Download PrepIQ BSE STRESS BSE Stress Echo Ultimate Exam and more Exams Technology in PDF only on Docsity!
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Question 1. Which component of the ischemic cascade is the earliest detectable change during myocardial ischemia? A) Decrease in systolic wall thickening B) Rise in intracellular calcium C) Reduction in ATP production D) Elevation of ST-segment on ECG Answer: C Explanation: The first metabolic alteration in ischemia is impaired oxidative phosphorylation, leading to a rapid fall in ATP levels before mechanical or electrical changes become apparent. Question 2. In the Bruce treadmill protocol, the target heart rate is usually set at what percentage of the age-predicted maximal heart rate? A) 60 % B) 70 % C) 85 % D) 95 % Answer: C Explanation: For diagnostic stress echo, a target of 85 % of the age-predicted maximum (220-age) is standard to ensure adequate stress. Question 3. Dobutamine stress echocardiography primarily increases myocardial oxygen demand by: A) Direct coronary vasodilation B) β1-adrenergic stimulation increasing heart rate and contractility C) α-adrenergic mediated afterload reduction D) Enhancing diastolic filling time Answer: B Explanation: Dobutamine is a β1-agonist that raises heart rate and contractility, thereby increasing myocardial oxygen consumption. Question 4. Which of the following is an absolute contraindication to pharmacologic stress echo? A) Controlled hypertension (BP 150/90 mmHg)
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B) Recent (<2 days) myocardial infarction C) Stable angina with low-dose aspirin D) Mild chronic obstructive pulmonary disease Answer: B Explanation: Recent MI within 48 hours poses a high risk of arrhythmia and hemodynamic instability, making it an absolute contraindication. Question 5. The “low-flow, low-gradient” aortic stenosis scenario is best evaluated with which stress modality? A) Exercise stress echo B) Dobutamine stress echo C) Adenosine stress echo D) Pacing stress echo Answer: B Explanation: Dobutamine stress helps differentiate true severe AS from pseudo-severe disease by augmenting flow and assessing gradient changes. Question 6. Which segment is NOT part of the standard 17-segment left-ventricular model used for wall-motion scoring? A) Basal inferior B) Mid-septal C) Apical lateral D) Mid-right ventricular free wall Answer: D Explanation: The 17-segment model includes only LV segments; the RV free wall is excluded. Question 7. A Wall Motion Score Index (WMSI) of 1.20 indicates: A) Normal global LV function B) Mild global hypokinesis C) Moderate global akinesis D) Severe global dyskinesis Answer: B
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A) Simultaneous review of ECG, blood pressure, and images B) Real-time comparison of rest and peak images side-by-side C) Automatic calculation of ejection fraction D) Reducing radiation exposure Answer: B Explanation: Quad-screen shows four synchronized windows (rest, low-stress, peak, recovery) facilitating direct visual comparison. Question 12. The optimal mechanical index (MI) setting for contrast-enhanced stress echo is: A) >0. B) 0.5–0. C) <0. D) 1.0–1. Answer: C Explanation: Low MI (<0.3) minimizes microbubble destruction while preserving contrast signal. Question 13. Which ECG change is considered a termination criterion during exercise stress echo? A) ST-segment depression ≥ 1 mm in two contiguous leads B) ST-segment elevation ≥0.5 mm in aVR C) T-wave inversion in V1-V2 only D) Presence of occasional premature ventricular beats Answer: A Explanation: Significant horizontal or down-sloping ST-depression in ≥2 leads signals ischemia and mandates test termination. Question 14. A patient develops severe nausea during dobutamine infusion. The most appropriate immediate action is: A) Increase the infusion rate to finish the protocol quickly B) Administer intravenous metoclopramide and continue C) Reduce the dose or stop infusion and treat symptomatically
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D) Switch to adenosine without stopping dobutamine Answer: C Explanation: Nausea can herald intolerance; the infusion should be reduced or stopped, and anti-emetics given if needed. Question 15. In the context of stress echo, “hibernating myocardium” is best identified by: A) Persistent akinesis at rest that improves with low-dose dobutamine B) Immediate hyperkinesis during peak stress C) Fixed scar on late gadolinium MRI only D) Normal wall motion at rest with new dyskinesis at peak stress Answer: A Explanation: Hibernating myocardium shows contractile reserve, improving with low-dose inotropic stimulation. Question 16. Which of the following is NOT a standard view for stress echo acquisition? A) Parasternal long axis (PLAX) B) Parasternal short axis at the level of papillary muscles C) Apical five-chamber D) Subcostal four-chamber Answer: D Explanation: Subcostal view is rarely used for wall-motion analysis in stress echo; the four standard views are PLAX, PSAX, Apical 4-chamber, and Apical 2 - chamber. Question 17. The primary purpose of using a semi-supine bicycle for stress echo is to: A) Allow simultaneous acquisition of high-quality images during exercise B) Reduce the risk of orthostatic hypotension compared to treadmill C) Provide a lower workload for elderly patients D) Eliminate the need for ECG monitoring Answer: A
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Question 21. Which of the following statements about the “low-dose” dobutamine protocol is correct? A) It starts at 10 μg/kg/min and increases to 20 μg/kg/min only B) It is designed to assess myocardial viability rather than ischemia C) It is contraindicated in patients with left bundle branch block D) It does not require continuous ECG monitoring Answer: B Explanation: Low-dose dobutamine (5- 10 μg/kg/min) is used to detect contractile reserve and viability. Question 22. The most common cause of inadequate endocardial border definition requiring contrast during stress echo is: A) Obesity (BMI > 35) B) Left-bundle branch block C) Prior myocardial infarction D) Hyperthyroidism Answer: A Explanation: Excess soft tissue attenuates ultrasound, frequently necessitating contrast in obese patients. Question 23. Which of the following is a sign of severe aortic stenosis that makes stress echo unsafe? A) Mean gradient 30 mmHg at rest B) Asymptomatic status with normal LV function C) Symptomatic severe AS (e.g., syncope) D) Bicuspid aortic valve without stenosis Answer: C Explanation: Symptomatic severe AS is an absolute contraindication to stress testing due to risk of hemodynamic collapse. Question 24. During diastolic stress echo, an increase in E/e′ ratio with exercise most strongly suggests: A) Improved LV relaxation B) Elevated left-atrial pressure and diastolic dysfunction
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C) Decreased preload D) Right-ventricular overload Answer: B Explanation: E/e′ rises with higher left-atrial pressures, indicating exercise-induced diastolic dysfunction. Question 25. The “target heart rate” for a 60-year-old patient undergoing exercise stress echo is closest to: A) 110 bpm B) 130 bpm C) 150 bpm D) 170 bpm Answer: B Explanation: Age-predicted max = 220- 60 = 160 bpm; 85 % of 160 ≈ 136 bpm, rounded to 130 bpm. Question 26. Which of the following is NOT a typical side effect of adenosine infusion? A) Transient AV block B) Bronchospasm in asthmatics C) Persistent hypertension D) Flushing and chest discomfort Answer: C Explanation: Adenosine commonly causes hypotension, not sustained hypertension. Question 27. In the context of stress echo, “wall-motion abnormality” is defined as: A) Any deviation from the normal 1-point score in the segmental model B) Only dyskinesis (score 4) C) Presence of any new or worsening hypokinesis, akinesis, or dyskinesis during stress D) Global reduction in ejection fraction without segmental changes Answer: C
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Question 31. In a stress echo lab, the “ALS” equipment requirement includes all EXCEPT: A) Defibrillator with pads B) Bag-valve-mask ventilation device C) Intravenous epinephrine ampoules D) Automated blood-pressure cuff only Answer: D Explanation: While BP monitoring is essential, an automated cuff alone does not constitute Advanced Life Support equipment. Question 32. The principal advantage of using a semi-supine bicycle over a treadmill for stress echo is: A) Higher maximal workload achievable B) Ability to acquire images at each stage without patient relocation C) Reduced need for ECG leads D) Lower incidence of hypertension during test Answer: B Explanation: The semi-supine position permits continuous imaging while the patient exercises. Question 33. Which of the following best describes a “biphasic response” on dobutamine stress echo? A) Progressive worsening of wall motion with increasing dose B) Initial improvement in contractility followed by deterioration at higher doses C) No change in wall motion throughout the protocol D) Immediate dyskinesis at the lowest dose Answer: B Explanation: Viable myocardium may first improve (low dose) then show ischemia (high dose), creating a biphasic pattern. Question 34. In the evaluation of hypertrophic cardiomyopathy (HCM) with stress echo, the most relevant finding is: A) Increase in LV outflow tract gradient with exercise B) Decrease in septal thickness during stress
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C) Development of new regional wall-motion abnormalities D) Reduction in mitral regurgitation severity Answer: A Explanation: Exercise-induced rise in LVOT gradient is a hallmark of obstructive HCM. Question 35. Which of the following is a contraindication to transesophageal pacing stress? A) Permanent atrial fibrillation B) Prior esophageal surgery or strictures C) Controlled hypertension D) Mild chronic obstructive pulmonary disease Answer: B Explanation: Esophageal pathology raises risk of injury during transesophageal pacing. Question 36. During a stress echo, the “peak-stress” image acquisition window should be centered on: A) The point of maximal heart rate regardless of image quality B) The moment when the patient feels the most dyspnea C) The frame where end-systolic volume is smallest D) The first beat after reaching target heart rate with acceptable image quality Answer: D Explanation: Images are captured at the first suitable beat after target HR is achieved to ensure diagnostic quality. Question 37. Which of the following is the most reliable quantitative measure of ischemia on stress echo? A) Change in ejection fraction ≥5 % B) Increase in end-systolic volume ≥10 % C) New wall-motion abnormality in ≥2 contiguous segments D) Reduction in mitral annular velocity (s′) Answer: C
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Question 41. The primary reason to use a low-mechanical-index (MI) setting when imaging with contrast agents is to: A) Increase frame rate for tachycardia B) Prevent microbubble destruction, preserving signal intensity C) Reduce patient discomfort from acoustic power D) Enhance color Doppler sensitivity Answer: B Explanation: Low MI preserves microbubble integrity, allowing continuous contrast visualization. Question 42. Which of the following best characterizes the “wall-motion score index” (WMSI) in a normal heart? A) 0. B) 1. C) 1. D) 2. Answer: B Explanation: All 16-17 segments scored as normal (1) give WMSI = 1.0, indicating normal function. Question 43. In the context of stress echo, “pre-test probability” refers to: A) The likelihood of a technical failure before the test starts B) The estimated chance of coronary artery disease based on clinical data before imaging C) The probability that the patient will reach target heart rate D) The chance of developing an adverse event during the test Answer: B Explanation: Pre-test probability integrates symptoms, risk factors, and baseline ECG to estimate CAD likelihood. Question 44. Which of the following is a common indication for stress echo in pre-operative assessment? A) Low-risk cataract surgery B) Intermediate-risk non-cardiac surgery requiring risk stratification
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C) Routine dental extraction D) Minor dermatologic procedures Answer: B Explanation: Stress echo helps evaluate cardiac risk before intermediate- or high-risk non-cardiac surgery. Question 45. During a stress echo, a patient’s blood pressure falls from 130/80 mmHg to 80/50 mmHg. The appropriate action is: A) Continue the test until target heart rate is achieved B) Administer intravenous phenylephrine and continue C) Immediately terminate the test and initiate resuscitation measures if needed D) Increase the dobutamine infusion rate Answer: C Explanation: Significant hypotension is a termination criterion; immediate cessation and treatment are required. Question 46. Which of the following statements about “contrast-enhanced” stress echo is TRUE? A) It eliminates the need for ECG monitoring B) It improves endocardial definition, allowing accurate wall-motion assessment in difficult windows C) It is contraindicated in patients with hypertension D) It reduces the duration of the stress protocol by half Answer: B Explanation: Contrast agents enhance endocardial border visualization, especially when native images are suboptimal. Question 47. In patients with severe chronic obstructive pulmonary disease (COPD), which stress modality is least likely to provoke bronchospasm? A) Dobutamine B) Adenosine C) Dipyridamole D) Exercise treadmill Answer: A
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Question 51. Which of the following is the most appropriate target for heart rate increase when using dobutamine stress echo in a 55-year-old patient? A) 100 bpm B) 115 bpm C) 140 bpm D) 165 bpm Answer: C Explanation: Target HR = 85 % of (220-55) ≈ 140 bpm. Question 52. In a patient with a pacemaker, the preferred stress echo protocol is: A) Exercise treadmill with pacemaker turned off B) Dobutamine infusion while maintaining paced rhythm C) Adenosine infusion with temporary pacing backup D) Pacing stress using the device’s rate-responsive mode Answer: B Explanation: Dobutamine can be administered safely while the pacemaker maintains adequate rate. Question 53. Which of the following best defines “viability” in the context of stress echo? A) Presence of any wall-motion abnormality at rest B) Ability of a myocardial segment to improve contractility with low-dose inotropic stimulation C) Permanent scar detected by late gadolinium enhancement D) Normal resting ejection fraction Answer: B Explanation: Viability implies contractile reserve, demonstrated by improvement with low-dose dobutamine. Question 54. A 68-year-old woman with a known left-main stenosis undergoes stress echo. Which of the following is the most appropriate action? A) Proceed with standard dobutamine protocol B) Cancel the test because left-main disease is a relative contraindication
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C) Perform low-dose dipyridamole stress only D) Use treadmill exercise with close monitoring Answer: B Explanation: Significant left-main disease carries high risk; stress testing is generally avoided unless absolutely needed. Question 55. The “quad-screen” display typically shows which four windows in sequence? A) Rest, low-dose, peak, recovery B) Basal, mid-ventricular, apical, subcostal C) Long-axis, short-axis, apical 4-chamber, apical 2-chamber D) ECG, blood pressure, SpO₂, image Answer: A Explanation: Quad-screen synchronizes the four stress stages for direct visual comparison. Question 56. Which of the following is the most common reason for terminating a dobutamine stress echo before reaching target heart rate? A) Development of a new murmur B) Persistent premature ventricular contractions (PVCs) >5/min C) Patient’s request to stop due to fatigue D) Appearance of a new wall-motion abnormality Answer: D Explanation: New or worsening wall-motion abnormality is a primary termination criterion indicating ischemia. Question 57. In stress echo, “peak-stress” images are typically captured at which point in the cardiac cycle? A) End-diastole B) Mid-systole C) End-systole (minimum LV volume) D) At the onset of the QRS complex Answer: C
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Question 61. In a patient with known severe mitral regurgitation, which stress echo finding predicts symptomatic deterioration? A) Decrease in E-wave velocity during exercise B) Increase in pulmonary artery systolic pressure >50 mmHg with exercise C) Reduction in LV end-diastolic volume during stress D) Improvement in mitral valve area Answer: B Explanation: Exercise-induced rise in pulmonary pressures reflects worsening MR and predicts symptoms. Question 62. Which of the following is the most appropriate approach when a patient experiences ventricular tachycardia during dobutamine infusion? A) Increase the infusion rate to finish the protocol quickly B) Administer intravenous lidocaine and continue the test C) Immediately stop the infusion and initiate ACLS protocol D) Switch to adenosine infusion Answer: C Explanation: VT is a serious arrhythmia; the infusion must be stopped and advanced cardiac life support initiated. Question 63. The “low-dose” dipyridamole protocol is primarily used to assess: A) Coronary flow reserve in microvascular disease B) Myocardial viability C) Exercise capacity in COPD patients D) Right-ventricular function Answer: A Explanation: Low-dose dipyridamole evaluates coronary vasodilatory reserve, useful in microvascular assessment. Question 64. Which of the following best describes the “semi-supine” bicycle position? A) Patient lies fully supine with legs extended B) Patient sits upright at 90° angle
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C) Patient is reclined at ~30–45° with legs pedaling D) Patient stands on a treadmill while pedaling a stationary bike Answer: C Explanation: Semi-supine positioning reclines the torso while allowing leg movement for exercise. Question 65. In stress echo interpretation, the term “fixed” wall-motion abnormality refers to: A) A segment that improves with stress B) A segment that remains abnormal at rest and stress, indicating scar C) A segment that shows alternating patterns during the test D) A segment that is normal at rest but abnormal during stress Answer: B Explanation: Fixed abnormalities do not change with stress, suggesting irreversible damage. Question 66. Which of the following is the most appropriate method to assess left-ventricular outflow tract (LVOT) gradient during stress echo in hypertrophic cardiomyopathy? A) Continuous-wave Doppler across the LVOT at peak stress B) M-mode measurement of septal thickness only C) Color Doppler mapping of mitral regurgitation jet D) Tissue Doppler imaging of the lateral wall Answer: A Explanation: Continuous-wave Doppler directly measures the instantaneous LVOT gradient, essential in HCM. Question 67. A 62-year-old man with atrial fibrillation undergoes stress echo. Which parameter is most reliable for assessing contractile reserve? A) Change in ejection fraction from rest to peak stress B) Wall-motion score index (WMSI) improvement C) Heart rate variability D) A-wave velocity on pulsed Doppler
