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A patient is sent to the echo lab with a diagnosis of Marfan's Syndrome. Which of the following are you most likey to find? a. aortic rupture b. cleft mitral valve c. dilated aortic root d. pericardial effusion - CORRECT ANSWER>>c. dilated aortic root A young patient is sent to the echo lab with a diagnosis of Kawasaki's disease. Which of the following would you look for? a. ASD b. right atrial myxoma c. MVP d. regional wall motion abnormalities - CORRECT ANSWER>>d. regional wall motion abnormalities Normally pericardial fluid drains into the: a. pleural space b. coronary sinus c. peritoneal space d. lymphatic system - CORRECT ANSWER>>d. lympathic system A patient who has a higher blood pressure in the right arm than the left may have: a. aortic stenosis b. hypoplastic left heart c. coarctation of the aorta d. patent ductus arteriosis - CORRECT ANSWER>>c. coarctation of the aorta Premature closure of the aortic valve on M-mode is most consistent with: a. mitral stenosis b. aortic stenosis c. aortic regurg
d. mitral regurg - CORRECT ANSWER>>d. mitral regurgitation An intra-aortic ballon pump assists the left venricle by increasing? a. pre-load b. after-load c. coronary blood flow d. systolic blood pressure - CORRECT ANSWER>>c. coronary blood flow The development of angina, dyspnea, and syncope are signs of advanced: a. aortic stenosis b. mitral stenosis c. aortic regurg d. mitral regurg - CORRECT ANSWER>>a. aortic stenosis Over stimulation of the parasympathetic nervous system will: a. increase the heart rate b. decrease the heart rate c. increase the contractility d. decrease the contractility - CORRECT ANSWER>>b. decrease the heart rate At cardiac catheterization a patient has equal end-diastolic pressures between both atria and both ventricles suggesting: a. patent ductus ateriosus b. constrictive percarditis c. chronic mitral regurgitation d. cardiac tamponade - CORRECT ANSWER>>b. constrictive pericarditis In normal patients why does the peak velocity of flow in the pulmonary artery occurs later than the peak velocity in the aorta? a. flow volume is lower b. flow volume is higher c. vascular resistance is lower d. vascular resistance is higher - CORRECT ANSWER>>c. vascular resistance is lower The beginning of systole is accompained by which heart sound: a. S b. S c. S d. S4 - CORRECT ANSWER>>a. S
Papillary muscle dysfunction usually results from: A. Dressler's syndrome B. Ischemic heart disease C. Bacterial endocarditis D. Rheumatic heart disease - CORRECT ANSWER>>B. Ischemic heart disease In order to record the vegetation's of endocarditis by echo, the vegetation's must have a diameter of at least: A. One centimeter B. Three millimeters C. Three centimeters D. Five millimeters - CORRECT ANSWER>>B. Three millimeters How many veins connect the pulmonary vascular bed with the left atrium in the normal heart? A. one B. two C. three D. four - CORRECT ANSWER>>D. four Which M-mode finding is considered to be a specific indicator of a fenestrated aortic valve? a. diastolic flutter of the mitral valve b. premature opening of the aortic valve c. diastolic flutter of the aortic valve d. eary systolic closure of the aortic valve - CORRECT ANSWER>>c. diastolic flutter of the aortic valve Which cardiac abnormalities are frequently noted on the echocardiogram of patients with Marfan's syndrome? A. mitral stenosis and pericardial effusion B. mitral valve prolapse and aortic dilatation C. left ventricular aneurysm and thrombus formation D. dilatation of the pulmonary artery and pulmonic stenosis - CORRECT ANSWER>>b. mitral valve prolapse and pericardial effusion Which term is used to describe a segment of ventrcular wall that exhibits no motion?
A. akinesis B. dyskinesis C. hypokinesis D. hyperkinesis - CORRECT ANSWER>>A. akinesis A true aneurysm of the left ventricle can usually be distinguished from a pseudoaneurysm because a pseudoaneurysm: A. has a smaller, more narrow neck than a true aneurysm B. never contain thrombi whereas a true aneurysm always contain a layered thrombus C. is always larger in overall size than a true aneurysm - CORRECT ANSWER>>A. has a smaller, more narrow neck than a true aneurysm Which type of cardiomyopathy is associated with amyloidosis? a. congestive b. restrictive c. hypertrophic d. infiltrative - CORRECT ANSWER>>d. infiltrative In a patient with carcinoid heart disease, the cardiac sonographer must devote special attention to identifying abnormalilties of the: a. aortic arch b. aortic valve c. mitral valve d. tricuspid valve - CORRECT ANSWER>>d. tricuspid Which two-dimensional echocardiographic view is best for identifying the malformed tricuspid valve apparatus that characterizes Ebstein's anomaly: a. apical two chamber b. apical four chamber c. parasternal long axis d. parasternal short axis - CORRECT ANSWER>>b. apical four chamber Infundibular pulmonary stenosis is uncommon as an isolated lesion and is usually associated with: a. tricuspid atresia b. atrial septal defect c. coarctation of the aorta d. ventricular septal defect - CORRECT ANSWER>>d. Ventricular septal defect
Doppler measures a pressure drop (gradient) by the Bernoulli equation. This equation actually measures the ___gradient across the valve. a. mean b. peak to peak c. peak instantaneous d. pressure half-time - CORRECT ANSWER>>c. peak instantaneous When a patient has a clinical diagnosis of pericarditis: a. a pericardal effusion is always present on echo b. a pericardial effusion may not be present on echo c. pericardial thickening is always present on echo d. pericardial thickening must not be present on echo - CORRECT ANSWER>>B. a pericardial effusion may not be present on echo In normal patients, most ventricular filling occurs: a. with atrial contraction b. in the first third of diastole c. in the middle third of diastole d. during the PR interval of the ECG - CORRECT ANSWER>>b. in the first third of diastole The patient you are examining has clear cut auscultatory and angiographic evidence for mital prolapse, yet the resting echocardiogram is normal. You should then: a. raise the patient's leg b. perform a cold pressor test c. echo the patient in the standing position d. have the patient hold his breathe in deep inspiration - CORRECT ANSWER>>c. echo the patient in the standing position Tricuspid valve closure normally occurs: a. before mitral closure b. simultaneous with mitral closure c. less than 0.06 seconds after mitral closure d. more than 0.06 seconds after mitral closure - CORRECT ANSWER>>c. less than 0.06 seconds after mitral closure Kawasaki's disease may lead to: a. aortic valve prolapse b. tricuspid regurgitation
c. coronary artery aneurysm d. ruptured chordae tendineae - CORRECT ANSWER>>c. coronary artery aneurysm Which echocardiographic techinique is best for the detection of mitral regurg? a. M-mode b. pulsed Doppler c. two-dimensional d. apexcardiogram - CORRECT ANSWER>>b. pulsed Doppler A two-dimensional echocardiogram shows increased thickness of the ventricular walls but normal LV size. The myocardium has a speckled appearance. Which type of cardiomyopathy might this represent? a. ischemic b. congestive c. infiltrative d. hypertrophic obstructive - CORRECT ANSWER>>c. infiltrative Atrial myxomas are usually attached to the: a. left atrial appendage b. mitral valve leaflets c. posterior left atrial free wall d. fossa ovalis region of the atrial septum - CORRECT ANSWER>>d. fossa ovalis region of the atrial septum Which 2-D views are best for direct imaging of the discrete subaortic membrane? a. parasternal long and short axis views b. apical five chamber and apical long axis views c. subcostal long axis and apical four chamber views d. parasternal long axis and apical two chamber views - CORRECT ANSWER>>b. apical five chamber and apical long axis views The 2-D echocardiogram of a teenage boy shows that the mid-portion of the atrial septum cannot be seen. Which type of congenital heart disease might this patient have? a. supra-mitral ring b. cor triatrium c. ostium primum ASD d. ostium secundum ASD - CORRECT ANSWER>>d. ostium secundum ASD
Doppler ultrasound may show retrograde flow velocites within the ascending aorta during diastole in the presence of: a. aortic regurg b. patient ductus arterosis c. aorticpulmonary window d. aorticsubclavian shunts - CORRECT ANSWER>>a. aortic regurg A patient with a recent myocardial infarction is dianosised with Dressler's syndrome. Special care in performing a 2-D study should be followed to rule out: a. RV infarction b. left atrial thrombi c. pericardial effusion d. aortic root dissection - CORRECT ANSWER>>c. pericardial effusion In a patient with mitral stenosis, a continuous wave Doppler study shows a peak diastole velocity of 2m/s. What is the peak pressure gradient across the mitral valve? a. 8 mm Hg b. 16 mm Hg c. 32 mm Hg d. 90 mm Hg - CORRECT ANSWER>>b. 16 mm Hg In patients with tricuspid atresia, blood flow will shunt from the right atrium to the left atrium through a: a. ostium primum defect b. patent foramen ovale c. coronary sinus defect d. patent ductus arteriosus - CORRECT ANSWER>>b. patent foramen ovale A 22 year old patient with Down Syndrome is referred to the echo lab. The most common lesion associated with these patients is: a. tetralogy of Fallot b. bicuspid aortic valve c. AV septal defect d. transposition of the great arteries - CORRECT ANSWER>>c. AV septal defect What is the standard echo view for contrast study for an ASD? a. RVIT view b. RVOT view c. subcostal four chamber view d. apical four chamber view - CORRECT ANSWER>>d. apical four chamber view
When obtaining a continuous wave Doppler aortic profile from the apex through a heavily calcified aortic valve you may: a. overestimate the velocity b. underestimate the velocity c. confuse the jet with mitral inflow d. confuse the jet with pulmonic stenosis - CORRECT ANSWER>>b. underestimate the velocity The Doppler jet of mitral stenosis obtained at the apex is sometimes confused with: a. aortic insufficiency b. mitral insufficiency c. pulmonic insuff d. tricuspid insuff - CORRECT ANSWER>>a. aortic insuff When Starr-Edwards prosthetic valves are located in both the mitral and aortic positions, mitral regurgitation is best detected from which window? a. apical b. subcostal c. suprasternal d. left parasternal - CORRECT ANSWER>>b. subcostal For patients with aortic stenosis and atrial fib, peak systolic aortic velocity will be: a. unaffected by R-R intervals b. lower following long R-R intervals c. higher following long R-R intervals d. higher following short R-R intervals - CORRECT ANSWER>>c. higher following long R-R intervals Aliasing on color flow Doppler is shown by a: a. mosaic of colors b. display of green c. reversal in color d. reversal in intensity - CORRECT ANSWER>>c. reversal in color Premature mitral valve closure on M-mode is a sign of high left ventricular diastolic pressure in: a. aortic stenosis b. aortic insuff c. mitral insuff
d. mitral ring calcification - CORRECT ANSWER>>d. mitral ring calcification On M-mode, a flail mitral valve may have a similar appearance to: a. a cleft mitral valve b. a stenotic mitral valve c. an infected mitral valve d. a parachute mitral valve - CORRECT ANSWER>>c. infected mitral valve One of the most common complicatations of a myocardial infarction is: a. aneurysm formation b. aortic insuff c. LV outflow obstruction d. calcification of the mitral ring - CORRECT ANSWER>>a. aneurysm formation In patients with large pericardial effusions the motion of the pericardium may be: a. damped b. increased c. unchanged d. paradoxical - CORRECT ANSWER>>a. damped Echocardiographically, patients with congestive cardiomyopathy have left ventricles which are: a. thick and hyperdynamic b. dilated and poorly contracting c. increased shortening fraction and hypertrophy d. hypertrophied with normal chamber size and motion - CORRECT ANSWER>>b. dilated and poorly contracting On a two-dimensional echocardiogram, a cleft mitral valve may be confused with an anatomic: a. bicuspid valve b. tricuspid valve c. floppy mitral valve d. parachute mitral valve - CORRECT ANSWER>>b. tricuspid valve In which view is the ultrasound beam most perpendicular to the interatrial septum? a. apical 4 chamber
b. apical long axis c. subcostal 4 chamber d. parasternal short axis - CORRECT ANSWER>>c. subcostal 4 chamber To determine peak aortic velocity in patients with aortic stenosis, the Doppler utilized should be: a. pulsed b. mechanical c. cross sectional d. continuous wave - CORRECT ANSWER>>d. continuous wave In patients with ventricular septal defects and left to right shunting the___maybe dilated. a. left atrium b. right atrium c. left ventricle d. pulmonary veins - CORRECT ANSWER>>a. left atrium Secondary findings in mitral stenosis can be: a. left ventricular hypertrophy and dilation b. left ventricular and atrial dilation c. right atrial enlargement and mitral regurg d. left atrial enlargement and signs of pulmonary hypertension - CORRECT ANSWER>>d. left atrial enlargement and signs of pulmonary hypertension Patients with long standing aortic stenosis will usually have: a. LVH b. LV dilation c. diastolic aortic flutter d. mitral ring calcification - CORRECT ANSWER>>a. LVH One advantage to using the parasternal long axis view to diagnose mitral valve prolapse is: a. there is less motion of the mitral annulus b. false prolapse caused by caused by the annulus shape is avodied c. the ultrasonic beam is perpendicular to the leaflets in systole d. the relative position of the mitral and tricuspid valves is better visulized - CORRECT ANSWER>>b. false prolapse caused by the annulus shape is avoided
Which technique would best allow you to assess the severity of aortic regurgitation? a. pulsed wave Doppler b. coninuous wave Doppler c. M-mode echocardiography d. two-dimensional echocardiography - CORRECT ANSWER>>a. pulsed wave Doppler Which of the following valves is most often affected in patients with rheumatic heart disease? a. aortic b. mitral c. pulmonic d. tricuspid - CORRECT ANSWER>>b. mitral "Electrical alternans" is seen on a patient's EKG. The echocardiogram will most likely show: a. aortic stenosis b. mitral valve prolapse c. ventricular septal defect d. large pericardial effusion - CORRECT ANSWER>>d. large pericardial effusion A common cause for right ventricular volume overload is: a. patent ductus b. pulmonic stenosis c. tetralogy of Fallot d. tricuspid regurgitation - CORRECT ANSWER>>d. tricuspid regurgitation Premature closure of the mitral valve can be seen in patients with: a. aortic insuff b. cleft mitral leaflet c. constrictive pericarditis d. left ventricular hypertrophy - CORRECT ANSWER>>a. aortic insuff On EKG, ventricular repolarization is represented by the: a. P wave b. T wave c. R wave d. QRS complex - CORRECT ANSWER>>b. T wave
The most common cause of mitral regurgitation in elderly patients is: a. atrial fib b. rheumatic heart disease c. calcified mitral annulus d. papillary muscle dysfunction - CORRECT ANSWER>>c. calcified mitral annulus A patent ductus arteriosus (PDA) has what type of murmur? a. systolic b. diastolic c. blowing d. continuous - CORRECT ANSWER>>d. continuous A patient is sent to the echo lab with the diagnosis of constrictive pericarditis. You perform a contrast study to look for: a. atrial level shunt b. persistant left superior vena cava c. systolic appearance of contrast in the IVC d. presystolic appearance of contrast in the IVC - CORRECT ANSWER>>d. presystolic appearance of contrast in the IVC Hemodynamically moderate aortic insuff will result in: a. pulmonic regurgitation b. increased cardiac output c. right ventricular hypertrophy d. left ventricular volume overload - CORRECT ANSWER>>d. left ventricular overload A patient with a systolic murmur and a fixed split S2 may have which of the following? a. tricuspid stenosis b. subaortic stenosis c. atrial septal defect d. transposition of the great arteries - CORRECT ANSWER>>c. atrial septal defect The pressure obtained by a pulmonary artery wedge measurement equals the pressure in the: a. aorta b. left atrium c. right ventricle
Which valve lesion is most commonly associated with left bundle branch block? a. Ebstein's anomaly b. mitral valve prolapse c. calcified aortic stenosis d. calcified mitral stenosis - CORRECT ANSWER>>c. calcified aortic stenosis Where is the lowest blood oxygen saturation usually found? a. coronary sinus b. pulmonary artery c. inferior vena cava d. superior vena cava - CORRECT ANSWER>>a. coronary sinus An advantage of continuous wave Doppler over pulsed Doppler is: a. range resolution b. low nyquist limit c. peak velocity detection d. aliasing can be detected - CORRECT ANSWER>>c. peak velocity detection Which window is best for evaluating the ball excursion of a Starr-Edward's mitral valve using M-mode technique? a. apical b. subcostal c. parasternal d. suprasternal - CORRECT ANSWER>>a. apical The anterior and apical wall of the left ventricle is supplied by which coronary artery? a. LAD b. left circumflex c. right coronary artery d. acute marginal - CORRECT ANSWER>>a. LAD The QRS of the electrocardiogram reflects which of the following? a. atrial depolarization b. atrial repolarization c. ventricular depolarization d. ventricular repolarization - CORRECT ANSWER>>c. ventricular depolarization
Which of the following auscultatory sounds is most suggestive of a bicuspid aortic valve? a. S b. opening snap c. mid-systolic click d. systolic ejection click - CORRECT ANSWER>>d. systolic ejection click High frequency systolic vibrations of the aortic valve on M-mode are most consistent with: a. mitral insuff b. low cardiac output c. aortic valve stenosis d. normal finding - CORRECT ANSWER>>d. normal finding IHSS may be suspected if the ratio of IVS thickness to LV posterior wall thickness is: a. 1.1 to 1 b. 5 to 1 c. 1.3 to 1 d d. 3 to 1 - CORRECT ANSWER>>c. 1.3 to 1 An M-mode sweep from LV to aorta is used in patients suspected with pericardial effusion to: a. rule out tamponade b. rule out Dressler's syndrome c. differentitate pericardial from pleural effusion d. differentiate restictive from constictive pericarditis - CORRECT ANSWER>>C. differentiate pericardial from pleural effusion In patients with larger pericardial effusions, which of the following can be a false postitive diagnosis on M-mode? a. aortic dissection b. MVP c. papillary muscle dysfunction d. Ebstein's anomaly - CORRECT ANSWER>>b. MVP When measuring mitral orifice size in a patient with mitral stenosis, care must be taken to: a. use high gain for maximum visualization of the leaflets b. measure the opening as close to the left atrium as possible. c. measure the opening at the leaflet tips
