control that sets the upper limit to which US info will be processed and displayed is: A. Depth B. Far C. Gain D. Overall gain E. Reject -Answer- A Control used when info from a precise point in the cardiac cycle is required is the: A. ECG trigger B. Overall gain C. Reject D. TGC -Answer- ADoppler control that eliminates low-level frequency shifts is: A. Filter B. Gain C. Output power D. Sample volume length -Answer- A Control labeled Doppler sample volume depth: A. Sets the range gate location for PW Doppler B. Does not affect the PRF C. Does not affect he maximum velocity that can be displayed without signal aliasing D. Is useful in CW Doppler -Answer- A Preferred transducer frequency for imaging a barrel-chested patient is: A. 2.5 MHz B. 3.5 MHz C. 5.0 MHz D. 7.0 MHz -Answer- A A maneuver that results in a decrease in venous return is: A. Inspiration B. Squatting C. Straight leg raising D. Valsalva -Answer- D A maneuver that results in acute increase in BP is: A. Inhalation of amyl nitrate B. Supine to standing C. Isometric handgrip D. Inspiration -Answer- C A maneuver that will result in tachycardia and a transient decrease in BP is: A. Inhalation of amyl nitrate B. Squatting C. Standing to supine D. Straight leg raise -Answer- A A maneuver that will increase venous return is: A. Expiration B. Squatting to standing C. Straight leg raise D. Supine to standing -Answer- C A maneuver that increases the obstruction in patients with HOCM is: A. Leg raise B. Standing to supineC. Valsalva D. Inspiration -Answer- C Possible pharmacologic treatments for HOCM include: A. Propanolol B. Epinephrine C. Dobutamine D. Lasix -Answer- A The method that would best allow visualization of shunt flow across an ASD is: A. M-mode echo B. 2D echo C. Contrast echo D. Stress echo -Answer- C The most common location for beginning the adult echo exam is: A. Apical B. Left parasternal C. Right parasternal D. Subcostal -Answer- B 3 basic planes of a complete 2D echo exam are: A. LAX, diagonal axis, 4C B. LAX, SAX, 4C C. LAX, SAX, Subcostal D. LAX, SAX 2C -Answer- B 2D echo view that best visualizes the proximal segments of the coronary arteries is the: A. PLAX LV B. PSAX AoV C. PSAX LV of papillary muscles D. Subcostal 4C -Answer- B 2D echo view that permits exam of the Ao Arch is: A. PLAX B. 2C C. Subcostal 4C D. SSN LAX -Answer- D Recommended method for determining LV volumes by 2D echo is: A. Method of discs B. Single plane area-length C. Bullet method D. Prolate ellipse method -Answer- A The ellipsoid single-plane method for determining LV volumes by 2D echo is also called:A. Area-length method B. Bullet method C. Length-diameter method D. Simpson's Rule -Answer- A A bright horizontal echo that gives the edge of an ASD/VSD a broadened appearance is referred to as the: A. A sign B. Fo sign C. T sign D. W sign -Answer- C When attempting to determine the presence of perimembranous VSD in the PLAX view, the tech should tilt the probe: A. Anteriorly B. Posteriorly C. Medially D. Laterally -Answer- C When attempting to determine whether an inlet VSD from the apical 4C is present, the tech should tilt the probe: A. Anteriorly B. Posteriorly C. Medially D. Laterally -Answer- B 2D echo view that is best approach to rule out coarctation of the Ao: A. PLAX B. PSAX AoV C. Subcostal 5C D. SSN LAX Ao Arch -Answer- D 2D echo view used to determine whether truncus arteriosus is present are the PLAX view and: A. Apical 5C B. Parasternal RVIT C. PSAX AoV D. PSAX LV -Answer- C 2D view that may be used to directly view a PDA is: A. PLAX LV B. PSAX Base C. Apical 5C D. Subcostal 4C -Answer- B Best 2D view for determining MVA is the:A. Apical 4C B. PLAX C. PSAX D. Subcostal 4C -Answer- C Gold-standard 2D echo view for diagnosis MVP is: A. Apical 4C B. PLAX C. PSAX MV D. Subcostal 4C -Answer- B Excellent 2D views for imaging TV include all of the following EXCEPT: A. PLAX B. PSAX AoV C. Apical 4C D. Subcostal 4C -Answer- A Smallest vegetation that TTE 2D echo can detect is: A. 1 mm B. 2 mm C. 3 mm D. 4 mm -Answer- C Hump or break occasionally seen on the M-mode of the MV between the E and F points is designated: A. B notch B. F wave C. Fo sign D. H wave -Answer- C LA dimension is measured on M-mode during: A. Systole B. End-systole C. Diastole D. End-diastole -Answer- B Method used most often for calculating EF by M-mode echo is: A. Ellipsoid biplane method B. Simpson's method of discs C. Single-plane area-length method D. Teicholtz Regression -Answer- D A quantitative measure of LV systolic wall thickening is: A. DT - ST / DT B. ST - DT / DT x 100 C. DT = STD. ST = ST / DT -Answer- B Top normal LV internal dimension at ED in an adult by M-mode is: A. 16 mm B. 26 mm C. 36 mm D. 56 mm -Answer- D Normal range for IVS and posterior wall of LV at ED by M-mode is: A. 6-11 mm B. 6-11 cm C. 0.6-.011 mm D. 60-110 mm -Answer- A The E-F slope of the M-mode of the AMVL reflects: A. Opening rate of the AMVL B. Rate of diastolic filling of the LV C. Rate of LA emptying during diastasis D. Rate of systolic filling of the LV -Answer- B E-F slope of the M-Mode of the AMVL is MV stenosis: A. Decreased B. Increased C. Notched D. Unaffected -Answer- A The MV M-Mode points that denote the beginning and end of diastole are: A. C-D B. D-C C. D-E D. E-F -Answer- B AMVL E-F slope is decreased in: A. LA myxoma B. LV volume overload C. MVP D. MV vegetation -Answer- A PVL most commonly recorded by M-mode is the A. Anterior B. Left C. Septal D. Right -Answer- B On M-mode, the abrupt downward motion of the PVL following atrial contraction is called the:A. "a" dip B. "b" dip C. "c" dip D. "d" dip -Answer- A Geometric shape of the RV: A. Prolate ellipse B. Pyramid C. Rectangle D. Circle -Answer- B Pressure overload of the RV may produce all of the following EXCEPT: A. D-shaped ventricle B. RV dilatation C. RVH D. Small, protected RV -Answer- D A RV volume overload pattern is associated with all of the following findings EXCEPT: A. Abnormal IVS motion B. Dilatation of the RV C. Pancaking of the IVS during ventricular diastole D. Pancaking of the IVS during ventricular systole -Answer- D The echo exam that would be the first choice to delineate suspected LA clot: A. SE B. Intracardiac echo C. TEE D. TTE -Answer- C Formula used for calculated EF: A. EDD - ESD B. EDV - ESV C. EDD - ESD / EDD x 100 D. EDV - ESV / EDV x 100 -Answer- C Formula used for calculated SV: A. EDV = ESV B. EDV - ESV C. ESV - EDV D. (EDV - ESV) / EDV -Answer- B The mean velocity of circumferential fiber shortening (Vcfm) may be calculated by: A. EDD - ESD / EDD B. EDD - ESD / LVET x EDD C. EDV - ESV D. EDV - ESV / EDV -Answer- BPressure obtained by a PA wedge reflects the pressure in the: A. LA B. PA C. RA D. RV -Answer- A Maneuvers that will increase the duration and severity of MVP include all of the following EXCEPT: A. Inhalation of amyl nitrate B. Valsalva maneuver C. Supine to standing D. Squatting -Answer- D Saline contrast injection to r/o ASD is performed. Contrast appears in the LA 4-8 cycles after the appearance of contrast in the RA. The best explanation is: A. L-R ASD shunt B. R-L ASD shunt C. LV-RA shunt D. Pulmonary arteriovenous fistula -Answer- D A maneuver that will increase venous return is: A. Supine to standing B. Standing to walking C. Valsalva maneuver D. Quiet expiration -Answer- B Effect inspiration has on venous return to the RA is: A. Decrease B. Increase C. Depends on inspiration depth D. No effect -Answer- B Recommended maneuver for performing TEE contrast exam in a patient with a possible PFO is: A. Inhalation of amyl nitrate B. Squatting C. Supine to standing D. Valsalva -Answer- D Possible complications of chronic MR include all of the following EXCEPT: A. A fib B. CHF C. Increased risk of sudden death D. PHTN -Answer- CCHF in a patient with significant MR occurs because of the increase pressure in: A. LA B. RA C. RV D. Aorta -Answer- A LA cardiac cath pressure tracing in a patient with significant MR may demonstrate an increase in the: A. "a" wave B. "v" wave C. "x" wave D. "Y" wave -Answer- B Diastolic MR is associated with: A. Flail MV B. MVP C. Severe AI D. Severe TR -Answer- C In patients with MR, cardiac cath measurements include all of the following EXCEPT: A. LV systolic/diastolic pressure B. MVA C. PA pressures D. Pulmonary capillary wedge pressure -Answer- B A heart sound with significant chronic pure MR is: A. Loud S1 B. Fixed split S2 C. S3 D. S4 -Answer- C Cardiac cath technique used to determine the severity of MR is: A. Cardiac fluoroscopy B. Coronary arteriography C. Left ventriculography D. Supravalvular angiography -Answer- C Possible complications of acute, severe MR include: A. Syncope B. Hemoptysis C. Pulmonary edema D. Systemic embolization -Answer- C Possible presenting symptoms of significant chronic MR include: A. Angina pectoris B. AscitesC. Fatigue D. Syncope -Answer- C Common finding associated with regurgitant murmur in the elderly is: A. AoV stenosis B. Mitral annular calcification C. MS D. MV vegetation -Answer- B Chronic MR results in all of the following EXCEPT: A. LAE B. LVE C. LV volume overload pattern D. Mitral annular calcification -Answer- D Possible etiologies for MR include all of the following EXCEPT: A. Mitral annular calcification B. MV endocarditis C. Papillary muscle dysfunction D. PHTN -Answer- D Possible ECG findings for patients with significant MR include all of the following EXCEPT: A. LAE B. LVH C. RAE D. RVH -Answer- C Patients with significant MR the IVRT may be: A. Increased B. Decreased C. Affected by respiration D. Unaffected -Answer- B Effects of chronic MR in IVS motion include: A. Akinesis B. Dyskinesis C. Hyperkinesis D. Paradoxical wall motion -Answer- C M-mode findings associated with significant chronic MR include all of the following EXCEPT: A. LAE B. LVE C. Fine diastolic flutter of MV D. Flying W of the PV -Answer- CA 2D echo finding that may indicate significant chronic MR is: A. Fine diastolic oscillations of MV B. LVE C. LVH D. Premature closure of MV -Answer- B Systolic bowing of the IAS toward the RA may indicate: A. ASD B. MR C. TR D. TS -Answer- B Effect significant MR has on PW Doppler tracing of the PV4 may be described as: A. S wave increases, D wave decreases B. S wave increases, D wave increases C. S wave decreases, D wave increases D. Unaffected -Answer- C Possible secondary echo/Doppler findings in patients with severe chronic MR include all of the following EXCEPT: A. Increased MV E velocity B. Increased peak AoV velocity C. Increased RV dimension D. Shortened time to peak velocity of the RVOT -Answer- B Doppler finding of MR in CAD is most likely due to: A. Flail MV B. MVP C. Papillary muscle dysfunction D. Subaortic stenosis -Answer- C An accepted manner for semi-quantitating of MR with PW Doppler is: A. Mapping technique B. Maximum velocity of MR C. Peak A velocity D. Pressure half-time -Answer- A An accepted method for determining the severity of MR by CW Doppler is spectral: A. Length B. Strength C. Velocity D. Width -Answer- B A color flow Doppler method for semi-quantitating MR is regurgitant jet: A. AreaB. Height C. Length D. Turbulence -Answer- A 1. Radius of MR flow convergence hemisphere is 1.1 cm. The proximal Isovelocity surface area (PISA) is: A. 1.21 cm2 B. 3.8 cm2 C. 7.6 cm2 D. 15.2 cm2 -Answer- C The proximal Isovelocity surface area of a MR jet is 7.6cm2. The aliasing flow velocity is 24 cm/sec. the time velocity integral (TVI) of the MR jet is 150 cm. The maximum velocity of the MR jet is 580 cm/sec. the MR stroke volume is: A. 24 cc B. 47 cc C. 150 cc D. 580 cc -Answer- B Peak MR velocity reflects the: A. Direction of the MR B. Etiology of MR C. Maximum pressure difference between the LA and LV D. Severity of MR -Answer- C In patients with significant MR, the CW Doppler tracing of the regurgitant lesion may demonstrate: A. Asymmetrical shape of the MR flow velocity spectral display B. Jet area of 20% C. Jet duration of less than 85 msec D. Symmetrical shape of MR flow velocity spectral display -Answer- A Cardiac Doppler evidence of severe MR includes all of the following EXCEPT: A. Darkly stained CW Doppler tracing B. MV E velocity 1.5 m/sec C. PV4 systolic flow reversal D. Regurgitant jet area of 8.0cm2 -Answer- B Flail MV can be differentiated from severe MVP on 2D echo because flail MVL demonstrates: A. Thicker MV B. Chronic MR C. Leaflet tips that point toward the LV D. Leaflet tips that point toward the LA -Answer- DIn patients with severe acute MR, the CW Doppler maximum velocity of the regurgitant jet is: A. Decreased B. Dependent largely on LV function C. Increased D. Unaffected -Answer- A Most common etiology of MS is: A. Congenital B. LA myxoma C. Rheumatic fever D. Severe mitral annular calcification -Answer- C Cardiac valves listed in order from most affected to least affected by rheumatic heart disease are: A. AoV, PV, TV, MV B. MV, AoV, TV, PV C. PV, AoV, TV, MV D. TV, MV, PV, AoV -Answer- B Signs & symptoms of MS secondary to rheumatic heart disease include: A. Angina pectoris B. Cyanosis C. PHTN D. Vertigo -Answer- C Auscultatory findings of MS include all of the following EXCEPT: A. Diastolic rumble at the apex B. Loud first heart sound C. Opening snap D. Systolic ejection murmur heard at the base -Answer- D A 23 y/o female complaining of dyspnea presents to the cardiologist. Upon exam a diastolic rumble and opening snap are heard. The patient remembers having rheumatic fever at the age of 10. Her ECG demonstrated LAE and RVH, the diagnosis is: A. AS B. MR C. Rheumatic MS D. PS -Answer- C Patients with MS, LAE, and Afib are at increased risk for developing: A. LA myxoma B. LA thrombus C. LV dilatation D. LV thrombus -Answer- BValvular disease with which Afib is most commonly associated is: A. Acute AI B. AS C. MVP D. Rheumatic MS -Answer- D Conditions that may lead to clinical symptoms that mimic those associated with rheumatic MS include: A. AI B. LA myxoma C. Pericardial effusion D. VSD -Answer- B Auscultatory findings in rheumatic MS include: A. Austin flint murmur B. Fixed spitting of S2 C. Loud S1 D. Mid-systolic click -Answer- C LA thrombus is most often associated with: A. Cor triatriatum B. Infective endocarditis C. MVP D. Rheumatic MS -Answer- D In pure rheumatic MS, the LA is and the LV is . A. Decreased, decreased B. Increased, decreased C. Increased, increased D. Unchanged, increased -Answer- B Formula used to determine MVA in the cardiac cath lab is: A. CO / BSA B. CO / MPG C. CO / DFP / 38 x vMPG D. CO / DFP / 44.3 x vMPG -Answer- C M-mode findings for MV in patients with rheumatic MS include all of the following EXCEPT: A. Anterior motion of the PMVL B. B notch of the AMVL C. Decreased E-F slope of the AMVL D. Thick MVLs -Answer- B In the M-mode echo, features of the MS include all of the following EXCEPT: A. Anterior motion of PMVLB. Decreased Ao root dimension C. Systolic anterior motion of MVL D. LAD/LAE -Answer- C In MS, the PMVL on M-mode moves: A. Anteriorly B. Laterally C. Medially D. Posteriorly -Answer- A Critical MS is said to be presented if the MVA is reduced to: A. 1.0 cm2 B. to 1.5 cm2 C. 1.5-2.5 cm2 D. 2.5-3.5 cm2 -Answer- A Secondary findings in MS may include: A. LA dilation and a normal small LV dimension B. LA dilation and pulmonary venous stenosis C. LV and LA dilation D. LVH and LA dilation -Answer- A Typical echo findings in a patient with isolated rheumatic MS include all of the following EXCEPT: A. D-shaped LV B. Dilated LV C. LAE D. LA thrombus -Answer- B A strong indication for MS on 2D echo is an AMVL that exhibits: A. Coarse, chaotic diastolic motion B. Diastolic doming C. Reverse doming D. Systolic bowing -Answer- B 2D echo exam reveals thin mobile MVL tips and a Doppler E wave velocity of 1.8 m/sec with a pressure half-time of 180 msec. The most likely diagnosis is: A. Abnormal relaxation of the LV B. AI C. Moderate-Severe mitral annular calcification D. Rheumatic MS -Answer- C The most accurate method for determining severity of MS is: A. Determining the maximum velocity across the MV by PW Doppler B. Measuring E-F slope of the AMVL by M-mode C. Measuring the thickness of the MVL'sD. Performing planimetry of the MV orifice by 2D echo -Answer- D 2D echo findings for rheumatic MS include all of the following EXCEPT: A. Hockey-stick appearance of AMVL B. Increased LA dimension C. Reverse doming of AMVL D. Thick MVL's and subvalvular apparatus -Answer- C The classic cardiac Doppler features of MS include all of the following EXCEPT: A. Increased E velocity B. Increased MVA C. Increased PHT D. Turbulent flow -Answer- B Abnormal MV PHT for patients with MS is: A. 0-30 msec B. 30-60 msec C. 60-90 msec D. 90-400 msec -Answer- D A deceleration time of 800 msec was obtained by PW Doppler in a patient with rheumatic MS. The PHT is: A. 220 msec B. 232 msec C. 400 msec D. 800 msec -Answer- B Doppler mean pressure gradient across a stenotic MV of 12 mmHg is obtained. The severity of the MS is: A. Mild B. Moderate C. Moderately severe D. Severe -Answer- D MS is considered to be severe by all of the following criteria EXCEPT: A. Mean PG /= 12 mmHg B. MVA 1.0cm2 C. MV Doppler A velocity 1.3 m/sec D. PHT 220 msec -Answer- C Secondary echo/Doppler findings in patients with rheumatic MS include all of the following EXCEPT: A. Abnormal IVS wall motion B. Increased right heart dimensions C. Increased TR jet velocity D. LV dilatation -Answer- DA key word that is often used to describe the characteristics of the valve leaflet in MVP is: A. Dense B. Doming C. Redundant D. Sclerotic -Answer- C The term myxomatous degeneration is associated with MV: A. Flail leaflet B. Prolapse C. Stenosis D. Vegetation -Answer- B The associated auscultatory findings for MVP include: A. Ejection click B. Friction rub C. Mid-systolic click D. Pericardial knock -Answer- C Secondary causes of MVP include all of the following EXCEPT: A. ASD B. Bicuspid AoV C. Cardiac tamponade D. Primary PHTN -Answer- B Echo characteristics of MVP include all of the following EXCEPT: A. Increased MV annulus B. Systolic bowing of MV toward LA C. Systolic doming of leaflets D. Thick, redundant leaflets -Answer- C When performing an echo on a patient with a thoracic skeletal abnormality (e.g. pectus excavatum), the tech must be careful to r/o: A. ASD B. Bicuspid valve prolapsed C. Coarctation of the Ao D. MVP -Answer- D A redundant MVL is considered present when the leaflet thickness on M-mode/2D echo is: A. /= 2mm B. /= 3mm C. /= 4mm D. /= 5mm -Answer- DMV chordal rupture usually results in: A. AI B. MR C. PI D. TR -Answer- B Possible causes of ruptured chordae tendineae of the MV include all of the following EXCEPT: A. Carcinoid heart disease B. Infective endocarditis C. MVP D. Trauma -Answer- A Conditions that may affect LV in the same way as in AI include all of the following EXCEPT: A. ASD B. MR C. PDA D. VSD -Answer- A Valvular annuloplasty is best accomplished by which of the following devices: A. Balloon B. Ring C. Stent D. Coil -Answer- B In M-mode of the Ao Root demonstrates fine vibrations in the LA. The most likely cause is: A. Flail MV B. LA myxoma C. LA thrombus D. MVP -Answer- A On M-mode/2D echo, dense echoes are noted posterior to normal MVL. The probable diagnosis is MV: A. Annular calcification B. Fibrosis C. Papilloma D. Vegetation -Answer- A The most likely etiology of the AS in a 47 y/o patient is: A. Annular B. Congenital C. Endocarditis D. Senile -Answer- BClassing symptoms associated with severe valvular aortic stenosis include all of the following EXCEPT: A. Angina pectoris B. Atypical CP C. CHF D. Syncope -Answer- B An effect of significant AS on the LV is: A. Asymmetric septal hypertrophy B. Concentric LVH C. Eccentric LVH D. Protected in significant AS -Answer- B Pathologies that may result in a LV pressure load include all of the following EXCEPT: A. Discrete Subaortic stenosis B. MS C. Systemic HTN D. Valvular AS -Answer- B Secondary echo findings associated with severe AS include all EXCEPT: A. Decreased LV systolic function (later in course) B. LVH C. Post stenotic dilatation of the AAO D. RVH -Answer- D Pulse that is characteristic of significant valvular AS is: A. Pulsus alternans B. Pulsus bisferiens C. Pulsus paradoxus D. Pulsus parvus et tardus -Answer- D Cardinal symptoms of valvular AS include all of the following EXCEPT: A. Angina pectoris B. CHF C. Palpitations D. Syncope -Answer- C Heart sounds associated with Significant valvular AS is: A. Loud S1 B. Fixed split S2 C. S3 D. S4 -Answer- D The murmur of AS is best described as a: A. Holodiastolic decrescendo murmur heard best at the left sterna border B. Holosystolic murmur heard at the apex radiating to the axillaC. Midsystolic murmur heard best at the right upper sterna border D. Midsystolic murmur heard best at the left upper sterna border -Answer- C Principle ECG finding in severe valvular AS is: A. Afib B. LAW C. LVH D. RVH -Answer- C The AVA considered critical AS is: A. 3 cm2 B. 2 cm2 C. 1 cm2 D. 0.75 cm2 -Answer- D The formula used to determine AVA in the cardiac cath lab is the: A. Bernoulli equation B. Continuity equation C. Doppler equation D. Gorlin equation -Answer- D When M-mode evaluation of a systolic ejection murmur reveals thick AoVL and an Ao cusp excursion of 2.0 cm, the most likely diagnosis is: A. Insufficiency B. Sclerosis C. Stenosis D. Vegetation -Answer- B The etiology of AS includes all of the following EXCEPT: A. Bacterial B. Congenital C. Degenerative D. Rheumatic -Answer- A Characteristic M-mode findings for AS include all of the following EXCEPT: A. A lack of systolic flutter of the AoVL B. Diastolic flutter of the AoVL C. Reduced leaflet separation in systole D. Thickening of the AoVL -Answer- B The M-mode echo demonstrates multiple echoes within the Ao Root. The AoV excursion as determined by 2D echo is 7mm. on physical examination, a crescendodecrescendo systolic ejection murmur and a diastolic decrescendo murmur were heard. The most likely diagnosis is AoV: A. Insufficiency B. StenosisC. Stenosis and AI D. Stenosis and MS -Answer- C Possible 2D echo findings in significant AS include all of the following EXCEPT: A. AoV calcification B. LVH C. Post-stenotic dilatation of the AAO D. Post-stenotic dilatation of the DAO -Answer- D In the PLAX view, severe AS is defined as an AoVL separation that measures: A. /= 14 mm B. /= 12 mm C. /= 10 mm D. /= 8 mm -Answer- D Cardiac Doppler parameters used to assess the severity of valvular AS include all of the following EXCEPT: A. Ao PHT B. Ao velocity ratio C. Mean PG D. Peak AoV velocity -Answer- A The Intracardiac pressure that will most likely be increased in patients with severe valvular AS is: A. LV pressure at ED B. PA pressure C. RA pressure D. RV pressure at ED -Answer- A The onset of flow to peak Ao velocity Doppler tracing in severe valvular AS is: A. Increased B. Decreased C. Decreased with expirations D. Increased with inspiration -Answer- A A Doppler mean PG of 18 mmHg is calculated in a patient with AS. The severity of stenosis is: A. Mild B. Moderate C. Moderately severe D. Severe -Answer- A The severity of AS may be underestimated if only the max velocity measurement is used in the following condition: A. Anemia B. Doppler intercept angle of 0 degreesC. Low CO D. Significant AI -Answer- C 2D view that best visualizes systolic doming of the AoVL is the: A. Apical 5C B. PLAX C. PSAX AoV D. Subcostal SAX AoV -Answer- B Of the 3 PG that can be measured in the cardiac cath lab, the largest is: A. Max peak instantaneous gradient B. Mean transvalvular systolic gradient C. Peak-peak gradient D. Peak-mean gradient -Answer- A Of the transvalvular PG that can be measured in echo lab, the most useful in examining the AS is: A. Mean diastolic gradient B. Mean systolic gradient C. Peak instantaneous PG D. Peak-peak gradient -Answer- B The tech may differentiate between the similar systolic flow pattern seen in coexisting severe AS and MR by all of the following methods EXCEPT: A. The Ao ejection time is shorter than the MR time B. MR flow always lasts until MV opening, whereas AS flow does not C. Mitral diastolic filling profile should be present during recording of MR D. Since both are systolic flow patterns, it is not possible to separate MR from AS - Answer- D Most common etiology for chronic AI is: A. Idiopathic dilation of the Ao root and Ao annulus B. Infective endocarditis C. Marfan's syndrome D. Trauma -Answer- A Characteristic feature of the murmur of AI is: A. Diastolic decrescendo blowing murmur heard best along the left sterna border B. Diastolic crescendo-decrescendo murmur heard best along the left upper sterna border C. Diastolic rumble following an opening snap D. Harsh systolic ejection murmur heard best at the right upper sterna border -AnswerA Murmur associated with severe AI is: A. Austin flint murmurB. Carvallo's murmur C. Graham Steel murmur D. Still's murmur -Answer- A A technique used in cardiac cath lab that determines the severity of AI is: A. Austin Flint technique B. Judkin's technique C. Left ventriculography D. Supravalvular aortography -Answer- D In significant chronic AI, M-mode/2D evidence includes all of the following EXCEPT: A. Hyperkinesis of the IVS B. Hyperkinesis of the posterior wall of LV C. Left ventricular dilation D. Paradoxical IVS motion -Answer- D Low frequency diastolic fluttering of the AoV closure line on the M-Mode of the AoV is: A. A normal findings B. Indicative of cusp rupture or flail AoV C. Pathognomic for bicuspid AoV D. Pathognomic for significant AS -Answer- B Septal motion in significant AI often demonstrates: A. Anterior motion during systole B. Exaggerated early diastolic dip C. Normal motion D. Thinning with dyskinesis during systole -Answer- B Premature closure of the MV is associated with all of the following EXCEPT: A. Acute severe MR B. Acute severe AI C. First degree AV block D. Loss of sinus rhythm -Answer- A Echo evidence of severe, acute AI includes all of the following EXCEPT: A. Premature closure of the MV B. Premature opening of the AoV C. Premature opening of the MV D. Reverse doming of the AMVL -Answer- C M-mode measurements that have been proposed as an indicator for AoV replacement in patients with severe chronic AS are LV: A. ED dimension /= 55 mm and fractional shortening of /= 25% B. ED dimension /= 50 mm and fractional shortening of /= 25% C. ED dimension /= 70 mm and fractional shortening of /= 55 mm D. ES dimension /= 55 mm and fractional shortening of /= 25% -Answer- DReverse diastolic doming of the AMVL is associated with: A. Flail MV B. Papillary muscle dysfunction C. Rheumatic MS D. Severe AI -Answer- D Hallmark M-mode finding for AI is: A. Coarse diastolic flow of AMVL B. Fine diastolic flutter of the AMVL C. Chaotic diastolic flutter of the MV D. Systolic flutter of the AoV -Answer- B A PW Doppler flow velocity profile of AI obtained from the apical 5C view will demonstrate a diastolic: A. Laminar high-velocity flow signal B. Laminar low-velocity flow signal C. Turbulent high-velocity flow D. Turbulent low velocity flow -Answer- C Simplest semiquantitative technique for determining the severity of AI using pulsed wave Doppler is: A. Comparing the detected jet height to LVOT height B. Detecting a laminar diastolic flow pattern, which indicates severe AI C. Flow mapping of the LV -Answer- D Severe AI can be diagnosed by CW Doppler by all of the following EXCEPT: A. A max velocity 3 m/sec B. A PHT of /= 33 msec C. AI decel slope /= 3 m/sec D. Darkened spectrum of the regurgitant jet -Answer- A Severity of AI may best be determined with color flow Doppler by the following method: A. Measuring AI jet aliasing area in the PLAX B. Comparing the AI jet height with LVOT height C. Measuring AI jet max height D. Noting the temporal pattern of color variance. -Answer- B Color flow Doppler technique that permits detection of 3+ to 4+ AI is: A. Early diastolic flow reversal in abdominal Ao B. Early diastolic flow reversal in descending thoracic Ao C. Holodiastolic flow reversal in the descending thoracic Ao D. Holosystolic flow reversal in the abdominal Ao -Answer- C Proximal flow convergence of an AI jet as seen on color flow Doppler may represent: A. Physiologic insufficiencyB. Mild (1+) AI C. Moderate (2+) AI D. Moderately Severe (3+ 4+) AI -Answer- D The MV inflow pattern often associated with severe acute AI is stage: A. I B. II C. III D. IV -Answer- C Doppler signal of AI may be differentiated from the Doppler signal of MS by the following guidelines: A. If the diastolic flow pattern commences before MV opening, then the signal is due to AI. B. If the diastolic flow pattern commences after MV opening, then the signal is due to AI. C. The Doppler flow velocity pattern of MS is laminar, while the Doppler flow velocity pattern of AI is turbulent. D. Since both MS and AI are diastolic, it is not possible to differentiate the Doppler flow velocity patterns. -Answer- A M-mode finding that indicates severe acute AI is premature AoV: A. Closure B. Diastolic flutter C. Mid-systolic closure D. Opening -Answer- D Posterior displacement of AoVL's into the LVOT during diastole is called AoV: A. Prolapsed B. Sclerosis C. Stenosis D. Vegetation -Answer- A 2D echo finding in a patient with pure AI is: A. LAE B. LVE C. RAE D. RVH -Answer- B High frequency diastolic flutter of the AoV with echos extending into the LVOT during diastole on M-mode echo represent: A. AAO aneurysm B. Flail AoVL C. Valvular Ao sclerosis D. Valvular Ao stenosis -Answer- B Most common etiology of acute AI is:A. Ao balloon valvuloplasty B. Hypertension C. Infective endocarditis D. Rheumatic fever -Answer- C A pulse that is associated with significant AI is: A. Pulsus alternans B. Pulsus bisferiens C. Pulsus paradoxus D. Pulsus parvus et tardus -Answer- B M-mode reveals diastolic flutter of the AMV and LV ES dimension of 58 mm. 2D echo demonstrates an Ao root is 4.5 cm in diameter with AoV sclerosis. The AI jet is mapped to the level of the papillary muscles by PW Doppler. The PHT of the CW Doppler tracing of the AI jet is 280 m/sec. the jet height to LVOT height ratio is 53%. The severity of AI in this case is: A. Physiologic insufficiency B. Mild (1+) C. Moderate (2+) D. Moderately Severe (3+) -Answer- D Most common etiology of TS is: A. Carcinoid heart disease B. Infective endocarditis C. Rheumatic fever D. RA myxoma -Answer- C M-mode finding for TS include all of the following EXCEPT: A. Anterior motion of the PTVL B. Decreased E-F slope of the ATVL C. Increased leaflet thickness D. Systolic doming of the ATVL -Answer- D The typical 2D echo findings in rheumatic TS include all of the following EXCEPT: A. Diastolic doming of ATVL B. Leaflet thickening C. Restricted motion of the tricuspid leaflets D. Systolic bowing of the PTVL -Answer- D Causes of TR include all of the following EXCEPT: A. Carcinoid heart disease B. Ebstein's Anomaly C. PHTN D. RV failure -Answer- D Signs and symptoms of significant TR include all of the following EXCEPT:A. Hepatomegaly B. Jugular venous distention C. Pulsus paradoxus D. RV failure -Answer- C The murmur of TR is best described as: A. Holodiastolic murmur heard best at lower left sterna border B. Pansystolic murmur heard best at lower left sterna border C. Pansystolic murmur heard best at the cardiac apex with radiation to the axilla D. Systolic ejection murmur heard best at the upper right sterna border -Answer- B Causes of organic TR include all of the following EXCEPT: A. Rheumatic heart disease B. RV infarct C. TVP D. Flail TV -Answer- B In significant chronic TR, all of the following are dilated EXCEPT: A. Hepatic veins B. IVC C. PV4 D. RA -Answer- C M-mode finding for ruptured chordae tendineae of the TV is: A. Coarse diastolic flutter of the ATVL B. Fine diastolic flutter of the ATVL C. Irregular low frequency diastolic fluttering of the ATVL D. RAE -Answer- C M-mode echo finding of the TV, systolic coarse chaotic oscillations of the TVL may indicate: A. Normal echo B. Afib/atrial flutter C. Flail TVL D. PI -Answer- C M-mode and 2D echo findings for chronic TR include: A. LV volume overload B. Paradoxical septal motion C. Protected RV D. RVH -Answer- B Methods for determining the severity of TR with PW Doppler include all of the following EXCEPT: A. Increased E wave velocity for the TV B. Mapping techniqueC. Max velocity of the TR jet D. Systolic flow reversal in the hepatic vein -Answer- C Cardiac Doppler findings associated with significant chronic TR include all of the following EXCEPT: A. Concave late systolic configuration of the regurgitant signal B. Increased E velocity of the TV C. Systolic flow reversal in the hepatic vein D. Systolic flow reversal in the PV4 -Answer- D Systolic reflux of saline contrast noted by 2D echo in the IVC denotes the presence of: A. Tamponade B. Constrictive pericarditis C. PI D. TR -Answer- D An Intracardiac pressure may be determined from the CW TR signal is: A. Mean pulmonary pressure B. PAEDP C. Systolic PA pressure D. Total pulmonary vascular resistance -Answer- C TVL that are in a fixed semi-open position with diffuse thickening are found in: A. Carcinoid heart disease B. Cardiac amyloidosis C. Cardiac hemochromatosis D. Cardiac sarcoidosis -Answer- A Possible echo/Doppler findings in a patient with carcinoid heart disease include all of the following EXCEPT: A. PI B. PS C. TVP D. TR -Answer- C Most common cause of pathologic PI is: A. Carcinoid heart disease B. Infective endocarditis C. PHTN D. Rheumatic heart disease -Answer- C PI is associated with: A. LV volume overload B. RAH C. RVH D. RV volume overload -Answer- DWhen PA systolic pressure exceeds 70 mmHg, dilation of the pulmonic annulus results in a regurgitation jet of high velocity is responsible for the murmur called: A. Austin flint B. Rivero-Carvallo C. Graham Steell D. Lillehei-Kaster -Answer- D An ED velocity of 2 m/sec for PI was obtained with an estimated RA pressure of 7 mmHg. The PA ED pressure (PAEDP) is: A. 2 mmHg B. 16 mmHg C. 23 mmHg D. 26 mmHg -Answer- C (4(PR-end velocity)2 + RAP) The normal PAEDP is: A. 0-5 mmHg B. 4-12 mmHg C. 9-19 mmHg D. 18-25 mmHg -Answer- B Fine diastolic flutter of the TV is a characteristic finding for: A. Infundibular stenosis B. Primary PHTN C. PI D. PS -Answer- C Most common type of RVOTO is: A. Subinfundibular B. Subvalvular C. Supravalvular D. Valvular -Answer- D Most common etiology of PS is: A. Carcinoid B. Congenital C. Infective endocarditis D. Rheumatic -Answer- B Characteristic M-mode PVL pattern in PS is: A. Absent "a" dip B. Deep "a" dip C. Reversed "a" dip D. Shallow "a" dip -Answer- B On M-mode echo, the effect of infundibular PS on the PV is:A. Absent "a" dip B. Coarse systolic flutter C. Deep "a" dip D. Shallow "a" dip -Answer- B Possible 2D echo findings for valvular PS include all of the following EXCEPT: A. PVP B. RVH C. Systolic doming of the PVL D. Valvular thickening -Answer- A Post-stenotic dilation of the main PA is a 2D echo finding for: A. PI B. Pulmonary tumor C. TR D. PS -Answer- D RVOTO associated with post-stenotic dilatation of the main PA is: A. Valvular B. Subvalvular C. Supravalvular D. Subinfundibular -Answer- A PA banding may result in all of the following EXCEPT: A. Pseudoaneurysm formation B. RVH C. Supravalvular PS D. Valvular PS -Answer- D Most common symptom of infective endocarditis is: A. CP B. Dyspnea C. Fever D. Orthopnea -Answer- C Complications of infective endocarditis include all of the following EXCEPT: A. CHF B. Embolization C. Valve ring abscess D. Valvular prolapse -Answer- D The classic manifestation of infective endocarditis is cardiac valve: A. Doming B. Sclerosis C. Tumor D. Vegetation -Answer- DInfective endocarditis is a greater risk in patients with: A. Afib B. CAD C. LV aneurysm D. Prosthetic heart valve -Answer- D Patient with Hx MVP presents to the echo lab with complaints of fever, night sweats and weight loss. The most likely explanation is: A. CHF B. CAD C. Infective endocarditis D. Kawasaki disease -Answer- C MV is considered to be prematurely closed due to severe acute insufficiency when the C point of MV closure occurs: A. On or before inception of the Q wave B. Less than 0.05 seconds after the Q wave C. 0.05-0.07 seconds after the Q wave of the ECG D. On or before inception of the T wave -Answer- A The usual site for attachment of vegetations on the MV/TV is the: A. Annulus B. Atrial side of the valve leaflets C. Papillary muscles D. Ventricular side of the valve leaflets -Answer- B Vegetation diameter as determined by 2D echo that is most often associated with systemic emboli is: A. 3 mm B. 5 mm C. 7 mm D. 10 mm -Answer- D The essential 2D echo finding of valve ring abscesses appear: A. Echolucent B. Hyperechoic C. Pedunculated D. Sessile -Answer- A Aortic ring abscess is usually caused by: A. Infective endocarditis B. Rheumatic fever C. Valvular prolapse D. Valvular regurgitation -Answer- AComplications associated with infective endocarditis that may be indications for surgery include all of the following EXCEPT: A. CHF B. Dyspnea C. Myocardial or annular abscess D. Recurrent systemic emboli -Answer- B M-mode appearance of MV and AoV vegetation is described as: A. Doming B. Prolapsing C. Shaggy D. Relapsing -Answer- C Another term for homograft prosthetic valve is: A. Allograft B. Autograft C. Biograft D. Heterograft -Answer- A All of the following are porcine tissue prosthetic valves EXCEPT: A. Bjork-Shiley B. Carpenter-Edwards C. Hancock D. Intact -Answer- A An example of bovine pericardium tissue valve is: A. Bjork-Shiley B. Intact C. Ionescu-Shiley D. Starr-Edwards -Answer- C A PV relocated to the Ao Position is called a: A. Allograft B. Autograft C. Heterograft D. Homograft -Answer- B Coarse fluttering of a tissue prosthetic valve leaflet on M-mode is associated with: A. Insufficiency B. Normal function C. Stenosis D. Vegetation -Answer- A Abnormal rocking motion of a prosthetic valve by 2D echo indicates prosthetic valve: A. Dehiscence B. StenosisC. Thrombus D. Vegetation -Answer- A Prosthetic valve prolapse as seen by 2D echo is associated with prosthetic valve: A. Insufficiency B. Normalcy C. Stenosis D. Vegetation -Answer- A A short interval between the Ao Second sound (A2) and MV opening recorded for a MV prosthesis may indicate all of the following EXCEPT: A. Perivalvular leak B. Poor LV function C. Prolonged PR interval on the ECG D. Prosthetic MV dysfunction -Answer- C Bioprosthetic leaflet denervation and calcification occurs: A. Only in adults B. More frequently in children C. Equally in children and adults D. Primarily in women 40 y/o or older -Answer- B A prosthetic heart valve is associated with a relatively high rate of outlet strut fracture is: A. Bjork-Shiley B. Carpentier-Edwards C. Ionescu Shiley D. Starr-Edwards -Answer- A An example of a bileaflet tilting disc prosthetic heart valve is: A. Medtronic-Hall B. Omniscience C. St. Jude's D. Starr-Edwards -Answer- C The cardiac Doppler formula that accurately determines the pressure gradient in the prosthetic aortic valve is: A. 4 x (V22) B. 4 x (V12 - V22) C. 4 x (V22 - V12) D. Area x V1 -Answer- C The best Doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is: A. 4 x (V2) 2 B. 4 x (V2 2- V12) C. (CSA LVOT x TVI LVOT) ÷ TVI MVD. 220 ÷ pressure half-time -Answer- C The best Doppler method for evaluating an aortic valve replacement is probably: A. Deceleration slope B. Maximum peak instantaneous gradient C. Pressure half-time D. Velocity ratio -Answer- D Doppler evaluation of a prosthetic mitral valve should include all the following EXCEPT: A. Effective orifice area (continuity equation) B. Peak A velocity C. Peak and mean pressure gradients D. Pressure half-time -Answer- B Complications associated with prosthetic heart valve dysfunction include all the following EXCEPT: A. Dehiscence B. Leaflet degeneration C. Thrombosis D. Tumor -Answer- D A regurgitant jet area 1.0 cm2 is noted in a prosthetic aortic valve. This can be explained by: A. Ball variance B. Closing volume C. Disc embolization D. Disc occlusion -Answer- B With thrombotic obstruction of a prosthetic valve in the aortic position, continuous-wave Doppler findings include: A. Effective orifice area is normal B. Velocity ratio is increased C. Maximum velocity is increased D. Pressure half-time is increased -Answer- C Clinical evidence of porcine valve dysfunction is most likely to be seen when leaflets are thicker than: A. 1 mm B. 2 mm C. 3 mm D. 4 mm -Answer- C The most common etiology of constrictive pericarditis is: A. Cardiac surgery B. Idiopathic C. Rheumatic feverD. Tuberculosis -Answer- B The classic auscultatory finding in constrictive pericarditis is: A. Friction rub B. Mid-systolic click C. Opening snap D. Pericardial Knock -Answer- D Cardiac catheterization findings in constrictive pericarditis include: A. Absent "a" wave B. Dip-and-plateau waveform C. Increased "v" wave D. Increased peak-to-peak pressure gradient -Answer- B The square root is commonly found in: A. Aortic valve stenosis B. Constrictive pericarditis C. Pericardial effusion D. Pulmonary hypertension -Answer- B Echocardiographic signs associated with constrictive pericarditis include all the following EXCEPT: A. B notch B. Inferior vena cava plethora C. Railroad track sign D. Septal bounce -Answer- A Doppler evidence of constrictive pericarditis includes: A. Increased peak velocity across the mitral valve with inspiration B. Increased peak velocity across the aortic valve with inspiration C. Increased peak velocity across the mitral valve with expiration D. Increased peak velocity across the tricuspid valve with expiration -Answer- C An M-mode echocardiographic sign of constrictive pericarditis is: A. B notch sign B. Mid-late systolic dip sign C. Smoke-signal sign D. Square root sign -Answer- D An M-mode echocardiographic sign for constrictive pericarditis is: A. B notch B. Chaotic notch C. Fibrillatory notch D. Spanish notch -Answer- D A possible M-mode finding for constrictive pericarditis is premature opening of the:A. Aortic valve B. Mitral valve C. Pulmonic valve D. Tricuspid valve -Answer- C The absence of inferior vena cava collapse upon inspiration indicates elevated pressure in the: A. Aorta B. Left atrium C. Left ventricle D. Right atrium -Answer- D A prosthetic heart valve is associated with a relatively high rate of outlet strut fracture is: A. Bjork-Shiley B. Carpentier-Edwards C. Ionescu Shiley D. Starr-Edwards -Answer- C In acute pericarditis, a possible electrocardiographic finding in most if not all leads is: A. Depressed ST segments B. Elevated ST segments C. Increased QRS voltage D. Pathologic Q waves -Answer- B A possible auscultatory finding in a patient with pericarditis is: A. Fixed splitting of S2 B. Mid-systolic click C. Friction rub D. Pericardial knock -Answer- C The pulse associated with cardiac tamponade is: A. Pulsus alternans B. Pulsus bisferiens C. Pulsus paradoxus D. Pulsus parvus -Answer- C The single most reliable echocardiographic predictor of cardiac tamponade that can be identified by M-mode or two-dimensional imaging is diastolic collapse of the: A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle -Answer- D Pulsed-wave Doppler evidence of cardiac tamponade includes: A. Systolic flow reversal in the pulmonary veins B. Systolic flow reversal in the hepatic veinsC. Inspiratory increase in peak velocity across the mitral valve with an inspiratory decrease in peak velocity across the tricuspid valve D. Inspiratory decrease in velocity across the mitral valve with an inspiratory increase in velocity across the tricuspid valve -Answer- D The swinging heart syndrome is associated with: A. Cardiac trauma B. Constrictive pericarditis C. Mitral valve prolapsed D. Pericardial effusion -Answer- D Diastolic collapse of the right ventricle in cardiac tamponade occurs during: A. Early diastole B. Mid-diastole C. Late diastole D. Atrial systole -Answer- A The most effective treatment for cardiac tamponade is: A. Aspirin B. Bed rest C. Pericardectomy D. Pericardiocentesis -Answer- D Doppler evidence of cardiac tamponade from diastolic hepatic vein flow is: A. Expiratory decrease B. Expiratory increase C. Inspiratory increase D. Inspiratory reversal -Answer- A Fibrin within a pericardial effusion most likely indicates: A. Cardiac tamponade B. Constrictive pericarditis C. Infective endocarditis D. Long-standing pericardial effusion -Answer- D In patients with pericardial effusion, an echo-free space will be seen between the epicardium and the: A. Endocardium B. Fibrous pericardium C. Myocardium D. Parietal Serous Pericardium -Answer- D A large pericardial effusion precludes the diagnosis of all the following EXCEPT: A. Flail mitral valve B. Mitral valve prolapse C. Pulmonic valve prolapsedD. Systolic anterior motion (SAM) of the mitral valve -Answer- A A posterior echo-free space is detected during the systolic phase only by M-mode/twodimensional echocardiography. This is considered a: A. Normal finding B. Small pericardial effusion C. Moderate pericardial effusion D. Large pericardial effusion -Answer- A Air in the pericardial sac is known as: A. Cardiac tamponade B. Effusive-constrictive pericardium C. Hemopericardium D. Pneumopericardium -Answer- D The best guideline for differentiating pericardial effusion from pleural effusion by twodimensional echocardiography is: A. Pericardial effusion is located anterior to the descending aorta; pleural effusion is present posterior to the descending aorta. B. Pericardial effusion is present posterior to the descending aorta; pleural effusion is located anterior to the descending aorta. C. Pericardial effusion is usually seen as an anterior clear space; pleural effusion is usually seen as a posterior clear space. D. Pericardial effusion is usually seen as a posterior clear space; pleural effusion is usually seen as an anterior clear space. -Answer- A The most common location for a pericardial cyst is the: A. Hilium B. Left costophrenic angle C. Right costophrenic angle D. Superior mediastinum -Answer- C An echocardiographic finding in congenital absent pericardium is volume overload of the: A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle -Answer- D The most common etiology of systemic hypertension is: A. Idiopathic processes B. Renal disease C. Pheochromocytoma D. Psychogenic origin -Answer- ASecondary findings associated with systemic hypertension include al the following EXCEPT: A. Increased left ventricular mass B. Increased right ventricular mass C. Left atrial enlargement D. Left ventricular hypertrophy -Answer- B A patient with chronic systemic hypertension presents to the echocardiography laboratory. The following pulsed-wave Doppler data is acquired from the tips of the mitral valve leaflets: E:A ratio 1.2:1, deceleration time 210 msec, isovolumic relaxation time 83 msec, and pulmonary vein reversal 46cm/sec. The Doppler data indicates diastolic filling stage: A. I B. II C. III D. IV -Answer- B Electrocardiographic evidence associated with systemic hypertension includes: A. Left atrial enlargement B. Left ventricular hypertrophy C. Right atrial enlargement D. Right ventricular hypertrophy -Answer- B The most reliable M-mode indicator for pulmonary hypertension is: A. Deep "a" wave of the pulmonic valve B. Mid-systolic notching of the pulmonic valve C. Shallow "a" dip of the pulmonic valve D. Systolic flutter of the pulmonic valve -Answer- B M-mode findings associated with pulmonary hypertension include: A. Absent or shallow "a" dip of the pulmonic valve B. Deep "a" dip of the pulmonic valve C. Paradoxical "a" dip of the pulmonic valve D. Reverse "a" dip of the pulmonic valve -Answer- A Most of the interventricular septum in pulmonary hypertension is: A. Akinetic B. Hyperkinetic C. Hypokinetic D. Paradoxical -Answer- D A two-dimensional echocardiographic finding associated with pulmonary hypertension is: A. Flattening of the interventricular septum in diastole B. Flattening of the interventricular septum in systole C. Dyskinetic interventricular septal motionD. Hyperkinetic interventricular septal motion -Answer- B The Doppler finding used to calculate mean pulmonary artery pressure is: A. Mitral regurgitation B. Pulmonary insufficiency C. Right ventricular outflow tract acceleration time D. Tricuspid regurgitation -Answer- C All the following may be used to calculate pulmonary artery pressure by cardiac Doppler EXCEPT: A. Mitral regurgitation B. Pulmonary insufficiency C. Right ventricular outflow tract acceleration D. Tricuspid regurgitation -Answer- A Possible echocardiographic findings for pulmonary hypertension include all the following EXCEPT: A. Right atrial enlargement B. Right ventricular enlargement C. Pulmonary vein enlargement D. Tricuspid regurgitation -Answer- C The primary pulsed-wave mitral valve Doppler diastolic abnormality in a patient with systemic hypertension is stage: A. I B. II C. III D. IV -Answer- A A more appropriate name for idiopathic hypertrophic subaortic stenosis (IHSS) is: A. Aortic tunnel disease (ATD) B. Discrete subaortic valve stenosis (DSS) C. Hypertrophic Cardiomyopathy (HCM) D. Subaortic hourglass deformity (SHD) -Answer- C A common echoocardiographic finding in patients with hypertrophic obstructive cardiomyopathy is: A. Depressed ST segments B. Elevated ST segments C. Left ventricular hypertrophy D. Right ventricular hypertrophy -Answer- C With M-mode echocardiography, asymmetric septal hypertrophy is present when the interventricular septum to posterior wall ratio is: A. greater than or equal to 0:1 B. greater than or equal to 1:1C. greater than or equal to 1.2:1 D. greater than or equal to 1.3:1 -Answer- D The mitral valve finding most strongly associated with hypertrophic obstructive cardiomyopathy is mitral valve: A. Aneurism B. Fenestration C. Flail leaflet D. Systolic anterior motion -Answer- D A hallmark M-mode aortic valve finding in patients with hypertrophic obstructive cardiomyopathy is aortic valve: A. Diastolic flutter B. Fenestration C. Mid-systolic notching D. Vegetation -Answer- C A systolic high-velocity, late-peaking, dagger-shaped, continuous-wave Doppler signal is obtained. The most likely diagnosis is: A. Hypertrophic obstructive cardiomyopathy B. Mitral regurgitation C. Tricuspid regurgitation D. Valvular aortic stenosis -Answer- A M-mode findings associated with hypertrophic cardiomyopathy include all the following EXCEPT: A. Asymmetric septal hypertrophy B. Mid-systolic notching of the aortic valve C. Mid-systolic notching of the pulmonary valve D. Systolic anterior motion of the mitral valve -Answer- C Common two-dimensional echocardiographic findings in hypertrophic obstructive cardiomyopathy include all the following EXCEPT: A. Endocardial plaqueing of the interventricular septum B. Left atrial enlargement C. Left ventricular enlargement D. Thickening of the anterior mitral valve leaflet -Answer- C Pulsed-wave and color flow Doppler are useful in hypertrophic obstructive cardiomyopathy in all the following ways EXCEPT: A. Aid in guiding the continuous-wave Doppler beam B. Determine the presence and severity and severity of mitral regurgitation C. Help distinguish left ventricular outflow tract flow from mitral regurgitation D. Quantitate the severity of the left ventricular outflow tract obstruction -Answer- DThe pulsed-wave Doppler mitral flow pattern most often associated with hypertrophic obstructive cardiomyopathy is stage: A. I B. II C. III D. IV -Answer- A A speckled or ground-glass appearance of the ventricular septum seen two-dimensional echocardiography is found in: A. Constrictive Pericarditis B. Coronary artery disease C. Dilated cardiomyopathy D. Hypertrophic cardiomyopathy -Answer- D Characteristics findings in patients with idiopathic dilated cardiomyopathy include all the following EXCEPT: A. Asymmetric septal hypertrophy B. Dilated, poorly contracting left ventricle C. Low cardiac output D. High intracardiac pressures -Answer- A The characteristics shape of the left ventricle in patients with dilated cardiomyopathy is: A. Elongated B. Rectangular C. Spherical D. Triangular -Answer- C Early in the disease stage, the usual Doppler mitral inflow pattern in patients with dilated cardiomyopathy demonstrates: A. Abnormal compliance pattern B. Abnormal relaxation pattern C. Normal pattern D. Pseudonormal pattern -Answer- B A common mitral valve finding of dilated cardiomyopathy in two-dimensional echocardiography is: A. Decreased E septal separation B. Reverse diastolic doming C. Incomplete closure of the mitral valve D. Premature closure of the mitral valve -Answer- C Characteristics signs of decreased stroke volume on M-mode include all the following EXCEPT: A. Decreased D-E excursion of the mitral valve B. Gradual closure of the aortic valve during systole C. Increased "a" dip of the pulmonic valveD. Increased mitral valve E-point septal separation -Answer- C The most common regurgitation found in patients with dilated cardiomyopathy is: A. Aortic insufficiency B. Mitral regurgitation C. Pulmonary insufficiency D. Tricuspid regurgitation -Answer- B The most common etiology of secondary, non-ischemic dilated cardiomyopathy in the Western world is: A. Alcohol B. Infection (e.g., viral) C. Chemotherapy D. Pregnancy (postpartum) -Answer- A Functional classifications of cardiomyopathy include all the following EXCEPT: A. Dilated (congestive) B. Hypertrophic C. Non-dilated D. Restrictive -Answer- C A common late complication associated with dilated cardiomyopathy is: A. Infective endocarditis B. MR C. Systemic emboli D. Ventricular gallops -Answer- C Echocardiographic findings in dilated cardiomyopathy include all the following EXCEPT: A. Apical mural thrombus B. Dilated ventricular cavities C. Enlarged atrial cavities D. Increased mitral valve leaflet excursion -Answer- D The most common cause of primary dilated cardiomyopathy is: A. Adriamycin toxicity B. CAD C. Hemochromatosis D. Idiopathic -Answer- D Possible causes of restrictive cardiomyopathy include all the following EXCEPT: A. Alcohol B. Amyloidosis C. Hemochromatosis D. Sarcoidosis -Answer- A The echocardiographic features of amyloidosis include all the following EXCEPT:A. Dilatation of the ascending aorta B. Increased ventricular wall thickness C. Multivalvular regurgitation D. Pericardial effusion -Answer- A The cardiomyopathy with which cardiac hemochromatosis is most often associated is: A. Dilated B. Hypertrophic C. Idiopathic D. Subaortic -Answer- A Possible echocardiographic findings in sarcoid heart disease include: A. Asymmetric septal hypertrophy B. Concentric left ventricular hypertrophy C. Dilatation of the ascending aorta D. Posterior basal aneurysm -Answer- D Common echocardiographic/Doppler findings in systemic lupus erythematosus include: A. Aortic dissection B. Granular appearance of the myocardium C. Pericarditis D. Valvular aortic stenosis -Answer- C The cardiac involvement associated with acquired immunodeficiency syndrome (AIDS) is: A. Dilated Cardiomyopathy B. Hypertrophic cardiomyopathy C. Infiltrative cardiomyopathy D. Restrictive cardiomyopathy -Answer- A The most common etiology for ischemic heart disease is coronary artery: A. Aneurysm B. Atherosclerosis C. Embolus D. Spasm -Answer- B Angina occurring at rest that is not preceded by exercise or an increase in heart rate is called: A. Labile B. Prinzmetal's C. Stable D. Unstable -Answer- B The most specific echocardiographic findings for ischemic muscle is: A. Abnormal diastolic wall motion at the ischemic segment B. Alterations In systolic thickeningC. Normal diastolic wall motion D. Normal systolic wall motion -Answer- B Tardokinesis is a delay in: A. Left ventricular filling B. Right ventricular filling C. Valve opening D. Wall motion -Answer- D A wall motion score of 3 assigned to a certain segment of left ventricular muscle indicates: A. Akinetic wall motion B. Dyskinetic wall motion C. Hypokinetic wall motion D. Normal wall motion -Answer- A The definition of