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The peak velocity of aortic regurgitation indicates the maximum pressure gradient between: the aorta and the LV in systole the aorta and the LV in diastole the LV and the LA in diastole the LV and the LA in diastole - Correct Answer-the aorta and the LV in diastole Which type of image resolution improves with proper placement of the focal zone at the area of interest? temporal lateral contrast elevational - Correct Answer-Lateral The tissue of the interventricular septum will be best visualized when: the US beam is parallel to the long axis of the septum the US beam is perpendicular to the long axis of the septu the dynamic range is increased harmonics is turned off - Correct Answer-the US beam is perpendicular to the long axis of the septum A 38yr old male presents for an echo due to a systolic murmur and has no other cardiac symptoms. Due to patient habitus, 2D imaging is significantly limited but the EF% appears normal. The aortic valve velocity is 4m/s with a peak pressure gradient of 64mmHg and no aortic insufficiency is detected. Which of the following is the most likely etiology of the aortic stenosis? bicuspid AV infective endocarditis degenerative disease Marfans syndrome - Correct Answer-bicuspid AV All of the following are evaluated on a cardiac MRI, except:
regurgitant volume of mitral regurgitation left ventricular mass mitral valve prolapse left ventricular systolic volume - Correct Answer-mitral valve prolapse Cardiac MRI cannot demonstrate the fine structures and motion of the valves. You are performing a resting echo with contrast for wall motion evaluation. Just after the injection of microbubble contrast, the patient complains of feeling short of breath and their face appears to be flushed. The heart rate on the EKG is 117bpm. Which of the following correctly describes their symptoms? the patient is most likely experiencing a vasovagal reaction to the contrast this is a normal response to perfluorocarbon contrast media the symptoms are most likely related to anxiety the patient is most likely experiencing an anaphylactic reaction to the contrast - Correct Answer-the patient is most likely experiencing an anaphylactic reaction to the contrast Tachycardia, bronchospasm, wheezing, pruitis, erythema, hives and a feeling of impending doom are symptoms related to an anaphylactic response. Because the short time frame between contrast injection and the symptoms, the most likely cause of the symptoms is an allergic reaction. Flattening of the IVS is least likely to be associated with which of the following? 3mm muscular VSD Congestive heart failure Large ASD Pulmonary HTN - Correct Answer-3mm muscular VSD Which of the following correctly describes the way to tell the difference between a vasovagal response and anaphylaxis caused by contrast injection?
If the peak velocity of the E wave on the mitral tracing is 1.2m/s and the tissue Doppler assessment of the septal annulus indicates a peak velocity of E' of 6cm/s, the LV diastolic filling pressures are ________________. decreased increased unable to be estimated without more information normal - Correct Answer-increased 1.2m/s = 120cm/s E/E' = 120/6 = 20 E/E' <8 is normal, >15 indicates increased LV filling pressures All of the following correctly describe end diastolic pressure in the left ventricle, except: is normally at least 3X the right ventricular diastolic pressure it is elevated with moderate - severe aortic insufficiency it is equivalent to the mean left atrial pressure it is defined as LV preload - Correct Answer-is normally at least 3X the right ventricular diastolic pressure Left ventricular diastolic pressure is equivalent to the mean left atrial pressure. LV preload is defined as the diastolic pressure in the left ventricle. Significant AI will increase the diastolic pressure in the left ventricle. The diastolic pressure in the normal RV is usually less than 5mmHg below the LV diastolic pressure. Which of the following best describes the primary reason why the TEE probes are soaked in a disinfectant for a specified amount of time? Soaking the probe too long in a disinfectant solution can damage the bonding effect of the glue used to assemble the probes.
Soaking the probe too long in a disinfectant solution will decrease the flexibility of the rubber coated portion of the probe causing cracks. Soaking the probe too long in a disinfectant solution will cause the disinfectant to be absorbed inside the probe and damage the electrical components. Soaking the probe too long in a disinfectant solution will degrade the imaging capabilities of the piezoelectric element. - Correct Answer-Soaking the probe too long in a disinfectant solution can damage the bonding effect of the glue used to assemble the probes. _________________ adjusts the brightness of the entire image where ________________ adjusts the brightness of specific portions of the image. overall gain, output power monitor contrast, time-gain compensation post processing, pre processing overall gain, time-gain compensation - Correct Answer-overall gain, time-gain compensation The least common type of ASD seen in patients today is? - Correct Answer-coronary sinus defect Septum Secundum: most common, mid septal area Septum Primum: 2nd most common, close to AV valves Sinus Venosus: near SVC entrance Coronary Sinus Defects: inferior portion of septum, rare If the peak velocity of the E wave on the mitral tracing is 1.2m/s and the tissue Doppler assessment of the septal annulus indicates a peak velocity of E' of 6cm/s, the LV diastolic filling pressures are ________________. decreased increased unable to be estimated without more information normal - Correct Answer-increased
4 - Correct Answer- 3 Wall Motion Scoring used to grade systolic wall function. Score Index calculated by adding the scores from the walls and dividing by the number of segments. 1 = Normal or hyperdynamic 2 = Hypokinesis 3 = Akinesis 4 = Dyskinesis 5 = Aneurysmal Which method of mitral regurgitation assessment is most accurate for evaluating a mechanical MVR in the apical 4 chamber view? peak pressure gradient by CW Doppler vena contracta regurgitant jet area PISA radius - Correct Answer-PISA radius Valve masking limits Doppler evaluation of a mechanical MVR in the apical view. The masking occurs behind to the valve on the image but the PISA radius is measured above the valve. A patient presents for an echo because they have been experiencing positional and respiratory variation in chest pain. You expect to find which of the following on the exam? pericarditis congestive heart failure hypertrophic cardiomyopathy Kawasaki's syndrome - Correct Answer-pericarditis When considering treatment options for an aneurysm of the LV, the most important information the surgeon needs to see in the echo report for consideration is:
size of the aneurysm presence of bypass grafts within affected segment motion of unaffected wall segments presence/absence of thrombus - Correct Answer-motion of unaffected wall segments FeedBack: The unaffected wall segments will be used to recreate the left ventricular wall once the aneurysmal section is removed. Which imaging technique will provide the best evaluation of a 2mm vegetation on the aortic valve? tissue Doppler transesophageal echo transthoracic echo with saline contrast transthoracic echo with perfluorocarbon contrast - Correct Answer-transesophageal echo All of the following are advantages of bioprosthetic valves over mechanical valves, except: no noise heard from apparatus no anticoagulation need more durable A porcine valve can be used to replace any cardiac valve but there are numerous kinds of mechanical valves designed for each native valve. - Correct Answer-more durable
used to better evaluate the flow velocities in the IVC - Correct Answer-used to evaluate the IVC for the appearance of presystolic contrast reversal at the RA junction A contrast echo can aid in the diagnosis of constrictive pericarditis by evaluating the IVC. The appearance of presystolic contrast reversal at the RA junction is a positive indication for constrictive pericarditis. Which of the following describes findings associated with asymmetrical septal hypertrophy seen with hypertrophic obstructive cardiomyopathy? septal to posterior wall thickness ratio of 1.3:1 or greater septal to posterior wall thickness ratio of 3:1 or greater septal to posterior wall thickness ratio of 2:1 or greater posterior to septal wall thickness ratio of 1.3:1 or greater - Correct Answer-septal to posterior wall thickness ratio of 1.3:1 or greater Asymmetrical septal hypertrophy is diagnosed when the thickness of the septal wall is greater than the posterior wall with a septal to posterior wall ratio of 1.3:1 or greater. Which of the following vessels drains the coronary blood from the apex and septum of the left ventricle? thebesian vein great cardiac vein small cardiac vein middle cardiac vein - Correct Answer-great cardiac vein The great cardiac vein drains blood from the myocardium that is supplied by the left anterior descending artery. The apex and septum are supplied with blood by the LAD artery. The pulmonary capillary wedge pressure evaluated on a right heart cath represents the pressure in the _____________ right atrium pulmonary artery left atrium left ventricle - Correct Answer-left atrium
Which of the following correctly describes the continuing education requirements for technologists that are registered in echocardiography through CCI? Sonographers must complete 36 CME credits in a three year period. Sonographers must attend quarterly staff meetings in their echo lab. Sonographers must complete 36 CME credits annually. Sonographers must attend at least one echo conference annually. - Correct Answer- Sonographers must complete 36 CME credits in a three year period. For the best results when performing a CW Doppler evaluation of the aortic valve with the probe located along the right sternal border, the patient should be placed in the: lithotomy position trendelenburg position right lateral decubitus position left lateral decubitus position - Correct Answer-right lateral decubitus position You are performing mitral regurgitation assessment on a transesophageal echo by measuring the PISA radius of the jet. After optimizing the color flow of the mitral regurgitation jet, which of the following console adjustments should be made before freezing the image? shift the color baseline up to between 20 - 40cm/s to allow aliasing shift the color baseline down to between 20 - 40cm/s to allow aliasing increase the power output setting to increase aliasing switch to a variance color map before freezing the image - Correct Answer-shift the color baseline up to between 20 - 40cm/s to allow aliasing nce color map before freezing the image Reducing the color baseline improves the aliasing and aids in visualization of the hemispheric radius. IMPORTANT: when performing PISA on MR for TEE exams, the color baseline is shifted UP due to difference in approach. All of the following are considered critical findings on an echocardiogram, except:
Noonan's syndrome has a strong association with pulmonary stenosis caused by a dysplastic valve. A patient presents for an echo with a script that states "recent diagnosis of myocarditis". Which of the following is an expected finding on the exam? hypercontractile ventricular motion left ventricular dysfunction thickened valve leaflets of the PV and TV thickened valve leaflets of the AV and MV - Correct Answer-left ventricular dysfunction Myocarditis refers to the infection of the myocardial tissue. The inflammation of the tissues usually causes ventricular dysfunction. The American Heart Association recommends that a rescuer try to perform a minimum of ________________ compressions per minute on a child or infant. 30 60 80 100 - Correct Answer- 100 Which of the following cardiac wall segments are fed by the left circumflex artery? basal anterolateral mid anterolateral mid inferolateral basal anteroseptal - Correct Answer-basal anterolateral LAD supplies blood to the interventricular septum/apex via septal branches and the anterolateral wall of the left ventricle via the diagonal branches. The left circumflex artery branches into the obtuse marginal branches that perfuse the lateral wall of the left ventricle. The right coronary artery supplies the RV and the LV inferior wall and the inferior septal wall. Which of the following techniques can be used to most accurately differentiate a left sided cardiac mass from a sonographic artifact?
Use multiple views and planes to evaluate the area. Use microbubbles to delineate the chamber walls. Switch to a higher frequency transducer. Adjust compression, gain and add B color to enhance the image. - Correct Answer-Use microbubbles to delineate the chamber walls. All of the above choices are techniques used to assess the presence/absence of a mass versus an artifact but the most accurate would be the use of contrast to delineate the walls of the chamber. Thrombus forms adjacent to the ventricular walls with abnormal motion and due to stasis in the left atrium. Optison, Levovist and Definity are examples of microbubble contrast agents used in echo to evaluate wall motion and thrombus formation.
. ______________________ is the preferred method of diagnosis of constrictive pericarditis. Cardiac catheterization Echocardiography CT MRI - Correct Answer-Cardiac catheterization is the preferred method of diagnosis of constrictive pericarditis. All of the following are associated sonographic findings seen with aortic stenosis, except: right ventricular enlargement thickened AV leaflets left ventricular hypertrophy left ventricular enlargement - Correct Answer-right ventricular enlargement What is the best way to correct the color Doppler artifact? decrease rejection increase the color velocity scale decrease the Doppler gain increase color threshold - Correct Answer-decrease the Doppler gain
unsynchronized cardioversion biventricular pacemaker - Correct Answer-synchronized cardioversion Synchronized cardioversion is used in patients with unstable atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachycardia. Cardiac resynchronization AKA biventricular pacemaker is used to treat heart failure and the EF in this patient is 45% which is still "ok". Unsynchronized cardioversion is used for pulselessness and ventricular tachycardia or fibrillation. While performing the parasternal long axis views of the heart you notice dilatation of the aortic root. Which 2D echocardiographic view will help to best evaluate the extent of this aortic abnormality? apical 5 chamber suprasternal long axis subcostal short axis apical 3 chamber - Correct Answer-suprasternal long axis If the aortic root is dilated, the ascending, arch and descending aorta should be evaluated. This is best accomplished by using the suprasternal view. All of the following are potential findings related to a right ventricular infarction, except: dilated right ventricle globally decreased motion of the right ventricular free wall dilated right atrium high velocity tricuspid regurgitation carcinoid disease - Correct Answer-carcinoid disease Carcinoid disease causes an increase in the levels of serotonin in the blood stream. This leads to deposits forming on the tricuspid and pulmonary valves causing restricted valvular motion.
M-mode demonstrates ___________________ with atrial fibrillation. E to A reversal beat to beat variation in aortic velocity loss of the E wave variation in R-R intervals - Correct Answer-variation in R-R intervals A-fib causes variation in the length of diastole which is demonstrated as R-R interval variation on the m-mode. A-fib does cause beat to beat variation in the aortic velocity but that is detected using Doppler. In utero, a fetus with tricuspid atresia will demonstrate flow from the right atrium to the left atrium through the foramen ovale. If the foramen ovale remains open after birth, what other defect is required for the baby to survive? a ASD a VSD Eisenmenger's syndrome a patent ductus venosus - Correct Answer-a VSD The ductus arteriosus supplies blood from the aorta to the left pulmonary artery in the fetus. This will close a few days after birth. Even if the foramen ovale remains open after birth, there needs to be a path to allow the venous return to the RA to enter the RV. There must be a pathway between the ventricles to allow blood to enter the RV and exit the pulmonary artery to reach the lungs. You perform an echo on a 55yr old adult and identify tricuspid stenosis. What's the most likely cause for this finding? Atherosclerotic formation over time Carcinoid disease Rheumatic fever Congenital malformation - Correct Answer-Rheumatic fever Congenital malformation is not a cause for the "adult" condition. Carcinoid disease and atherosclerosis etiology are much more rare. Rheumatic fever is the most common cause for tricuspid stenosis in adults. The functional left ventricular outflow tract is defined as:
85% - Correct Answer-15% Ejection fractions are usually very low in patients with DCM, 10-20% on average. All of the following describe aortic prosthetic dehiscence, except: associated with endocarditis causes left ventricular pressure overload critical finding that requires immediate intervention causes left ventricular volume overload - Correct Answer-causes left ventricular pressure overload Valvular dehiscence is a critical finding where the valve struts detach from the heart. This causes significant regurgitation and volume overload. AVR dehiscence = LV volume overload, MVR = LA volume overload When evaluating the left atrium, a volume index of 44ml/m2 indicates _____________________. a normal size atrium a mildly dilated atrium a moderately dilated atrium a severely dilated left atrium - Correct Answer-a moderately dilated atrium d left atrium FeedBack: LA Volume Index <34ml/m2 normal LA size
35 - 41 ml/m2 mild dilatation 42 - 48 ml/m2 moderate dilatation
48 ml/m2 severe dilatatio Which of the following best describes the Doppler flow evaluation in severe cases of aortic coarctation? The flow at the stenosis will become a high velocity monophasic waveform with retrograde flow in diastole. The flow at the stenosis will become triphasic with a very high peak velocity. The flow in the abdominal aorta will be very low velocity and triphasic. The flow at the stenosis will become a high velocity monophasic waveform with forward flow in diastole and the flow in the abdominal aorta will be very low velocity and monophasic. The flow at the stenosis will become triphasic with a very high peak velocity and the flow in the abdominal aorta will be very low velocity and monophasic. - Correct Answer- The flow at the stenosis will become a high velocity monophasic waveform with forward flow in diastole and the flow in the abdominal aorta will be very low velocity and monophasiv Because the coarctation restricts the amount of flow moving distally into the abdomen, the distal tissues/organs receive less blood. The systolic contraction of the heart does not supply enough blood to the distal areas during systole and antegrade flow becomes continuous throughout the cardiac cycle. Which orthogonal plane is most commonly used to obtain a planimetry measurement of the mitral valve area? long axis short axis apical subcostal - Correct Answer-Short Axis Paradoxical motion of the IVS is associated with of all of the following abnormalities, except: left bundle branch block
