Multiple Choice Practice Examination (1) Flashcards
(158 cards)
1
Q
The congenital cardiac anomaly seen most frequently in adults is:
A. Ebstein’s anomaly
B. Bicuspid aortic valve
C. Ventricular septal defect
D. AV septal defect
A
Bicuspid aortic valve
2
Q
Which echocardiographic window is used in the detection and assessment of the inferior vena cava?
a. apical
b. subcostal
c. parasternal
d. suprasternal
A
Subcostal
3
Q
What is the number and location of the papillary muscles of a normal mitral valve?
A. 1, the posteromedial
B. 2, the posteromedial and anterolateral
C. 2, the inferno lateral and posteromedial
D. 3, the anterolateral, posteromedial, and inferolateral
A
2, the posteromedial and anterolateral
4
Q
Clinically, prolapse of the mitral valve is associated with:
a. opening snap and systolic murmur
b. diastolic murmur and third heart sound
c. fixed splitting of the second heart sound
d. midsystolic click and/or late systolic murmur
A
Midsystolic click and/or late systolic murmur
5
Q
Papillary muscle dysfunction usually results from:
a. Dressler’s syndrome
b. ischemic heart disease
c. bacterial endocarditis
d. rheumatic heart disease
A
Ischemic heart disease
6
Q
In order to record the vegetation’s of endocarditis by echocardiography, the vegetations must have a diameter of at least:
a. one centimeter
b. three millimeters
c. three centimeters
d. five millimeters
A
3 millimeters
7
Q
How many veins connect the pulmonary vascular bed with the left atrium in the normal heart?
a. one
b. two
c. three
d. four
A
Four
8
Q
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. early systolic closure of the aortic valve
A
Premature opening of the aortic valve
9
Q
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
A
Mitral valve prolapse and aortic dilatation
10
Q
Which term is used to describe a segment of ventricular wall that exhibits no motion?
A. Akinesis
B. Dyskinesis
C. Hypokinesis
D. Hyperkinesis
A
Akinesis
11
Q
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 contains thrombi whereas a true aneurysm always contains a layered thrombus
c. is always larger in overall size than a true aneurysm
A
Has a smaller, more narrow neck than a true aneurysm
12
Q
Which type of cardiomyopathy is associated with Amyloidosis?
a. congestive
b. restrictive
c. hypertrophic
d. infiltrative
A
Infiltrative
13
Q
In a patient with carcinoid heart disease, the cardiac sonographer must devote special attention to identifying abnormalities of the:
a. aortic arch
b. aortic valve
c. mitral valve
d. tricuspid valve
A
Tricuspid valve
14
Q
Which 2D 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
A
Apical 4 chamber
15
Q
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
A
Ventricular septal defect
16
Q
Which 2D echo view is best for the assessment of the interatrial septum?
a. apical long axis
b. apical four chamber
c.parasternal short axis
d. subcostal four chamber
A
Subcostal four chamber
17
Q
The most common type of atrial septal defect is the:
a. ostium primum
b. sinus venosus
c. coronary sinus
d. ostium secundum
A
Ostium Secundum
18
Q
M-mode echo demonstration of mid-systolic closure of the pulmonary valve along with a decreased “a” wave is most consistent with:
a. pulmonary hypertension
b. pulmonary insufficiency
c. valvular pulmonary stenosis
d. infundibular pulmonary stenosis
A
Pulmonary hypertension
19
Q
False overriding of the aorta may be produced on M-mode echo by:
a. using a transducer with too low a frequency
b. failure to turn the patient into a left decubitus position
c. positioning the transducer in too high an intercostal space
d. positioning the transducer in too low an intercostal space
A
Positioning the transducer in too high of an intercostal space
20
Q
Atrial fibrillation is most commonly associated with which valvular disease?
a. bicuspid aortic valve
b. mitral valve prolapse
c. calcific aortic stenosis
d. rheumatic mitral stenosis
A
Rheumatic mitral stenosis
21
Q
Which is an example of a bioprosthetic cardiac valve?
a. Starr-Edwards ball
b. Bjork-Shiley tilting disc
c. St. Jude Medical bileaflet
d. Ionescu-Shiley bovine pericardial
A
Ionescu-Shiley bovine pericardial
22
Q
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
A
Peak instantaneous
23
Q
When a patient has a clinical diagnosis of pericarditis:
a. a pericardial 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
A
A pericardial effusion may not be present on echo
24
Q
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
A
In the first third of diastole
25
The patient you are examining has clear cut auscultatory and angiographic evidence for mitral prolapse, yet the resting echo is normal. You should then:
a. raise the patient's legs
b. perform a cold pressor test
c. echo the patient in the standing position
d. have the patient hold his breath in deep inspiration
Echo the patient in the standing position
26
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
Less than 0.06 seconds after mitral closure
27
Kawasaki’s disease may lead to:
a. aortic valve prolapse
b. tricuspid regurgitation
c. coronary artery aneurysm
d. ruptured chordae tendineae
Coronary artery aneurysm
28
Which echo technique is best for the detection of mitral regurgitation?
a. M-mode
b. pulsed Doppler
c. two dimensional
d. apexcardiogram
Pulsed Doppler
29
A 2D echo 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
Infiltrative
30
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
Fossa ovalis region of the atrial septum
31
Which 2D views are best for direct imaging of a 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
Apical 5 chamber and apical long axis views
32
The 2D echo 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 triatriatum
c. ostium primum ASD
d. ostium secundum ASD
Ostium Secundum ASD
33
Which is the best placement of the Doppler transducer for recording maximum velocities across a bioprosthetic valve in the mitral position?
a. apical four chamber
b. parasternal long axis
c. subcostal four chamber
d. parasternal cross sectional
Apical 4 chamber
34
Premature opening of the pulmonary valve may be seen in?
a. cardiac tamponade
b. pulmonary insufficiency
c. constrictive pericarditis
d. acute severe pulmonary hypertension
Constrictive pericarditis
35
When the velocity of blood flow exceeds the Doppler nyquist limit, the following occurs:
a. damping
b. aliasing
c. mirroring
d. contouring
Aliasing
36
An underestimation of the severity of aortic stenosis by continuous wave Doppler may occur with:
a. high gain settings
b. low cardiac output
c. aortic regurgitation
d. increased cardiac output
Low cardiac output
37
Estimation of the mitral valve area from Doppler is calculated by the:
a. E to F slope
b. acceleration time
c. pressure half-time
d. peak diastolic velocity
Pressure half time
38
Doppler ultrasound may show retrograde flow velocities within the ascending aorta during diastole in the presence of:
a. aortic regurgitation
b. patient ductus arteriosus
c. aorticopulmonary window
d. aorticosubclavian shunts
Aortic regurgitation
39
A patient with a recent myocardial infarction is diagnosed with Dressler’s syndrome. Special care in performing a 2D study should be followed to rule out:
a. RV infarction
b. left atrial thrombi
c. pericardial effusion
d. aortic root dissection
Pericardial effusion
40
In a patient with mitral stenosis, a continuous wave Doppler study shows a peak diastolic velocity of 2 m/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
16 mmHg
41
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
Patent Foramen ovale
42
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
AV septal defect
43
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
Apical four chamber view
44
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
Underestimate the velocity
45
The Doppler jet of mitral stenosis obtained at the apex is sometimes confused with:
a. aortic insufficiency
b. mitral insufficiency
c. pulmonic insufficiency
d. tricuspid insufficiency
Aortic insufficiency
46
When Star-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
Subcostal
47
For patients with aortic stenosis and atrial fibrillation, 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
Higher following long R-R intervals
48
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
Reversal in color
49
Premature mitral valve closure on M-mode is a sign of high left ventricular diastolic pressure in:
a. aortic stenosis
b. aortic insufficiency
c. mitral insufficiency
d. 1st degree heart block
Aortic insufficiency
50
Midsystolic clicks and/or late systolic murmurs are most characteristic of:
a. mitral stenosis
b. pulmonary stenosis
c. aortic valve prolapse
d. mitral valve prolapse
Mitral valve prolapse
51
The 2 most frequently encouraged congenital heart lesions diagnosed in adults are:
a. ASD and VSD
b. ASD and PDA
c. ASD and bicuspid AoV
d. VSD and bicuspid AoV
ASD and bicuspid aortic valve
52
Endothelialized _____ can have the same tissue characteristics as myocardium by 2D echo:
a. thrombi
b. vegetation’s
c. anomalous chordae
d. ring calcification
Thrombi
53
Ebstein’s anomaly is characterized by a ____ displacement of all or part of the tricuspid valve into the RV cavity.
a. medial
b. lateral
c. superior
d. inferior
Inferior
54
On a 2D echo the motion of a congenitally stenotic aortic valve can generally be described as:
a. doming
b. akinetic
c. prolapsing
d. fluttering
Doming
55
Echocardiographically, a dense band of echoes between the posterior left ventricular wall and the mitral valve may represent:
a. mitral dissection
b. cleft mitral valve
c. left atrial myxoma
d. mitral ring calcification
Mitral ring calcification
56
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
An infected mitral valve
57
One of the most common complications of a myocardial infarction is:
a. aneurysm formation
b. aortic insufficiency
c. LV outflow obstruction
d. calcification of the mitral ring
Aneurysm formation
58
In patients with large pericardial effusions the motion of the pericardium may be
a. damped
b. increased
c. unchanged
d. paradoxical
Damped
59
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
Dilated and poorly contracting
60
On a 2D echo, a cleft mitral valve may be confused with an anatomic:
a. pulsed
b. mechanical
c. cross sectional
d. continuous wave
Tricuspid valve
61
In which view is the ultrasound beam most perpendicular to the interatrial septum?
a. pulsed
b. mechanical
c. cross sectional
d. continuous wave
Subcostal 4 chamber
62
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
Continuous wave
63
In patients with ventricular septal defects and left to right shunting the ____ may be dilated
a. left atrium
b. right atrium
c. left ventricle
d. pulmonary veins
Left atrium
64
Secondary findings in mitral stenosis can be:
a. left ventricular hypertrophy and dilation
b. left ventricular and left atrial dilation
c. right atrial enlargement and mitral regurgitation
d. left atrial enlargement and signs of pulmonary hypertension
Left atrial enlargement and signs of pulmonary hypertension
65
Patients with long standing aortic stenosis will usually have:
a. LVH
b. LV dilation
c. diastolic aortic flutter
d. mitral ring calcification
LVH
66
One advantage of 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 the annulus shape is avoided
c. the ultrasonic beam is perpendicular to the leaflets in systole
d. the relative position of the mitral and tricuspid valves is better visualized
False prolapse caused by the annulus shape is avoided
67
Patients with aortic insufficiency may have serial echoes to check for:
a. amount of mitral valve flutter
b. left ventricular wall thickness
c. diastolic aortic cusp separation
d. left ventricular dimension changes
Left ventricular dimension changes
68
Which of the following parameters is least likely to affect serial left ventricular dimension measurements on M-mode?
a. respiration
b. patient position
c. transducer position
d. transducer frequency
Transducer frequency
69
A left ventricular thrombus is usually in an area of:
a. hyperkinesis
b. abnormal wall motion
c. ventricular enlargement
d. ventricular hypertrophy
Abnormal wall motion
70
In order to distinguish between pleural and pericardial effusions on a 2D echo it is helpful to
identify the:
a. abdominal aorta
b. ascending aorta
c. transverse aorta
d. descending aorta
Descending aorta
71
Rupture of the interventricular septum is most often a complication of:
a. aortic insufficiency
b. myocardial infarction
c. perforation by pacing wires
d. subacute bacterial endocarditis
Myocardial infarction
72
An M-mode of a mitral heterograft valve resembles an M-mode of which valve?
a. mitral
b. aortic
c. pulmonic
d. tricuspid
Aortic
73
Which technique would best allow you to assess the severity of aortic regurgitation?
a. pulsed wave Doppler
b. continuous wave Doppler
c. M-mode echocardiography
d. two-dimensional echocardiography
Pulsed wave Doppler
74
Which of the following valves is most often affected in patients with rheumatic heart disease?
a. aortic
b. mitral
c. pulmonic
d. tricuspid
Mitral
75
“Electrical alternans” is seen on a patient’s EKG. The echo will most likely show:
a. aortic stenosis
b. mitral valve prolapse
c. ventricular septal defect
d. large pericardial effusion
Large pericardial effusion
76
On the EKG, ventricular repolarization is represented by the:
a. P wave
b. T wave
c. R wave
d. QRS complex
T wave
77
A common cause for right ventricular volume overload is:
a. patent ductus
b. pulmonic stenosis
c. tetralogy of Fallot
d. tricuspid regurgitation
Tricuspid regurgitation
78
Premature closure of the mitral valve can be seen in patients with:
a. aortic insufficiency
b. cleft mitral leaflet
c. constrictive pericarditis
d. left ventricular hypertrophy
Aortic insufficiency
79
The most common cause of mitral regurgitation in elderly patients is:
a. atrial fibrillation
b. rheumatic heart disease
c. calcified mitral annulus
d. papillary muscle dysfunction
Calcified mitral annulus
80
A patent ductus arteriosus (PDA) has what type of murmur?
a. systolic
b. diastolic
c. blowing
d. continuous
Continuous
81
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. persistent left superior vena cava
c. systolic appearance of contrast in the IVC
d. pre systolic appearance of contrast in the IVC
Presystolic appearance of contract in the IVC
82
Hemodynamically moderate aortic insufficiency will result in:
a. pulmonic regurgitation
b. increased cardiac output
c. right ventricular hypertrophy
d. left ventricular volume overload
Left ventricular volume overload
83
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
Atrial septal defect
84
The pressure obtained by a pulmonary artery wedge measurement equals the pressure in the:
a. aorta
b. left atrium
c. right ventricle
d. pulmonary artery
Left atrium
85
Filling of the coronary arteries occurs during what part of the cardiac cycle?
a. atrial diastole
b. ventricular systole
c. ventricular diastole
d. isovolumic contraction
Ventricular diastole
86
The A-dip in the M-mode pulmonary valve is caused by contraction of the:
A. left atrium
b. right atrium
c. left ventricle
d. right ventricle
Right atrium
87
Which is the first arterial branch of the ascending aorta?
a. innominate
b. left subclavian
c. right subclavian
d. left common carotid
In nominate
88
Which of the following is associated with severe, acute mitral regurgitation?
a. mitral stenosis
b. pulmonary edema
c. left atrial enlargement
d. left ventricular hypertrophy
Pulmonary edema
89
A patient is referred to the echo lab because of positional and respiratory variation in chest pain. Which of the following diseases are they likely to have?
a. angina
b. pericarditis
c. aortic stenosis
d. coronary artery spasm
Pericarditis
90
What percent of left ventricular filling is normally contributed by atrial systole?
a. 10
b. 30
c. 50
d. 70
30%
91
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
Calcified aortic stenosis
92
Where is the lowest blood oxygen saturation usually found?
a. coronary sinus
b. pulmonary artery
c. inferior vena cava
d. superior vena cava
Coronary sinus
93
An advantage of continuous wave Doppler over pulsed wave Doppler is:
a. range resolution
b. low nyquist limit
c. peak velocity detection
d. aliasing can be detected
Peak velocity detection
94
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
Apical
95
A patient is sent to the echo lab with a diagnosis of Marfan’s syndrome. Which of the following are you most likely to find?
a. aortic rupture
b. cleft mitral valve
c. dilated aortic root
d. pericardial effusion
Dilated aortic root
96
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. atrial septal defect
b. right atrial myxoma
c. mitral valve prolapse
d. regional wall motion abnormalities
Regional wall motion abnormalities
97
Normally pericardial fluid drains into the:
a. pleural space
b. coronary sinus
c. peritoneal space
d. lymphatic system
Lymphatic system
98
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 arteriosus
Coarctation of the aorta
99
Premature closure of the aortic valve on M-mode is most consistent with:
a. mitral stenosis
b. aortic stenosis
c. aortic regurgitation
d. mitral regurgitation
Mitral regurgitation
100
An intra-aortic balloon pump assists the left ventricle by increasing:
a. pre-load
b. after-load
c. coronary blood flow
d. systolic blood pressure
Coronary blood flow
101
The development of angina, Dyspnea, and syncope are signs of advanced:
a. aortic stenosis
b. mitral stenosis
c. aortic regurgitation
d. mitral regurgitation
Aortic stenosis
102
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
Decrease the heart rate
103
At cardiac catheterization a patient has equal end diastolic pressures between both atria and both ventricles suggesting:
a. patent ductus arteriosus
b. constrictive pericarditis
c. chronic mitral regurgitation
d. cardiac tamponade
Constrictive pericarditis
104
In normal patients why does the peak velocity of flow in the pulmonary artery occur 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
Vascular resistance is lower
105
The beginning of systole is accompanied by which heart sound?
a. S1
B. S2
C. S3
D. S4
S1
106
Of the following conditions, which is NOT a cause of increased left ventricular mass?
a. aortic stenosis
b. systemic hypertension
c. mitral valve prolapse
d. aortic insufficiency
Mitral valve prolapse
107
Which of the following terms refers to increased LV wall motion:
a. dyskinesis
b. hyperkinesis
c. hypokinesis
d. akinesis
Hyperkinesis
108
The anterior and apical wall of the left ventricle is supplied by which coronary artery?
a. left anterior descending
b. left circumflex
c. right coronary artery
d. acute marginal
Left anterior descending
109
The QRS of the electrocardiogram reflects which of the following?
a. atrial depolarization
b. atrial repolarization
c. ventricular depolarization
d. ventricular repolarization
Ventricular depolarization
110
Which of the following ausculatory sounds is most suggestive of a bicuspid aortic valve?
a. S4
b. opening snap
c. mild-systolic click
d. systolic ejection click
Systolic ejection click
111
High frequency systolic vibrations of the aortic valve on M-mode are most consistent with:
a. mitral insufficiency
b. low cardiac output
c. aortic valve stenosis
d. normal findings
Normal findings
112
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. 3 to 1
1.3 to 1
113
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. differentiate pericardial from pleural effusion
d. differentiate restrictive from constrictive pericarditis
Differentiate pericardial from pleural effusion
114
In patients with larger pericardial effusions, which of the following can be a false positive diagnosis on M-mode?
a. aortic dissection
b. mitral valve prolapse
c. papillary muscle dysfunction
d. Ebstein's anomaly
Mitral valve prolapse
115
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
d. measure the opening at end diastolic
Measure the opening at the leaflet tips
116
The use of the continuity equation in a patient with aortic stenosis is based on the premise that:
a. the worse the stenosis, the higher the V1
b. the worse the stenosis, the lower the V1
c. The higher the cardiac output the lower the V2
d. flow below the valve is equal to flow above the valve
Flow below the valve is equal to flow above the valve
117
The false appearance of mitral valve prolapse on M-mode can be created by:
a. placing the transducer too high on the chest
b. placing the transducer too low on the chest
c. failure to roll the patient in the left lateral decubitus position
d. failure to demonstrate aortic-mitral continuity
Placing the transducer too high on the chest
118
A b-notch on the mitral valve M-mode is associated with:
a. atrial fibrillation
b. increased pulmonary pressures
c. first degree AV block
d. increased LV end diastolic pressure
Increased LV end diastolic pressure
119
An akinetic apical LV wall is most consistent with a blockage in the:
a. right coronary artery
b. left anterior descending coronary artery
c. left circumflex coronary artery
d. acute marginal coronary artery
Left anterior descending coronary artery
120
Diastolic collapse of the RV anterior wall is consistent with:
a. right ventricular volume overload
b. right ventricular pressure overload
c. pericardial constriction
d. pericardial tamponade
Pericardial tamponade
121
Patients receiving Adriamycin therapy are often referred to the echo lab to:
a. rule out atrial myxoma
b. rule out constrictive pericarditis
c. evaluate left ventricular function
d. evaluate right ventricular function
Evaluate left ventricular function
122
A patient with a crescendo/decrescendo systolic murmur and a decreased A2 would probably be sent to the echo lab to evaluate:
a. mitral insufficiency
b. tricuspid insufficiency
c. pulmonic stenosis
d. aortic stenosis
Aortic stenosis
123
After a patient has had a mitral commissurotomy, which of the following will be seen on echo?
a. the mitral motion will be normal
b. the mitral ring will appear as bright echo reflectors
c. the valve will still appear rheumatic
d. the E-to-F slope will decrease
The valve will still appear rheumatic
124
In a patient with IHSS:
a. the aortic valve will show mid-diastolic closure
b. the LV posterior wall to septal ratio is usually greater than 1.3
c. mitral regurgitation is often present
d. the systolic anterior motion of the MV will decrease with Valsalva maneuver
Mitral regurgitation is often present
125
Each of the following statements regarding echocardiography in patients with infiltrative endocarditis are true EXCEPT:
a. vegetation’s as small as 3mm can be recognized
b. it is easy to distinguish between new and healed vegetation’s
c. pre-existing valve disease may obscure the presence of a vegetation
d. vegetation’s usually appear on the flow side of valve leaflets
It is easy to distinguish between new and healed vegetations
126
A P-R interval longer than 0.2 seconds on the ECG is called:
a. left bundle branch block
b. normal sinus rhythm
c. 1st degree AV block
d. complete heart block
1st degree AV block
127
Normal sinus rhythm means that:
a. the SA node is the pacemaker
b. the AV node is the pacemaker
c. the heart rate is 40-60 beats per minute
d. P-R interval is at least 0.2 sec’s
The SA node is the pacemaker
128
During the Q-T interval on the ECG:
a. the ventricles are filling
b. the atria are filling
c. the AV valves are open
d. the semilunar valves are closed
The atria are filling
129
Which of the following does NOT usually happen with left heart failure?
a. elevation of LV end-diastolic pressure
b. elevation of pulmonary venous pressures
c. fall in cardiac output
d. fall in aortic pressure
Fall in aortic pressure
130
Which of the following is NOT a common symptom of congestive heart failure?
a. dyspnea on exertion
b. pedal edema
c. orthopnea
d. syncope
Syncope
131
Mitral regurgitation results in:
a. increase in preload
b. increase in afterload
c. decrease in preload
d. decrease in afterload
Increase in preload
132
Long standing severe mitral stenosis usually leads to:
a. angina
b. congestive heart failure
c. syncope
d. hypertension
Congestive heart failure
133
Stroke volume refers to:
a. the liters per minute pumped by the heart
b. cardiac output X heart rate
c. ejection fraction of the left ventricle
d. the volume of blood ejected with each heart beat
The volume of blood ejected with each heart beat
134
In aortic stenosis the:
a. LA diastolic pressure exceeds that of the LV
b. LV systolic pressure exceeds that of the aorta
c. LV diastolic pressure exceeds that of the aorta
d. aortic systolic pressure exceeds that of the LV
LV systolic pressure exceeds that of the aorta
135
The heart responds to increased preload by an increase in:
a. systolic pressure
b. diastolic pressure
c. afterload
d. contractility
Contractility
136
A patient with a left atrial myxoma may have symptoms similar to those patients having:
a. mitral stenosis
b. mitral ring calcification
c. flail mitral leaflet
d. Papillary muscle dysfunction
Mitral stenosis
137
The best position for recording the left ventricular filling wave forms by 2D/pulsed Doppler echo is:
a. parasternal short-axis with the Doppler sample volume positioned at the mitral valve leaflet tips
b. parasternal long-axis with the sample volume positioned in the left atrium
c. apical four-chamber with the sample volume positioned at the mitral valve leaflet tips
d. apical four-chamber with the sample volume positioned in the left atrium
e. apical five-chamber with the sample volume in the left ventricular inflow tract
Apical 4 chamber with the sample volume positioned at the mitral valve leaflet tips
138
Visualization of the lateral segment of the left ventricle is best when the sonographer uses which of the following views?
a. subxiphoid four-chamber view
b. apical long-axis view
c. parasternal long-axis view
d. apical four-chamber and parasternal short-axis views
e. apical long-axis and parasternal long-axis views
Apical 4 chamber and Parasternal short axis views
139
In long standing aortic stenosis, the MOST common secondary echo findings would be:
a. left ventricular hypertrophy (LVH)
b. left ventricular (LV) dilation
c. mitral ring calcification
d. diastolic aortic flutter
Left ventricular hypertrophy
140
When amyl nitrite is administered to a patient who has hypertrophic obstructive cardiomyopathy (HOCM) it is likely to:
a. decrease septal thickening
b. increase the systolic anterior motion of the mitral valve
c. decrease systolic flow velocity in the left ventricular outflow tract
d. increase pulmonary venous return
e. produce a slower heart rate.
Increase the systolic anterior motion of the mitral valve
141
Which one of the following statements is NOT true about aneurysms of the left ventricle as seen by 2D echo?
a. aneurysms have thin walls
b. the size of an aneurysm decreases in systole
c. the apex of the left ventricle is usually involved
d. a thrombus is frequently present
e. multiple views are needed for complete assessment
The size of an aneurysm decreases in systole
142
A patient presents with a grave IV/VI systolic crescendo/decrescendo murmur. The MOST likely pathology is:
a. mitral stenosis
b. mitral regurgitation
c. aortic stenosis
d. aortic regurgitation
e. tricuspid regurgitation
Aortic stenosis
143
When ultrasound waves travel through a medium which contains many small scatterers (red blood cells), the amount of sound that is scattered would:
a. increase sharply with increasing frequency
b. increase sharply with increasing wavelength
c. be independent of frequency
d. decrease with increasing beam area
e. decrease sharply with increasing frequency
Increase sharply with increased frequency
144
With phased array transducers, the transmitted sound beam is swept by:
a. mechanically oscillating the transducer elements
b. mechanically rotating the transducer elements
c. varying the timing of pulses to the transducer elements
d. varying the voltage of pulses to the transducer elements
e. varying the resonant frequency of the transducer elements
Varying the timing of pulses to the transducer elements
145
In a normal individual, during isovolumetric contraction, the:
a. aortic valve opens allowing blood to be ejected from the left ventricle
b. mitral valve is open allowing blood flow into the left ventricle
c. pressure in the left ventricle increases; no valves are open
d. pressure in the left ventricle decreases; no valves are open
e. pressure in the left ventricle is the same as it is in end diastole; no valves are open
Pressure in the left ventricle increases; no valves are open
146
Myocardial blood flow is most predominant during which phase of the cardiac cycle?
a. isovolumic relaxation phase
b. systole
c. isovolumic contraction
d. diastole
Diastole
147
Myocardial blood flow in the normal heart returns to the right atrium via the:
a. pulmonary veins
b. azygos veins
c. superior vena cava
d. coronary sinus
Coronary sinus
148
A ventricular premature beat originates in:
a. the atrioventricular node
b. an ectopic focus
c. the sinus node
d. the left coronary artery
e. coronary sinus
An ectopic focus
149
A cracked transducer face can lead to a dangerous situation involving:
a. thermal damage
b. electrical shock
c. depolarization
d. mechanical shock
e.ultraviolet beam
Electrical shock
150
The Doppler shift frequency from moving reflectors is the:
a. received ultrasonic frequency
b. transmitted ultrasonic frequency
c. ratio of transmitted and received ultrasonic frequencies
d. difference between the transmitted and received ultrasonic frequencies
e. sum of the transmitted and received ultrasound frequencies
Difference between the transmitted and received ultrasonic frequencies
151
To improve the axial resolution of a transducer, a manufacturer must:
a. increase the diameter
b. decrease the diameter
c. decrease the damping
d. curve the crystal
e. shorten the pulse
Shorten the pulse
152
If the distance to a reflector doubles, the time between pulse transmission and echo detection at the transducer:
a. decreases by one-quarter
b. decreases by one-half
c. remains the same
d. doubles
e. quadruples
Doubles
153
A prominent eustachian valve is seen in the right atrium. The eustachian valve is:
a. a normal valve of the inferior vena cava commonly seen in the subcostal view
b. a normal valve of the coronary sinus seen in a parasternal short-axis
c. the portion of the atrial septum which is patent before birth and did not fuse after delivery
d. a term which can be applied to the tricuspid valve
e. a normal valve of the superior vena cava commonly seen in the subcostal view
A normal valve of the inferior vena cava commonly seen in the subcostal view
154
The right ventricular systolic pressure may be predicted:
a. when the pulmonary artery pressure is low by precise correlation of pulmonary valve closure times
b. by accurate measurement of end systolic and end diastolic anterior right ventricular wall thickness
c. with continuous wave Doppler detection of tricuspid valve insufficiency
d. with pulsed Doppler interrogation of the main pulmonary artery
With continuous wave Doppler detection of tricuspid valve insufficiency
155
Which one of the following is NOT a frequent echo finding in a patent who has hypertrophic cardiomyopathy?
a. asymmetric septal hypertrophy
b. mitral prolapse
c. Midsystolic closure of the aortic valve
d. systolic anterior motion of the mitral valve
e. mitral insufficiency
Mitral prolapse
156
The 2D image of a phased array echo is produced by:
a. rotating a single crystal transducer through a 360° arc
b. oscillating a single low frequency transducer through a 30° to 90° arc
c. sequentially activating a series of adjacent crystals to angulate the ultrasound beam
d. a microcomputer that keeps the M-mode signal in phase with the cardiac cycle
e. simultaneous activation of a linear array of piezoelectric crystals
Sequentially activating a series of adjacent crystals to angulate the ultrasound beam
157
In the normal newborn, the free wall of the right ventricle is:
a. not visible by echocardiography
b. 2 to 4 mm thick
c. 6 to 8 mm thick
d. best visualized with a low frequency transducer
2 to 4 mm thick
158
Which of the following conditions is NOT associated with overriding of the aorta?
a. pulmonary atresia with a ventricular septal defect (pseudotruncus)
b. tetralogy of Fallot
c. pulmonary atresia with intact ventricular septum
d. truncus arteriosus
e. double outlet right ventricle
Pulmonary atresia with intact ventricular septum
