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PTE Masters + A Practical Approach to Transesophageal Echocardiography > High Yield PTEexam Review part 24 - 26 > Flashcards

High Yield PTEexam Review part 24 - 26 Flashcards

1
Q

What is the diagnosis here?

A

Hypoplastic Left Heart

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2
Q

What is 1

A

1 = LV

Dx: Hypoplastic Left Heart

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3
Q

Label 2

A

Hypoplastic Left Heart

2 RA

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4
Q

Label 3

A

Hypoplastic Left Heart

3 RV

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5
Q

Label 4

A

Hypoplastic Left Heart

4 Sono Shunt

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6
Q

Label 5

A

Hypoplastic Left Heart

5 Pulmonic Valve (Neo aortic valve)

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7
Q

What are the two first stage operations that can be performed for hypoplastic left heart?

A
  1. BT Shunt
  2. Sano
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8
Q

For hypoplastic left heart syndrome, the patient will either get a Sano or a BT shunt.

What is the next procedure for the child?

A

Bidirectional Glenn

Connects the SVC to the RPA (All pulmonary blood flow both Right lung and left lung would come from SVC)

  • IVC drains normally into the RA
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9
Q

What are the advantages and disadvantages of a Sano procedure for Hypoplastic Left Heart Syndrome (Vs. BT shunt)?

A

Sano

  • Comes off RV (RV to PA conduit)
  • Doesn’t Lower Aortic Diastolic Pressure
  • Disadvantage of BT = Lowers Aorto Diastolic BP (Diastolic runoff to the lungs) and flow from Aorta to the Lungs, Lowers Diastolic perfusion pressure of all your organs (Coronary arteries)

You don’t have that problem with Sano

Disadvantage of Sono = Make a ventriculotomy in the RV (single RV) which is their only ventricle. This hole will increase is size as kid grows (RV aneurysm can happen)

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10
Q

What are the advantages and disadvantages of a BT shunt for Hypoplastic Left Heart Syndrome (Vs. Sano)?

A

BT shunt

Advantage: No ventriculotomy (Unlike the sono)

  • Disadvantage = Lowers Aorto Diastolic BP (Diastolic runoff to the lungs) and flow from Aorta to the Lungs, Lowers Diastolic perfusion pressure of all your organs (Coronary arteries)
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11
Q

For hypoplastic left heart syndrome, the patient will either get a Sano or a BT shunt. This is followed by a Bidirectional Glenn. What is the final procedure?

A

Fontan (Connect the IVC to the Right PA)

(See “e” in the photo)

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12
Q

What echocardiographic aspects do you want to assess before performing Fontan Procedure?

A
  1. BT shunt patent
  2. ASD is wide open (IAS resected)
  3. Competent Tricuspid Valve
  4. Competent Pulmonic (Neo-aortic Valve)
  5. Adequate RV function
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13
Q

What determines the SAO2 in a patient with Hypoplastic Left heart?

3 things

A
  1. Deoxygenated blood in single ventricle (Mixed Venous Sat)
  2. Oxygenated blood from pulmonary veins i.e. Pulmonary venous sat (Left to right shunt through IAS)
  3. % of Each (Qp/Qs) (PVR / SVR)
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14
Q

What is the function of the reject function of ultrasound?

A

Eliminates very low level (Amplitude) signals decreasing noise on the 2D image

  • When we have very low amplitude signals on 2D grayscale display can be associated with meaningful diagnostic information or meaningless noise

Reject function allows echocardiographer to determine if low amplitude info is displayed or rejected

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15
Q

What are the 5 functions of the ultrasound receiver?

A
  1. Amplification
  2. Compensation
  3. Compression
  4. Demodulation
  5. Rejection (Reject = Threshold = Suppression)
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16
Q

Label 1

A

left atrial appendage

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17
Q

Label 2

A

Right Coronary Cusp

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18
Q

Label 3

A

Left Coronary Cusp

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19
Q

Label 4

A

Flail P2 scallop of Mitral valve

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20
Q

Which parameter is determine by ultrasound source and medium through which sound travels?

A. Period

B. Wavelength

C. Frequency

D. Amplitude

E. Power

F. Velocity

G. Intensity

A

B = Wavelength

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21
Q

Which parameter is determine by ultrasound source ONLY through which sound travels?

A. Period

B. Wavelength

C. Frequency

D. Amplitude

E. Power

F. Velocity

G. Intensity

A

A and C

Period and Frequency

Deals with seconds, so the sound source only

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22
Q

Which parameter is determine by medium ONLY through which sound travels?

A. Period

B. Wavelength

C. Frequency

D. Amplitude

E. Power

F. Velocity

G. Intensity

A

Velocity = medium only

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23
Q

What are the three parameters of strength of the ultrasound?

What determines strength (Source, Medium, or both)?

A
  1. Amplitude
  2. Power
  3. Intensity

All determined by sound source

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24
Q

How does stiffness affect velocity of sound?

A

Directly proportional

Increase stiffness = Increase in velocity

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25
Q

How does density affect velocity of sound?

A

Inversely proportional

Density increases = Velocity decreases

26
Q

What is the speed of ultrasound through (Rank fastest to slowest)
Air

Bone

Fat

Lung

Soft Tissue

A

Bone (Fastest speed)

Soft tissue

Fat

Lung

Air (Slowest)

27
Q

Does the high pass wall filter utilized for Doppler ultrasound eliminate:

Low frequency signals* or *low amplitude signals?

A

Low frequency signals (Small doppler shift signals)

28
Q

Answer the question

A

B = Mitral E/A and e’ decrease as age increases

Age results in progressive decrease in active LV relaxation

29
Q

What are the 4 variables are recommended for evaluation of diastolic function using TTE?

A
  1. Mitral annular e’ peak velocity
  2. E/e’
  3. LA max volume index
  4. TR Peak Velocity
30
Q

What is the view?

A

UE Aortic Arch Short Axis

31
Q

Label 1, 2, 3

A

UE AA SAX

1 Aorta

2 Innominate Vein

3 Pulmonary Valve

32
Q

Why does bone have the highest velocity of ultrasound?

A

Bone is very stiff and stiffness is directly related to velocity

33
Q

Answer question below

A

TOF repair

Torrential PR and RV showing Volume Overaload

34
Q

How is a tetrology of Fallot repair performed?

A
  1. Close the VSD
  2. Transannular patch on the pulmonic valve creates torrential Pulmonary insufficiency
  3. Severe PI creates RV volume overload
35
Q

What does the neck of an aneurysm of the LV look like?

A

Wide

36
Q

What does the neck of an pseudoaneurysm of the LV look like?

A

Narrow

37
Q

What does the neck / A diameter of an aneurysm of the LV look like?

A

>0.5

38
Q

What does the neck / A diameter of an pseudoaneurysm of the LV look like?

A

<0.5

39
Q

What does the transitional of normal myocardium to an aneurysm of the LV look like?

A

Gradual

40
Q

What does the transitional of normal myocardium to an pseudoaneurysm of the LV look like?

A

Abrupt

41
Q

What type of Valve is this?

A

Bileaftlet mechanical valve

42
Q

Is this bileaflet mechanical valve stenotic?

What are the lines at 1?

A

No

1 = Valve clicks

43
Q

What does a power doppler do?

What does it NOT detect?

A

Only signifies presence of a doppler shift (No delta F)

No direction and no speed and no velocity

44
Q

What is Power Doppler also known as? (What other mode)

A

Energy Mode

OR

Color Angio

45
Q

What are some advantages of power doppler?

A

Increases sensitivity to low flow

Unaffected by angle unless it is exactly 90 degrees

Unaffected by aliasing since velocity is ignored

46
Q

What are some disadvantages of power doppler?

A

Lower Frame rates than conventional CFD

No measure of velocity or direction

Susceptible to motion of transducer, patient, or soft tissues which may result in a burst of color or flash artifact

47
Q

What pass filter is utilized in TDI?

A

Low pass wall filter ON (Whatever you need to see, you will select THAT wall filter)

High pass wall filter is OFF

48
Q

What 2 clinical phenomenom is Ebsteins Anomaly associated with?

A
  1. Secundum ASD
  2. Wolff-Parkinson-White syndrome (WPW)
49
Q

What tricuspid leaflets are seen in the modified bicaval view?

A

Left = Posterior / Septal

Right = Anterior

50
Q

Label A, B, C

A 
A = IVC
B = Coronary Sinus

C = SVC

51
Q

Rank the order of:
EF, FAC and FS

A

EF > FAC > FS

Volumes (3d) –> Areas 2d –> 1d (Distances)

52
Q

What are the normal values for:

​EF, FAC and FS

A

​EF = >55%

FAC = >36 - 64%

FS = >25%

53
Q

What is the formula for velocity of circumferential shortening? (VcF)

A

VcF = FS / ET

VcF = {[EDD - ESD] / EDD} x ET

54
Q

Label A

A

LLPV

55
Q

Label B

A

LUPV

56
Q

What is the last step when the ultrasound machine receives signals?

A

Rejection = (Alphabetical order)

57
Q

What are the 5 functions of a receiver?

A
  1. Amplification
  2. Compensation
  3. Compression
  4. Demodulation
  5. Rejection
58
Q

Label A

A

Right Lower Pulmonary Vein

59
Q

Label B

A

RUPV

60
Q

When using agitated saline contrast to visualize PFO following release of PPV, bubbles entering the LA within how many cardiac cycles are considered specific for a positive contrast study?

A

3

PTE Masters + A Practical Approach to Transesophageal Echocardiography (54 decks)

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