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ARDMS-RDCS STUDY GUIDE EXAM 20 0 QUESTIONS
AND CORRECT ANSWERS FOR THE LATEST UPDATE
Which is the following is the typical treatment for advanced pericarditis? a. thoracentesis b. stent placement c. heart transplant d. pericardectomy - CORRECT ANSWER-d When recording flow velocity on the LVOT, the: a. PW Doppler cursor should be placed distal to the aortic valve closure b. CW doppler should be placed parallel to the aortic valve closure c. CW doppler should be placed perpendicular to the aortic valve closure d. PW Doppler cursor should be placed proximal to the aortic valve closure - CORRECT ANSWER-d The ultrasound system relies on the ____________________ for accurate recording of motion clips on an echo a. R wave and T wave on the EKG b. system timer to be set at 5 seconds c. QRS on the EKG d. system timer to be set at 3 seconds - CORRECT ANSWER-a Which of the following describes how to differentiate a ruptured chordae attached to a flail anterior mitral leaflet from a vegetation attached to the anterior mitral leaflet? a. Flail leaflets usually cause regurgitation and vegetations normally cause stenosis. b. Mitral vegetations normally form on the atrial side of the valve and the ruptured chordae related to a flail leaflet will be identified on the ventricular side of the valve. c. Vegetations are much more hypoechoic than the chordae tendinae. d. A flail mitral leaflet demonstrates a distinct appearance on m-mode that is easily differentiated from the m-mode appearance of vegetation on the valve. - CORRECT ANSWER-b
Propranolol can be used to treat A: patent ductus arteriosus B: subaortic stenosis caused by hypertrophic cardiomyopathy C: vegetation formation on the tricuspid valve D: carcinoid disease - CORRECT ANSWER-b
- Which type of valvular regurgitation usually demonstrates the highest pressure gradient? A: Pulmonary insufficiency B: Aortic insufficiency C: Tricuspid regurgitation D: Mitral regurgitation - CORRECT ANSWER-d ____________________ is defined as an abnormal connection of the left subclavian vein to the coronary sinus. A: DiGeorge syndrome B: persistent left SVC C: persistent right SVC D: Ebstein malformation - CORRECT ANSWER-b You identify thickened, tethered mitral leaflets, decreased E-F slope on PW Doppler, and right ventricular hypertrophy on an echo. These are all signs of A: mitral valve prolapse B: mitral stenosis C: endocarditis
A: Measure the wall thickness in systole and diastole B: use m-mode to demonstrate the velocity of the segment of interest and the adjacent normal segments C: Take 2-3 tissue Doppler samples from the area of interest D: Take 2-3 PW Doppler samples from the area of interest - CORRECT ANSWER-c If there is a weak signal and significant fluctuation in the vertical position of the EKG tracing across the screen: A: the skin contact with the electrodes is poor B: the EKG should be increased to a maximum level C: the alcohol used to clean the skin is causing artifact D: a cell phone or other nearby electrical device is causing interference - CORRECT ANSWER-a A patient currently undergoing chemotherapy for breast cancer is referred for an echo. A small mass is noted within the right ventricular wall and a mild pericardial effusion. There is debris and fibrous strands throughout the effusion. The mass is in the right ventricle is most likely A: primary cardiac malignancy B: rhabdomyoma C: secondary cardiac malignancy D: myxoma - CORRECT ANSWER-c Global longitudinal strain is measured from: A: parasternal views B: subcostal views C: apical views
D: more than one of the above - CORRECT ANSWER-c Which of the following is the most common cause of tricuspid regurgitation? A: pulmonary HTN B: atherosclerosis C: prolapse D: rheumatic fever complication - CORRECT ANSWER-a When measuring the left ventricular end systolic volume, you should use the cine function to: A: find the frame just after the MV closes B: find the frame just before the MV opens C: find the frame just before the AV opens D: find the frame at the peak of the R wave - CORRECT ANSWER-b Which of the following statements is correct regarding tricuspid valve prolapse(TVP)? A: TVP rarely leads to significant tricuspid regurgitation. B: TVP most commonly occurs as an isolated finding. C: TVP refers to abnormal diastolic displacement of the valve leaflet into the RA. D: The anterior and septal leaflets are most commonly involved. - CORRECT ANSWER-d Dobutamine is used to assess suspected hibernating myocardium. If the affected wall motion improves at low doses but declines at higher doses, A: the myocardium has irreversible damage and reperfusion would not be recommended B: the patient will be scheduled for a transesophageal echo to better evaluate the endocardium C: the patient will be scheduled for a reperfusion procedure
B: interventricular septum and inferior wall = 1.1cm thickness C: interventricular and interatrial septum = 1.1cm thickness D: right ventricular free wall =0.5cm thickness - CORRECT ANSWER-b When measuring left atrial volume; A: LA length is measured from the center of the mitral annulus to the inner edge of the posterior LA wall B: the same view used for LV volumes should be used for measurement of LA volumes C: the proximal pulmonary veins should be included in the tracing D: place a caliper at the center of the MV annular plane, trace the cavity to create a full circle and return to the center of the MV annulus - CORRECT ANSWER-a
- A vena contracta width greater than or equal to _____ indicates severe mitral regurgitation. A: 3mm B: Smm C:. 7mm D: 9mm - CORRECT ANSWER-c The best view to evaluate the left atrial appendage is: A: apical 4 chamber B: parasternal long axis C: apical 2 chamber D: subcostal - CORRECT ANSWER-c If the systemic BP is 120/80, LVOT velocity is 1m/s and the aortic valve velocity is 5m/s, what is the peak pressure gradient at the valve?
A: 100mmHg B: 64mmHg C: 4mmHg D: 25mmHg - CORRECT ANSWER-a Severe dilatation of the aortic root is diagnosed at _____ or greater A: 5.0cm B: 6.0cm C: 4.5cm D. 3.8cm - CORRECT ANSWER-a A Sonographer should instruct the patient on the use of the Borg Scale during: A: a stress echo B: a saline contrast exam C: a transesophageal echo D: a microbubble contrast exam - CORRECT ANSWER-a Diastolic flow reversal in the hepatic veins and a mitral E/A ratio of 1.9 correlates with which of the following? A: constrictive pericarditis B: right upper and lower pulmonary vein stenosis C: moderate mitral stenosis D: 2mm perimembranous VSD - CORRECT ANSWER-a The early heart tube normally: A: loops medially then laterally
B: mitral valve prolapse C: carcinoid disease D: supravalvular aortic stenosis - CORRECT ANSWER-b You are performing an apical view during a microbubble contrast echo on a patient with suspected wall motion abnormalities in the basal anterolateral left ventricular segment. You notice significant swirling of the contrast in the area of the apex. How can you adjust the controls to reduce this artifactual swirling? A: move the focal zone to the apex B: inject contrast at a faster rate C: turn off harmonic imaging D: decrease the mechanical index setting - CORRECT ANSWER-d Which of the following is true regarding an Austin Flint murmur? A: It is associated with significant mitral regurgitation causing mitral valve fluttering seen on the m- mode tracing. B: It is associated with a large VSD causing paradoxical interventricular septal motion seen on the m- mode. C It is associated with severe aortic regurgitation causing compression/vibration of the anterior mitral valve leaflet in diastole
D: It is associated with severe aortic stenosis causing vibration of the aortic root in systole; Seen on the m-mode tracing of the aortic root. - CORRECT ANSWER-c Atrial depolarization is represented by what part of the EKG tracing? A: P wave B: QRS wave C: R wave D: T wave - CORRECT ANSWER-a You identify a left atrial mass with an irregular shape and a "grape cluster" appearance. It is heterogeneous with areas of calcification. These findings are most suggestive of: A: rhabdomyoma B: hypernephroma C: fibroma D: myxoma - CORRECT ANSWER-d Which of the following will decrease after a mitral commissurotomy in a patient with isolated mitral stenosis? A: pressure half time B: mitral valve area C: A wave velocity D: mitral regurgitation - CORRECT ANSWER-a What is the average normal aortic valve size? A: 3-4cm B: 2-3cm ;
C: E to A reversal D: dagger shaped waveform - CORRECT ANSWER-a Renal cell carcinoma most commonly metastasizes to the heart through the A: IVC B: portal venous system C: lymphatic system D: aorta - CORRECT ANSWER-a Which type of cardiomyopathy is related to fatty and fibrous tissue replacement of the myocardium of the right ventricle? A: right ventricular hemochromatosis B: lipomatous septal hypertrophy C: arrhythmogenic right ventricular cardiomyopathy D: endomyocardial fibrosis - CORRECT ANSWER-c The pattern of wall hypertrophy in hypertensive heart disease is ______________, and in hypertrophic cardiomyopathy the pattern is usually
A: symmetric, the same B: symmetric, asymmetric C: asymmetric, symmetric D: focal, diffuse - CORRECT ANSWER-b A 22yr old patient presents for an echo and you identify biventricular wall thickening, mild pericardial effusion and thickening of the leaflets of
all four valves. Which of the following is the most likely cause for these findings? A: amyloidosis B: hypertrophic cardiomyopathy C: carcinoid disease D: rheumatic fever - CORRECT ANSWER-a A patient presents for an echo due to a recent stroke. The order states that they are looking for an embolic source for the stroke. She has been admitted to the hospital and is currently on her second day of Heparin treatment due to a recent diagnosis of DVT in her left leg. A recent VQ scan was normal with no evidence of pulmonary embolism. Which of the following is a potential reason for why the study was ordered? A: to evaluate the patient for CHF B: to evaluate the patient for a possible vegetation on the tricuspid valve C: to evaluate the patient for a possible patent foramen ovale D: to evaluate the patient for a possible VSD - CORRECT ANSWER-c Which of the following is a normal response seen
When placing the electrodes on a patient for a 12 lead EKG for to a stress echo, the electrode for left arm is placed: A: 2cm below the left clavicle B: at the anterior axillary line between the last rib and the iliac crest C: left forearm D: right forearm - CORRECT ANSWER-a How is the contraction velocity of the left atrial appendage evaluated? A: M-mode sample line positioned approximately 1 cm proximal to the entry of the appendage into the body of the LA B: M-mode sample line positioned approximately across the left atrium and the body of the left atrial appendage C: PW Doppler sample volume positioned 1cm proximal to the entry of the appendage into the body of the LA D: PW Doppler sample volume positioned in the center of the left atrial appendage - CORRECT ANSWER- c Systole is defined as: A: from the end of the isovolumic contraction period to the start of the isovolumic relaxation period B: from mitral valve closure to aortic valve closure C: from the end of the isovolumic relaxation period to the start of the isovolumic contraction period D: from the opening of the aortic valve to aortic valve closure - CORRECT ANSWER-b If the heart rate is 80bpm and the stroke volume is 50mL, what is the cardiac output? A: 4000mL B: 400 L/min C: 4 mL/min
D: 4 L/min - CORRECT ANSWER-d Which of the following should be suspected on the echo in the presence of a diastolic murmur? A: aortic stenosis B: MVP C: ASD D: mitral stenosis - CORRECT ANSWER-d Which of the following adjustments should be made to the Doppler settings when evaluating left ventricular inflow in a patient with constrictive pericarditis? A: Decrease the PRF to demonstrate the expected low velocity peaks of the mitral waveform B: Decrease the sweep speed C: Increase the PRF to demonstrate the expected E peak velocities greater than 2.0m/s D: Increase the sweep speed - CORRECT ANSWER-b The motion of which of the following wall segments can be evaluated on the apical four chamber view? A: basal anteroseptal wall B: mid anteroseptal wall C: lateral right ventricular wall D: basal inferolateral wall - CORRECT ANSWER-c Which of the following is the most common type of infiltrative cardiomyopathy to develop restrictive cardiomyopathy? A: endomyocardial fibrosis
presents for his annual echo. What measurement is most important for you to obtain during today's exam? A: dp/dt B: peak velocity across the pulmonic valve C: LV wall thickness in diastole D: aortic root diameter - CORRECT ANSWER-d What is the difference between an aortic dissection and an intramural hematoma? A: An intramural hematoma has no intimal flap or false lumen like a dissection does B: An intramural hematoma only affects the abdominal aorta and a dissection only affects the ascending segment
C An intramural hematoma is always spontaneous and a dissection is always caused by trauma D: An intramural hematoma forms on top of the intima and a dissection has thrombus formation posterior to the intima - CORRECT ANSWER-a Which of the following is a responsibility of the Sonographer assisting with a pericardiocentesis? A: measure the volume of the fluid on the preliminary echo B: cover the highest frequency linear probe with a sterile probe cover C: instruct the patient breathing techniques necessary during the procedure D: send the needle to be sterilized after the procedure - CORRECT ANSWER-c After the ductus arteriosus closes and atrophies it is called the: A: supracardiac ligament B: ligamentum arteriosum C: infracardiac ligament D: ligamentum venosus - CORRECT ANSWER-b Which of the following describes a technique used to differentiate constrictive pericarditis from restrictive cardiomyopathy? A: Ask the patient to perform the Valsalva maneuver while using Doppler to evaluate aortic outflow. B: Measure the deceleration time of the mitral valve C: Evaluate the respiratory collapse of the IVC D: Use tissue Doppler to assess the mitral annulus - CORRECT ANSWER-d You identify mitral valve prolapse on an echo. Which of the following describes what you should do to evaluate this patient for a commonly
