A & P Flashcards
(109 cards)
1
Q
Normal Anatomy
In a normal left-sided aortic arch, the fist branch should be the:
A
innominate artery or brachiocephalic artery4
2
Q
normal anatomy
A
3
Q
The branches arising from the aortic arch are the:
A
- innominate (brachiocephalic) artery
- left common carotid artery
- left subclavian artery
4
Q
In this PLAX view, the arrow is pointing to the:
A
RCC
*Registered Nurse
5
Q
The weakest point of the aorta is the:
A
Isthmus
*Isthmus is located just after the 3rd branch of the aortic arch (left subclavian) and in the region where the ductus arteriosus entered in the fetus. This area is considered the weakest point of the aorta and is a location sonographers should interrogate closely when evaluating for a dissection.
6
Q
Name the layers of the heart walls in order from inner to outer:
A
endocardium
myocardium
epicardium
7
Q
The atrioventricular node is located in the:
A
inferior portion of RA, near the opening of the coronary sinus and the center of Koch’s triangle.
8
Q
The arrow (gray one) in this image is pointing to the:
A
Left main coronary artery
*the image demonstrates the left coronary artery originating from the left coronary cusp
9
Q
In this image, the arrow is pointing to the:
A
right coronary artery
10
Q
The pulmonary artery branches into the:
A
LPA and RPA
11
Q
The sinoatrial node is located in the:
A
a superior portion of RA
*The sinoatrial node (SAN) is located near the point where the SVC enters the heart. The impulse initiated by the SAN travels to the AV node to the bundle of His (a small band of cardiac muscle cells specialized for electrical conduction) and then to the right bundle branch (RBB) and left bundle branch (LBB) , and purkinje fibers at the terminal end of the cardiac conduction system.
12
Q
The arrow in the following image is pointing to the:
A
RPA
13
Q
What do echocardiographers mean when they use the term basilar area of the ventricle?
A
The basilar area of the heart is at the level near the AV valves
14
Q
The infundibulum is related to the area of the RV called the:
A
outflow tract
*The infundibulum is a funnel-shaped passage leading directly out of the RV
15
Q
In the left-sided aortic arch, what are the three primary branches?
A
innominate artery
left common carotid artery
left subclavian artery
16
Q
The term tunica adventitia refers to the:
A
outer lining of the arterial wall
17
Q
The term tunica intima is defined as the:
A
inner lining of the arterial wall
*The intima is thin and consist of a surface layer of smooth endothelium over a base membrane and connective tissue.
*The media is thicker and composed of smooth muscle and a connective tissue, largely of the elastic type, usually arranged in a circular pattern.
*The adventitia is somewhat thinner than the media and contains white fibrous connective tissue and sometimes a few smooth muscle fibers, all arranged longitudinally; this adventitial layer usually contains the vasa vasorum, tiny vessels that carry blood to and from the walls of the large arteries.
18
Q
The great arteries of the heart are the:
A
aorta and pulmonary artery
19
Q
Changes in the orientation and shape of the interatrial septum are seen as the pressure changes within the atria. Which if the following statement is/are true?
- increased LAP may result in the interatrial septum bowing more toward the RA
- as the LAP increases, the interatrial septum bows more prominently toward the RA
- with chronically increased LAP, the interatrial septum bows toward the LA during diastole and systole
- increased RAP may result in the interatrial septum bowing toward the LA
- 1 & 4
A
5
20
Q
The arrow in this image is pointing to the:
A
coronary sinus
*aligning posterior in the A4C view allows you to demonstrate the coronary sinus. The coronary sinus collects blood from several smaller veins to form one vein and functions as the main vein of the heart. As seen in this image, the coronary sinus is the main cardiac vein that enters into the RA.
21
Q
The arrow in the following image is pointing to the:
A
coronary sinus
*PLAX view showing dilated coronary sinus, raising suspicion for persistent left SVC
22
Q
The coronary sinus returns blood to the:
A
RA
23
Q
The pericardium consists of two layers. Which of the following best describes the visceral layer?
- a thin fibrous structure that is apposed to the pleural surfaces laterally
- a layer that is contiguous with the epicardial surface of the heart
- the muscle layer of the heart
- the inner lining of the cardiac chambers that makes up valve tissue
- the layer apposed to the endothelial lining of the cardiac chambers
A
2
The pericardium consists of 2 layers that surround a potential space adjacent to the heart - the parietal and visceral layers. The parietal layer is attached to the pleural surface and, and the visceral layer is contiguous with the epicardial surface of the heart
*appose - to put before : apply (one thing) to another. 2 : to place in juxtaposition or proximity
*contiguous - sharing a common border; touching
24
Q
The term pericarditis denotes:
A
inflammation of the pericardium
*it is caused by infection, uremia, trauma, and myocardial infection
25
In this PSAX view, the arrow is pointing to the following PV leaflet:
**anterior leaflet**
\*the other leaflet in this view is the right pulmonic leaflet or the posterior pulmonic leaflet
26
The tricuspid valve has:
3 cusps: an anterior, a posterior, and a septal cusp
27
29. The arrow in this image pointing to the:
anterior leaflet
28
30. a 27-year-old male presents for echo. What is demonstrated on the following image?
29
31. Name each point on the anterior mitral valve leaflet cad
30
The mitral valve is composed of all of the following except:
1. chordae tendineae
2. fibrous bands
3. mitral annuli
4. papillary muscle
5. leaflet scallops
2
\*The mitral apparatus is composed of the mitral valve leaflets, chordae tendineae, pap muscle, and mitral annulus.
Fibrous bands can be found in the pericardial space of some patients with pericardial effusion. The mitral valve is **septophobic** and **does not attach to the IVS.**
31
Name each point on the anteriro mitral valve leaflet:
A: **D** - end systole
B: **E** - early opening
C: **F** - mid-diastolic closure
D: **A** - atrial systole
E: **C** - closusre of MV
32
When attempting to identify the morphology of the RV, in the A4C, what would you look for in order to distinguish the TV from the MV?
1. more apical insertion of the septal leaflet of the TV (in relation to the anterior mitral leaflet)
2. more basal insertion of the septal leaflet of the TV (in relation to the anterior mitral leaflet)
3. superior insertion of the septal leaflet of the tricuspid valve in relation to the anterior mitral leaflet
4. The presence of four distinct papullary muscles
5. 1 and 3
1
\*The more apical insertion of the tricuspid septal leaflet relative to the mitral anterior leaflet distinguishes the RV. The **TV is more apical in location compare to the MV.**
33
The most superiror and lateral of the cardiac valve is/are the:
pulmonic valve
34
What is the arrow pointing to this image?
right coronary cusp
35
What is the arrow pointing to?
posterior leaflet of MV
36
What is the arrow pointing to?
anterior leaflet of MV
37
What is the arrow pointing to?
anterior leaflet of MV
38
Wha is the arrow pointing to?
posterior leaflet of MV
39
The great cardiac vein and the small anterior cardiac vein drain the right and left ventricles into which of the following?
RA
40
The arrow is pointing to the:
normal coronary sinus
41
Which view best demonstrate the IVC?
subcostal view
42
In the hepatic vein spectral Doppler waveform, what does the S wave represent?
**systolic annular motion**
\*during systole, the annulus is pulled toward the apex, resulting in forward flow in the hepatic veins.
[https://www.cardioserv.net/hepatic-veins/](https://www.cardioserv.net/hepatic-veins/)
[https://www.cardioserv.net/hepatic\_vein\_right\_heart/](https://www.cardioserv.net/hepatic_vein_right_heart/)
43
In the hepatic vein spectral Doppler waveform, what does the D wave represents?
**early-diastolic inflow**
\*during early diastole, the early inflow is represented as the D wave on the spectral Doppler waveform of the hepatic vein
44
The mid-anterior and mid-anteroseptal segments of the LV are seen in the PSAX view. These segments receive their blood supply from the:
**Left Anterior Descending artery (LAD)**
\*In the PSAX view, the LAD can be seen feeding the mid-cavity, mid-anaterior, and mid-anteroseptal segments. The mid-anteroseptal and mid-inferolateral segments are fed by the CX (left circumflex artery)
45
Which vessel supplies blood flow to both the basal inferolateral and anterolateral segments of the heart?
Left Circumflex artery (CX)
46
Which LV segments are demonstrated in the A4C view?
**anterolateral and inferoseptal**
\*the anterolateral and inferoseptal LV segments are demonstrated in the A4C view
47
Which LV segments are demonstrated in the A2C view?
**anterior and inferior**
48
Which LV segments are demonstrated in the apical long-axis view (A3C)?
anteroseptal and inferolateral
49
Which LV segment is the arrow pointing to in this image?
mid-inferolateral segment
50
Which LV segment is the arrow pointing to in this image?
mid-inferior segment
51
Which LV segment is the arrow pointing to in this image?
basal inferoseptal segment
52
Which LV segment is the arrow pointing to in this image?
mid-anteroseptal segment
53
Which LV segment is the arrow pointing to in this image?
basal anterior
54
Which LV segment is the arrow pointing to in this image?
apical lateral segment
55
Which LV segment is the arrow pointing to in this image?
apical lateral segment
56
During normal stress test, the coronary arteries should dilated to provide more blood to the:
myocardium
57
Reasons for early termination of exercise stress echo include all of the following except:
1. arrhythmia
2. malignant HTN
3. significant angina
4. fatigue
5. extreme CP
4
58
All of the following are key elements in the interpretation of stress echo except:
1. minimum workload
2. duration of exercise
3. symptoms
4. BP response
5. wall segment motion
1
\*stress echo assesses heart function during maximum, not minimum, cardiac workload.
59
Normally in dobutamine stress echo, the CO:
increases
\*CO in liters per minute increases because the HR increases. **CO (L/min) = SV x HR**
Therefore, if the HR increases and SV remains constant, the CO will increase.
60
In which stage of dobutamine infusion does contractility begin to change?
increased contractility begins to occur during low-dose dobutamine infusion
61
A 65-year-old patient with exertional angina is referred for stress echo. During the rest time period there are no WMA present. During acquisition of the postexercise images, a WMA is noted in the mid and apical segments of the anteroseptal wall in the apical long-axis view. This most likely denotes hemodynamically significant stenosis in the:
**LAD (left anterior descending artery)**
\*LAD provides blood supply to the apical lateral, apical cap, apical anterior, apical anteroseptal, and basal anteroseptal segments.
62
A 71-year-old patient is referred for dobutamine stress echo. There are no WMA present during the rest time period. During acquisition of the peak-dose images, a WMA is noted in the basal, mid, and apical segments of the anterolateral wall in the A4C view. This most likely denotes hemodynamically significant stenosis in the:
LAD
\*The LAD provides blood flow to the anteroseptal and anterior segments
63
66. Dobutamine stress echo in a 75-year-old patient reveals no WMAs during the rest time period. During acquisition of the peak-dose images, a WMA is noted in the basal and mid-inferiro segments of the A2C. The most likely diagnosis is hemodynamically significant stenosis in the:
RCA
The RCA provides blood supply to the basal inferior and mid-inferior segments of the LV
64
67. Dobutamine stres echo in a 71-year-old patient reveals no WMAs during the resting time period. During acquisition of the peak-dose images, a WMA is noted in the mid and apical segments of the septal wall in the PLAX view. You suspect hemodynamically significant stenosis in the:
LAD
* The LAD provides blood flow to the anteroseptal and anterior segment
65
68. Stress echo in a 72-year-old male shows no WMAs during the rest time period. The post exercise images reveal a WMA in the apical segment of the septal wall in the PLAX view. You suspect hemodynaically significant stenosis in the:
LAD
The LAD provides blood supply to apical lateral, apical cap, apical anterior, apical anteroseptal, and basal anteroseptal segments
66
69. A 70-year-old female patient is referred for exercise stress echo. During the rest time period, there are no WMAs present. In the post exercise images, a WMA is noted in the basal, mid, and apical segments of inferior wall of the A2C view. This most likely denoted a hemidynamically significant stenosis in the:
RCA
\*In the A2C view, the RCA can be seen providing blood supply to the basal inferior and mid-inferior segments of the LV
67
70. Which statement is true for the term blood pressure?
1. it is reported in cm H2O unless otherwise specified
2. It is constant throughout the cardiac cycle
3. It represents and can be used interchangeably with the term blood flow
4. It represents the force exerted by the blood against any unit area of the vessel wall
5. It is the same as hydrostatic pressure
**4**
It represents the force exerted by the blood against any unit area of the vessel wall
68
71. The 3rd heart sound represents:
**rapid early-diastolic filling of the LV**
\*The 3rd heart sound is heard with rapid early-diastolic filling and is heard in patients with a dilated LV
69
72. The 4th heart sound represents:
**Atrial contraction**
The 4th heart sound represents atrial contraction and is heard in cases associated with a poorly compliant ventricle.
70
73. Which of the following is the definition of ventricle systole?
1. relaxation of the ventricle
2. the time period between closure and of the MV and opening of the AoV
3. the time period between closure of AoV and opening of the MV
4. contraction of ventricle
5. time period of before ejection
4: ventricular systole is defined as contraction of ventricle
71
flag question
75. which of the following describes isovolumetric contraction?
1. relaxation of the ventricle
2. the time period between closure of the MV and opening of the AoV
3. the time period between closure of AoV and opening of the MV
4. contraction of ventricle
5. time period before ejection
**2**
isovolumetric contraction is the time period between closing of the MV and opening of the AoV. During this moment, there is no overall volume change because all heart valves are closed.
72
!76. Which of the following describes isovolumetric relaxation?
1. relaxation of the ventricle
2. the time period between closure of the MV and opening of the AoV
3. the time period between closure of AoV and opening of the MV
4. contraction of ventricle
5. time period before ejection
My Ans: **3**
isovolumetric relaxation is the time period between closing of the AoV and MV opening, in which there is no volume change.
73
77. this image demonstrates an estimated EF of:
1. 15-25%
2. 30-40%
3. 50-60%
4. 60-70%
5. 80-90%
My Ans: **1**
## Footnote
The EF is calculated as a percentage by the formula (LVIDd2 - LVIDs2) / LVIDd2 x 100, where LVIDd is the LV internal dimension in diastole and LVIDs is the LV internal dimension in systole.
In this case, the calculation would be performed by estimating the measurements, utilizing the scale to the left of the image (each line represents **1 cm**).
The LVIDd can be estimated to be 5 cm and the IVIDs can be estimated to be 4.5 cm. The formula would then be (5.02 - 4.52) / 5.02. The answer would be (25 - 20.25) / 25 x 100 = 19%
74
flag question
78. a patient presents with concentric LVH, a five-year hx of uncontrolled HTN, and an E/A ratio of 2.1. Which of the following would be the accurate classification of DD in this patient?
1. normal
2. grade 0
3. grade 1
4. grade 2
5. grade 3
**5**
An E/A ratio of greater than 2.0 would be classified as grade 3 DD
75
flag question
79. a 50-year-old male with an E/A ratio of 3.6 and a reversal of flow velocity of 0.36 m/s has:
1. normal diastolic filling
2. prolonged filling time
3. restrictive filling
4. pseudonormalization
5. no DD
**restrictive filling**
76
80. The reversal flow velocity used to assess diastolic function with pulmonary inflow is given by measuring which of the following?
1. E wave
2. C wave
3. S wave
4. D wave
5. A wave
My Ans: **5** A wave
normal pulmonary venous flow will exhibit forward flow in systole (S wave) and diastole (D wave) and then reversal flow with atrial contraction (A wave, sometimes referred as A wave reversal or the R wave)
77
81. when using Doppler tissue imaging to assess LV diastolic function, you should place the cursor:
1. at the septal and lateral mitral annulus
2. in the lateral LV wall
3. in the inferior LV wall
4. in the anterior LV wall
5. 1 & 3
My Ans: **1** at the septal and lateral mitral annulus
78
82. This PLAX view demonstrates the aortic valve during:
1. IVRT
2. IVCT
3. diastasis
4. diastole
5. systole
My Ans: **systole**
In this PLAX view, the AoV is demonstrated in an open position. The AoV is open during systole.
79
83. The 1st heart sound represents:
1. closure of the AV valves
2. closure of the semilunar valves
3. atrial contraction
4. ventricular contraction
5. rapid early-diastolic filling of the LV
My Ans: **closure of the AV valves**
\*The 1st heart sound represents closure of AoV. The TV is usually quiet, as the pressure in the right heart is relatively low. **TV closure may be heard if there is _elevated right heart pressure_**.
80
84. The 2nd heart sound represents:
1. closure of the AV valves
2. closure of the semilunar valves
3. atrial contraction
4. ventricular contraction
5. rapid early-diastolic filling of the LV
My Ans: **closure of the semilunar valves**
\*The 2nd heart sound is best heard at the **superior left sternal border**
81
\*flag question
85. A 65-year-old female presents with ventricular arrhythmia. The regurgitant fraction is estimated to be 38%. What is demonstrated in this image?
1. trivially physiologic MR
2. mild MR
3. moderate MR
4. moderate to severe MR
5. severe MR
My Ans: mild MR
correct Ans: 3. **moderate MR**
82
86. Which of the following is/are associated with MS?
1. pan-systolic murmur
2. blowing early-diastolic murmur
3. opening snap murmur
4. systolic ejection murmur with crescendo-decrescendo
5. 2 & 3
My Ans: **5. blowing early-diastolic murmur & opening snap murmur**
\*The murmur associated with MS is a blowing early-diastolic murmur associated with blood flow through the stenotic valve and an opening snap associated with leaflet rebound.
83
87. You are asked to pay particular attention to the semilunar valves. These valves are the:
My Ans: **AoV & PV**
84
88. The posterior leaflet of the MV appear to have a smaller excursion than the anterior leaflet because:
1. It is intersected at an angle that does not show its full size
2. The leaflet never completely opens
3. Its excursion is smaller
4. Its shape is different from that of the anterior leaflet
5. 3 & 4
My Ans: 5. **Its excursion is smaller & Its shape is different from that of the anterior leaflet**
\*_The_ **_posterior leaflet_** _of MV is_ **_smaller_** _than the anterior leaflet and also has a_ **_scalloped shape_**
85
89. The best 2D echo view for Doppler analysis of the TV inflow is the:
1. PLAX
2. PSAX
3. A4C
4. SSN LAX
5. subcostal 4C
My Ans: **3. A4C**
\*A4C provides the best Doppler angle for evaluating the E/A waves of the tricuspid inflow
86
90. The best 2D echo view for Doppler analysis of the MV inflow is the:
1. PLAX
2. PSAX
3. A4C
4. A5C
5. Sub 4C
My Ans: **3. A4C**
\*A4C provides the best Doppler angle for evaluating the E/A waves of the mitral inflow
87
91. The MV opens when:
1. The pressure in the LA exceeds the pressure in the LV
2. The pressure in the LV exceeds the pressure in the LA
3. The pressure in the RA exceeds the pressure in the RV
4. The pressure in the RV exceeds the pressure in the RA
5. The pressure in the LA and LV are equal
My Ans: **1. The pressure in the LA exceeds the pressure in the LV**
\*Valves open when there is a pressure differential. When pressure in the LA exceeds the pressure in the LV, the MV will open.
88
!!! flag question
92. When evaluating patient with an enlarged coronary sinus, you should check for:
1. Kawasaki disease
2. persistent left SVC
3. interrupted IVC
4. WMA due to ischemia
5. Takayasu's arteritis
My Ans: 5. Takayasu's arteritis
Correct Ans: **2. persistent SVC**
\*a dilated coronary sinus may indicate a persistent left SVC. A persistent left SVC receives blood from the left arm veins and drains into the coronary sinus, increasing blood volume and thereby enlarging the coronary sinus.
\*note: it's coronary sinus, not coronary artery
89
!!! flag question
93. The image on the left was taken with the patient breathing normally. The image on the right was taken when the patient sniffed. Based on these images, what is the best estimate of this individual's central venous pressure?
1. 0 mmHg
2. 3 mmHg
3. 5 mmHg
4. 8 mmHg
5. 15 mmHg
My Ans: 4. 8 mmHg
**Correct Ans: 15 mmHg**
\*Note that the diameter does not change mush with respiration
90
94. What is the arrow pointing to in this image?
My Ans: **IVC**
91
95. What is the arrow pointing to in this image?
My Ans: **hepatic vein**
92
96. The normal appearance if the S wave on the PV Doppler signal is:
1. above the baseline in systole with annular motion
2. below the baseline in systole with annular motion
3. above the baseline in diastole with early opening of the MV
4. below the baseline in diastole with early opening of the MV
5. below the baseline during the IVRT
My Ans: **above the baseline in systole with annular motion**
\*The **S wave** is demonstrated _above the baseline_, indicating forward flow during **systolic annular motion**, in which the annulus is moving toward the apex. When the PVs are imaged from the apical window, the _flow in the PVs is going toward the TDR,_ draining into the LA. Flow moving toward the TDR is demonstrated in red with color Doppler and above the baseline with PW Doppler.
93
97. What is the normal appearance of the S wave on the hepatic vein Doppler signal?
1. above the baseline in systole with annular motion
2. below the baseline in systole with annular motion
3. above the baseline in diastole with early opening of the TV
4. below the baseline in diastole with early opening of the TV
5. below the baseline during the IVRT
My Ans: **2 below the baseline in systole with annular motion**
\*The S wave is demonstrated **below the baseline**, **indicating forward flow during systolic annular motion,** in which the annulus is moving toward apex. When the hepatic veins are imaged from the _subcostal window_, **the flow in the hepatic veins is going away from the TDR**, _draining from the liver into the IVC._ The flow moving away from the TDR is demonstrated in blue with color Doppler and below the baseline with PW
94
98. What is the normal appearance of the D wave on the PV Doppler signal?
1. above the baseline in systole with annular motion
2. below the baseline in systole with annular motion
3. above the baseline in diastole with early opening of the MV
4. below the baseline in diastole with early opening of the MV
5. below the baseline during the IVCT
My Ans: 3. **above the baseline in diastole with early opening of the MV**
\*The D wave is demonstrated above the baseline, indicating forward flow during early diastole with opening of the MV, in which blood the blood flow moving toward the ventricle. When the PVs are imaged from the apical window, the flow in the PVs is going toward the TDR, draining into the LA. Flow moving toward the TDR is demonstrated in red with color Doppler and above the baseline with PW.
95
99. What is the normal appearance of the D wave on the hepatic vein Doppler signal?
1. above the baseline in systole with annular motion
2. below the baseline in diastole with early opening of the TV
3. below the baseline in systole with annular motion
4. below the baseline during the IVRT
5. above the baseline in diastole with early opening of the TV
My Ans: **2. below the baseline in diastole with early opening of the TV**
\*The D wave is demonstrated above the baseline, indicating forward flow during systolic annular motion, in which the annulus is moving toward the apex. When the hepatic veins are imaged from the subcostal window, the flow in the hepatic veins is going away from the TDR, draining from the liver into the IVC. Flow moving away from the TDR is demonstrated in blue with color Doppler and below the baseline with PWD
96
!! flag question
100. What does the A wave represent on the PV Doppler waveform?
1. blood flow with atrial annular motion
2. blood flow with atrial contraction
3. blood flow with atrial regurgitation
4. blood flow with mitral early inflow
5. blood flow with pulmonary artery regurgitation
My Ans: 3. blood flow with atrial regurgitation
Correct Ans: 2. **blood flow with atrial contraction**
\*The **A wave** represents blood _flow reversal associated with atrial contraction_
97
101. Atrial contraction occurs after which wave in the ECG cycle?
1. P wave
2. Q wave
3. R wave
4. S wave
5. T wave
My Ans: **P wave**
*The P wave on an ECG is the electrical stimulus that begins the mitral A wave, which coincides (*\*occur at or during the same time) with the atrial kick and late-diastolic filling.
98
!! flag question
102. The clinical definition of diastole is:
1. The interval from AoV closure to MV closure
2. The interval between AoV closure and PV closure
3. The interval from AoV opening to AoV closure
4. The interval between MV opening and TV closure
5. The interval from MV opening to MV closure
My Ans: The interval from MV opening to MV closure
Correct Ans: **The interval from AoV closure to MV closure**
99
!!! flag question
103. The four phases of diastole are:
1. isovolumic contraction, early systolic filling, diastasis, and isovolumic relaxation
2. isovolumic contraction, early systolic filling, diastasis, and atrial contraction
3. isovolumic relaxation, early systolic filling, diastasis, and atrial contraction
4. isovolumic relaxation, early systolic filling, atrial contractiion, and isovolumic contraction
5. isovolumic relaxation, atrial contraction, diastasis, and isovolumic contraction
My Ans: isovolumic contraction, early systolic filling, diastasis, and isovolumic relaxation
Correct Ans: **isovolumic relaxation, early systolic filling, diastasis, and atrial contraction**
\*The clinical definition of diastole is the period from AoV closure to MV closure. This period is divided into 4 phases: (1) IVRT, (2) rapid early-diastolic filling, (3) diastasis, (4) atrial contraction
100
104. The term excitation-contraction coupling refers to:
1. a process that results in absolute refractory state
2. a process in which there is relaxation of the cardiac muscle
3. a process in which an electrical discharge allows changes in cell membrane permeability that result in cardiac muscle contraction
4. a process in which a muscle cell is unable to initiate an electrical charge
5. a process in which the cardiac muscle cannot contract
My Ans: **3. a process in which an electrical discharge allows changes in cell membrane permeability that result in cardiac muscle contraction**
\*Excitation-contraction coupling (E-C coupling) generally refers to the physiologic conversion of an electrical stimulus to a mechanical response
101
!! flag question
105. The isovolumic relaxation time period ends when the:
1. MV opens
2. MV closes
3. AV opens
4. AV closes
5. PV opnes
My Ans: MV closes
Correct Ans: **MV opens**
\*The IVRT represents the period between closure of AoV and opening of the MV. During this interval, the LV pressure falls below the LAP, allowing the MV to open.
102
106. The arrow in this image is pointing to the:
1. isovolumic time period
2. early-diastolic filling phase
3. diastasis phase
4. atrial contraction phase
5. IVCT period
My Ans: **early-diastolic filling phase**
\*The second phase of diastole is early-diastolic filling. During this phase, the MV is opening and blood is flowing from the LA to the LV. This is seen _in M-mod as the_ **_E point_**, and with spectral Doppler as **E velocity**
103
107. The Arrow in this image is pointing to the:
1. isovolumic time period
2. early-diastolic filling phase
3. diastasis phase
4. atrial contraction phase
5. isovolumic contraction time period
My Ans: **atrial contraction phase**
\*The 4th phase is lare-diastolic filling due to atrial contraction. During this period, LAP is higher than the LV pressure and blood flows from the atrium to ventricle
104
108. The P wave on an electrocardiogram (ECG) represents:
1. ventricular deporlarization
2. ventricular relaxation
3. atrial depoarization
4. atrial relaxation
5. IVCT period
My Ans: **atrial depoarization**
\*The P wave corresponds with atrial depolarization and simultaneous contraction of atria
105
!! flag question (watch the image carefully and the line of M-mode)
109. In this image, what is represented by the line labeled 1?
My Ans: end ventricular diastolic diameter
correct Ans: **LA diameter**
106
!!! flag question
110. In a normal patient, tricuspid velocities will:
1. increase slightly with inspiration
2. decrease slightly with inspiration
3. increase more than 40% with inspiration
4. decrease more than 40% with inspiration
5. increase slightly with expiration
My Ans: decrease slightly with inspiration
Correct Ans: **increase slightly with inspiration**
\*in the normal patient, tricuspid velocities in _tricuspid velocities_ **_increase_** _slightly with_ **_inspiration_.**
As the patient **inhales**, the _intrathoracic pressure_ **_falls_** (diaphragm moves downward thus lowering the thoracic pressure and drawing more blood to heart) and there is a **slight increase in flow velocity** thorough the **TV and PA**.
When the patient **exhales**, the _intrathoracic pressure_ **_increases_** and flow into the **LA through the MV and aorta** **increases slightly**
107
!!! flag question \*review
111. In a normal patient, mitral velocities will:
1. increase slightly with inspiration, varying less than 10%
2. decrease slightly with inspiration, varying less than 10%
3. increase more than 40% with inspiration
4. decrease more than 40% with inspiration
5. increase more than 40% with expiration
My Ans: increase more than 40% with expiration
correct Ans: **decrease slightly with inspiration, varying less than 10%**
**\*note**
* In a normal patient, _mitral velocities will_ **_decrease_** _slightly with_ **_inspiration_**; the velocities should _not differ more than_ **_10%_** from beat to beat
* Upon **inspiration**, _intrathoracic and intrapericardial pressures will_ **_decrease_.** This will result in **_increased RV filling_** _and_ **_SV_** as blood flows to the lungs
* since the pericardial space is limited, one will see a compensatory **_decrease_** _in the_ **_LV velocities and SV_**
* With **_expiration,_** _the intrathoracic and intrapericardial pressure_ **_increase_,** resulting in an **increase in LV velocities and filling** and a slight **decrease in RV diastolic filling**
108
112. Which of the following best describes the cardiac structures during IVCT?
1. all valves are open and cardiac pressures are all above 120 mmHg
2. semilunar valves are open and AV valves are closed
3. all valves are closed and ventricular volumes are stable
4. all valves are open with unstable ventricular volume
5. all of the above
My Ans: **all valves are closed and ventricular volumes are stable**
109
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