Valvular Disease Flashcards
(153 cards)
1
Q
Patients with mitral stenosis, left atrial enlargement and atrial fibrillation are at an increased risk for the development of: A. Left Ventricular Thrombus B. Left Atrial Myxoma C. Left Atrial Thrombus D. Left Ventricular dilatation
A
C. Left Atrial Thrombus
2
Q
Typical echocardiographic findings in a patient with isolated rheumatic mitral stenosis including all of the following EXCPET: A. Left Atrial thrombus B. Left Atrial enlargement C. "D" shaped Left Ventricle D. Dilated left ventricle
A
D. Dilated Left Ventricle
3
Q
Mitral stenosis is considered to be severe by all of the following criteria EXCEPT:
A. MV Doppler A wave peak velocity >1.3 m/s
B. MV Area <1.0 cm2
C. MPG >10 mmHg
D. PHT >220
A
A. MV Doppler A wave peak velocity >1.3 m/s
4
Q
Congestive heart failure in a patient with significant chronic mitral regurgitation occurs because of increased pressure in the: A. Aorta B. Left Atrium C. Left Ventricle D. Right Ventricle
A
B. Left Atrium
5
Q
Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral stenosis include: A. Aortic stenosis B. Pericardial effusion C. Left Atrial Myxoma D. Ventricular atrial myxoma
A
C. Left Atrial Myxoma
6
Q
Chronic significant mitral regurgitation may result in all of the following EXCPET: A. LAE B. LVE C. MAC D. LV volume overload pattern
A
C. MAC
7
Q
A strong indication for mitral stenosis on 2D echo is an anterior mitral valve leaflet that exhibits: A. Reverse Doming B. Systolic Bowing C. Diastolic Doming D. Coarse, chaotic diastolic motion
A
C. Diastolic doming
8
Q
The classic description of the murmur of chronic mitral regurgitation is:
A. Diastolic decrescendo murmur heard best at LSB
B. Continuous machinery-like murmur
C. Systolic ejection murmur best heard at RUSB
D. Holosystolic murmur best heard at the apex radiating to the axilla
A
D. Holosystolic murmur best heard at the apex radiating to the axilla
9
Q
The most common presenting symptom of significant chronic mitral regurgitation is: A. Dyspnea B. Ascites C. Systemic embolization D. Hemoptysis
A
A. Dyspnea
10
Q
The most common etiology of mitral stenosis in adults is: A. Left atrial myxoma B. Severe MAC C. Congenital D. Rheumatic Fever
A
D. Rheumatic Fever
11
Q
The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are: A. Mitral, Aortic, Tricuspid, Pulmonic B. Aortic, Pulmonic, Tricuspid, Mitral C. Pulmonic, Aortic, Tricuspid, Mitral D. Tricuspid, Mitral, Pulmonic, Aortic
A
A. Mitral, Aortic, Tricuspid, Pulmonic
12
Q
All of the following are causes for chronic mitral regurgitation EXCPET: A. Ruptured papillary muscle B. Cleft MV C. Rheumatic heart disease D. MAC
A
A. Ruptured papillary muscle
13
Q
Signs and symptoms of mitral stenosis secondary to rheumatic heart disease include: A. Vertigo B. Cyanosis C. Pulmonary Hypertension D. Angina Pectoris
A
C. Pulmonary Hypertension
14
Q
M-mode and 2D findings associated with significant chronic mitral regurgitation include all of the following EXCEPT:
A. LAE
B. LV volume overload pattern
C. LVE
D. Fine diastolic fluttering of the mitral valve
A
D. Fine diastolic fluttering of the mitral valve
15
Q
The classic cardiac doppler features of mitral valve stenosis including all the following EXCEPT: A. Increased PHT B. Turbulent Flow C. Increased E velocity D. Increased mitral valve area
A
D. Increased mitral valve area
16
Q
The most accurate method for determining the severity of mitral valve stenosis is:
A. Determining the max velocity across the MV by PW Doppler
B. Performing planimetry of the MV orifice by 2D echocardiography
C. Measuring the E-F slope of the anterior MV leaflet by M-mode
D. Measuring the thickness of the MV leaflets
A
B. Performing planimetry of the MV orifice by 2D echocardiography
17
Q
2D echocardiographic examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.8 m/s with a PHT of 180 msec in an elderly patient. The most likely diagnosis is: A. Abnormal relaxation of the LV B. Aortic regurgitation C. Rheumatic mitral stenosis D. Moderate to Severe MAC
A
D. Moderate to severe MAC
18
Q
2D echocardiographic findings for rheumatic mitral stenosis include all of the following EXCPET:
A. Increased LA dimension
B. Hockey-stick appearance of the AMVL
C. Thickened MV leaflets and subvalvular apparatus
D. Reverse doming of the AMVL
A
D. reverse doming of the AMVL
19
Q
Systolic bowing of the inter-atrial septum toward the right atrium throughout the cardiac cycle may be an indication of: A. Tricuspid Atresia B. Tricuspid Stenosis C. Tricuspid Regurgitation D. Mitral Regurgitation
A
D. Mitral Regurgitation
20
Q
Possible signs and symptoms associated with acute severe mitral regurgitation include: A. Anasarca B. Pulmonary edema C. Systemic embolization D. Hemoptysis
A
B. Pulmonary Edema
21
Q
The abnormal mitral valve PHT for patients with mitral valve stenosis is: A. 60 to 90 msec B. 0 to 30 msec C. 30 to 60 msec D. 90 to 400 msec
A
D. 90 to 400 msec
22
Q
All of the following are possible etiologies of anatomic mitral regurgitation EXCEPT: A. Ruptured chordae tendineae B. MAC C. MVP D. Dilated Cardiomyopathy
A
D. Dilated Cardiomyopathy
23
Q
The most likely heart sound to be heard in patients with significant chronic pure mitral regurgitation is: A. S3 B. Loud S1 C. Fixed split S2 D. Ejection Click
A
A. S3
24
Q
Cardiac MRI provides all of the following information in the evaluation of mitral regurgitation EXCPET:
A. Detailed visualization of the mitral valve apparatus
B. Regurgitant Volume
C. LV mass
D. LV volumes
A
A. Detailed visualization of the mitral valve apparatus
25
Secondary echographic/Doppler findings in patients with rheumatic mitral stenosis include all of the following EXCEPT:
A. LV Dilation
B. Increased right heart dimensions
C. Abnormal interventricular septal wall motion
D. Increased tricuspid regurgitant jet velocity
A. LV Dilation
26
```
A Doppler MPG across a stenotic mitral valve of 22 mmHg is obtained. The Severity of the mitral stenosis is:
A. Mild
B. Severe
C. Moderately Severe
D. Moderate
```
B. Severe
27
```
The equation used in the cardiac catheterization laboratory to determine mitral valve area is the:
A. Bernoulli
B. Doppler
C. Continuity
D. Gorlin
```
D. Gorlin
28
```
A deceleration time of 800 msec was obtained by CW Doppler in a patient with rheumatic mitral valve stenosis. The PHT is:
A. 800 msec
B. 220 msec
C. 232 msec
D. 400 msec
```
C. 232 msec
29
```
Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to:
A. 1 to 1.5 cm2
B. 1.5 tp 2.5 cm2
C. <1 cm2
D. 2.5 to 3.5 cm2
```
C. <1 cm2
30
In patients with severe acute mitral regurgitation, the CW Doppler peak velocity of the regurgitant jet is:
A. Dependent largely upon left ventricular global systolic function
B. Unaffected
C. Increased
D. Decreased
D. Decreased
31
```
Quantitative approaches to determine the severity of mitral regurgitation include all of the following EXCEPT:
A. Regurgitant jet area
B. Regurgitant volume
C. Regurgitant fraction
D. Effective regurgitant orifice
```
A. Regurgitant Jet Area
32
```
In patients with significant mitral regurgitation, the isovolumic relaxation time may be:
A. Increased
B. Affected by respiration
C. Unaffected
D. Decreased
```
D. Decreased
33
```
The term myxomatous degeneration is associated with mitral valve:
A. Flail
B. Vegetation
C. Stenosis
D. Prolapse
```
D. Prolapse
34
```
The cardinal symptoms of valvular aortic stenosis include all of the following EXCEPT:
A. Syncope
B. Anasarca
C. Congestive Heart Failure
D. Angina Pectoris
```
B. Anasarca
35
The complications of mitral valve prolapse include all of the following EXCPET:
A. Significant mitral regurgitation
B. Increased risk of infective endocarditis
C. Valvular stenosis
D. Mitral valve repair and replacement
C. Valvular stenosis
36
```
The most common symptoms of mitral valve prolapse include all of the following EXCPET:
A. Atypical chest pain
B. Palpitations
C. Syncope
D. Ascites
```
D. Ascites
37
In patients with significant mitral regurgitation, the CW Doppler tracing of the regurgitant lesion may demonstrate a(n):
A. Symmetrical shape of the MR flow velocity spectral display
B. Jet area < 20%
C. Asymmetrical shape of the MR flow velocity spectral display
D. Jet duration of < 85 msec
C. Asymmetrical shape of the MR flow velocity spectral display
38
Cardiac Doppler evidence of severe mitral regurgitation includes all of the following EXCEPT:
A. Mitral valve E wave velocity < 1.0 m/sec
B. Pulmonary vein systolic flow reversal
C. Regurgitant jet area/ left atrial area ratio >40%
D. Dense, triangular CW Doppler tracing
A. Mitral valve E wave velocity < 1.0 m/sec
39
Echocardiographic characteristics of mitral valve prolapse include all of the following EXCEPT:
A. Diastolic doming of the mitral valve leaflets
B. Systolic bowing of the mitral valve leaflets towards the left atrium
C. Increased mitral valve annulus diameter
D. Thickened, redundant, myxomatous leaflets
A. Diastolic doming of the mitral valve leaflets
40
```
The most likely etiology of aortic valve stenosis in a 47 year old patient is:
A. Endocarditis
B. Degenerative
C. Annular
D. Congenital
```
D. Congenital
41
```
Mitral valve chordal rupture usually results in:
A. Mitral regurgitation
B. Pulmonary Insufficiency
C. Aortic Insufficiency
D. Tricuspid regurgitation
```
A. Mitral regurgitation
42
```
All of the following are useful color-flow doppler techniques in the evaluation of mitral regurgitation EXCEPT:
A. Jet area
B. Peak velocity
C. PISA diameter
D. Vena contracta width
```
B. Peak velocity
43
```
The effect significant mitral regurgitation has on the PW Doppler tracing of the pulmonary veins may be described as:
A. Unaffected
B. S wave reverses, D wave increases
C. S wave increases, D wave decreases
D. S wave increases, D wave decreases
```
B. S wave reverses, D wave increases
44
```
Secondary causes of mitral valve prolapse include all of the following EXCEPT:
A. Bicuspid aortic valve
B. Primary pulmonary hypertension
C. cardiac tamponade
D. Atrial septal defect
```
A. Bicuspid aortic valve
45
```
A key word that is often used to describe the characteristics of the valve leaflets in mitral valve prolapse is:
A. Redundant
B. Dense
C. Sclerotic
D. Doming
```
A. Redundant
46
The peak mitral regurgitation velocity as determined with CW Doppler reflects the:
A. Direction of the regurgitant jet
B. Max pressure difference between the left atrium and the left ventricle
C. Etiology of the mitral regurgitation
D. Severity of the mitral regurgitation
B. Max pressure difference between the left atrium and the left ventricle
47
Flail mitral valve can be differentiated from severe mitral valve prolapse on 2D echocardiography because flail mitral valve leaflet demonstrates:
A. Chronic mitral regurgitation
B. Leaflet tip that points toward the left atrium
C. A thicker mitral valve
D. Leaflet tip that points toward the left ventricle
B. Leaflet tip that points toward the left atrium
48
```
On M-mode and 2D echocardiography dense echoes are noted posterior to normal mitral valve leaflets. The probable diagnosis is mitral valve:
A. Papilloma
B. Vegetation
C. Aneurysm
D. Annular calcification
```
D. Annular calcification
49
```
Diastolic mitral regurgitation is associated with:
A. Severe aortic regurgitation
B. Mitral valve prolapse
C. Flail mitral valve
D. Severe tricuspid regurgitation
```
A. Severe aortic regurgitation
50
```
The associated auscultatory findings for mitral valve prolapse include:
A. Friction rub
B. Pericardial knock
C. Ejection click
D. Mid-systolic click
```
D. Mid-systolic click
51
```
All of the following are associated with mitral valve prolapse EXCEPT:
A. Pulmonary atresia
B. Mitral regurgitation
C. Tricuspid valve prolapse
D. Aortic valve prolapse
```
A. Pulmonary atresia
52
```
Which of the following is most commonly associated with mitral valve prolapse?
A. Left heart pressure overload
B. Right heart pressure overload
C. Right heart volume overload
D. Left heart volume overload
```
D. Left heart volume overload
53
```
The etiology of aortic valve stenosis includes all of the following EXCPET:
A. Rheumatic
B. Degenerative
C. Bacterial
D. Congenital
```
C. Bacterial
54
```
In patients with significant pure mitral regurgitation, the E velocity of the mitral valve PW Doppler tracing is:
A. Decreased
B. Increased with inspiration
C. Unaffected
D. Increased
```
D. Increased
55
```
A common finding associated with a regurgitant murmur in the elderly is:
A. Aortic valve stenosis
B. Mitral valve stenosis
C. Mitral valve vegetation
D. Mitral annular calcification
```
D. Mitral annular calcification
56
All of the following are true statements concerning mitral regurgitation EXCEPT:
A. Severity of mitral regurgitation is not affected by afterload
B. Mitral regurgitation may be acute, chronic or intermittent
C. Regurgitant jet area, vena contracta width, and proximal isovelocity surface area are recommended when determining severity
D. Mitral regurgitation may result in an increased in preload
A. Severity of mitral regurgitation is not affected by afterload
57
```
The gold standard 2D echocardiographic view recommended to diagnose the presence of mitral valve prolapse is:
A. Subcostal five-chamber
B. Apical four-chamber
C. PSAX MV
D. PLAX
```
D. PLAX
58
```
There is posterior mitral valve prolapse present. With color flow on, which direction will the mitral regurgitation jet be baffled?
A. Inferior
B. Cephalad
C. Anterior
D. Posterior
```
C. Anterior
59
```
An accepted method for determining the severity of mitral regurgitation by CW Doppler is spectral:
A. Jet density
B. Velocity
C. Length
D. Width
```
A. Jet density
60
```
A color flow doppler method for semi-quantitating mitral regurgitation is regurgitant jet:
A. Turbulence
B. Height
C. Area
D. Length
```
C. Area
61
Possible 2D echocardiographic findings in significant aortic valve stenosis include all the following EXCEPT:
A. Post-stenotic dilatation of the descending aorta
B. Post-stenotic dilatation of the descending aorta
C. Aortic valve calcification
D. Left ventricular hypertrophy
B. Post-stenotic dilatation of the descending aorta
62
```
The aortic valve is considered critical aortic valve stenosis is:
A. < 1.5 cm2
B. < or equal to 0.75 cm2
C. < 3 cm2
D. < 2 cm2
```
B. < or equal to 0.75 cm2
63
All of the following are associated with significant chronic aortic regurgitation EXCEPT:
A. Congestive heart failure
B. Holosystolic murmur heard best at the cardiac apex
C. Angina pectoris
D. Wide pulse pressure
B. Holosystolic murmur heard best at the cardiac apex
64
The characteristic feature of the murmur of chronic aortic regurgitation is a:
A. Diastolic rumble following an opening snap
B. Diastolic decrescendo murmur heard best along the left sternal border
C. Diastolic crescendo-decrescendo murmur heard best along the left upper sternal border
D. Harsh systolic ejection murmur heard best at the right upper sternal border
B. Diastolic decrescendo murmur heard best along the left sternal border
65
All of the following are 2D echocardiography findings in a patient with significant chronic aortic regurgitation EXCEPT:
A. Left atrial enlargement
B. Abnormal aortic valve or aortic root
C. Left ventricular enlargement
D. Hyperkinetic left ventricular wall motion
A. Left atrial enlargement
66
```
Reverse diastolic doming of the anterior mitral valve leaflet is associated with:
A. Rheumatic mitral valve stenosis
B. Severe aortic regurgitation
C. Flail mitral valve
D. Papillary muscle dysfunction
```
B. Severe aortic regurgitation
67
```
A doppler MPG of 18 mmHg is calculated in a patient with valvular aortic stenosis. The severity of the aortic stenosis is:
A. Severe
B. Moderately severe
C. Moderate
D. Mild
```
D. Mild
68
```
Pathologies that may result in a left ventricular pressure overload include all the following EXCEPT:
A. Systemic hypertension
B. Valvular aortic stenosis
C. Discrete subaortic stenosis
D. Mitral valve stenosis
```
D. Mitral valve stenosis
69
The characteristic M-mode findings for aortic valve stenosis include all the following EXCEPT:
A. Reduced leaflet separation in systole
B. A lack of systolic flutter of the aortic valve leaflets
C. Thickening of the aortic valve leaflets
D. Diastolic flutter of the aortic valve leaflets
D. Diastolic flutter of the aortic valve leaflets
70
An effect of significant aortic valve stenosis on the left ventricle is:
A. Asymmetrical septal hypertrophy
B. Eccentric left ventricular hypertrophy
C. Protected in significant aortic valve stenosis
D. Concentric left ventricular hypertrophy
D. Concentric left ventricular hypertrophy
71
```
All of the following may be measured in the cardiac catheterization laboratory when evaluating aortic stenosis EXCEPT:
A. Peak Velocity
B. MPG
C. PPG
D. Peak to peak pressure gradient
```
A. Peak velocity
72
```
Cardiac doppler parameters used to assess the severity of valvular aortic stenosis include all the following EXCEPT:
A. MPG
B. Aortic PHT
C. Peak aortic valve velocity
D. Aortic velocity ratio
```
B. Aortic PHT
73
```
The doppler max peak instantaneous peak pressure gradient in a patient with aortic stenosis is 100 mmHg. The cardiac catheterization peak to peak pressure gradient will most likely be:
A. Lower than 100 mmHg
B. Dependent upon respiration
C. Equal to 100 mmHg
D. Higher than 100 mmHg
```
A. Lower than 100 mmHg
74
```
Aortic valve with reduced systolic excursion. On physical exam there was a crescendo-decrescendo systolic ejection murmur and a diastolic decrescendo murmur heard. The most likely diagnosis is aortic valve:
A. Regurgitation
B. Stenosis and regurgitation
C. Flail
D. Stenosis and mitral valve prolapse
```
B. Stenosis and regurgitation
75
```
In the PLAX view, severe aortic valve stenosis is defined as an aortic valve leaflet separation that measures:
A. < or equal to 10 mm
B. < or equal to 8 mm
C. > or equal to 14 mm
D. < or equal to 12 mm
```
B. < or equal to 8mm
76
The 2D view which best visualizes systolic doming of the aortic valve leaflets is the:
A. Subcostal short axis view of the aortic valve
B. Parasternal short-axis view of the aortic valve
C. Apical five-chamber view
D. Parasternal long-axis view
D. Parasternal long-axis view
77
```
The murmur associated with severe aortic regurgitation is:
A. Austin-Flint
B. Graham-Steel
C. Carvallo's
D. Still's
```
A. Austin-Flint
78
The hallmark M-mode finding for aortic regurgitation is:
A. Chaotic diastolic flutter of the mitral valve
B. Coarse diastolic flutter of the anterior mitral valve leaflet
C. Systolic flutter of the aortic valve
D. Fine diastolic flutter of the anterior mitral valve leaflet
D. Fine diastolic flutter of the anterior mitral valve leaflet
79
```
The onset of the flow to peak aortic velocity CW Doppler tracing in severe valvular aortic stenosis is:
A. Decreased with expiration
B. Decreased
C. Increased with inspiration
D. Increased
```
D. Increased
80
The most common etiology of chronic aortic regurgitation is:
A. Trauma
B. Infective endocarditis
C. Dilatation of the aortic root and aortic annulus
D. Marfan's syndrome
C. Dilatation of the aortic root and aortic annulus
81
Cardiac magnetic resonance imaging provides all of the following information in a patient with aortic regurgitation EXCPET:
A. Effective regurgitant orifice
B. Regurgitant volume
C. Detailed resolution of the aortic valve
D. Left ventricular volumes
C. Detailed resolution of the aortic valve
82
```
The formula used to determine aortic valve area in the cardiac catheterization laboratory is the:
A. Bernoulli equation
B. Gorlin equation
C. Continuity equation
D. Doppler equation
```
B. Gorlin equation
83
```
Of the transvalvular pressure gradients that can be measured in the echocardiographic laboratory, the most useful in examining aortic valve stenosis is probably:
A. Peak to peak gradient
B. Mean diastolic gradient
C. Mean systolic gradient
D. Peak instantaneous pressure gradient
```
C. Mean systolic gradient
84
```
When 2D evaluation of a systolic ejection murmur reveals a thickened aortic valve with normal systolic excursion and a peak velocity across the aortic valve of 1.5 m/s. The diagnosis is most likely aortic valve:
A. Prolapse
B. Sclerosis
C. Regurgitation
D. Stenosis
```
B. Sclerosis
85
```
All of the following represents possible etiologies for acute aortic regurgitation EXCEPT:
A. Infective endocarditis
B. Aortic dissection
C. Aortic valve sclerosis
D. Trauma
```
C. Aortic valve sclerosis
86
Secondary echocardiographic findings associated with severe aortic stenosis include all of the following EXCEPT:
A. Decreased left ventricular systolic function (late in course)
B. Left ventricular hypertrophy
C. Right ventricular hypertrophy
D. Post-stenotic dilatation of the ascending aorta
C. Right ventricular hypertrophy
87
The murmur of aortic stenosis is described as:
A. Systolic ejection murmur heard best at the right upper sternal border
B. Holosystolic murmur heard best at cardiac apex
C. Diastolic rumble
D. Holodiastolic decrescendo murmur heard best at right sternal border
A. Systolic ejection murmur heard best at the right upper sternal border
88
```
The severity of aortic stenosis may be underestimated if only the maximum velocity measurement is used in the following condition:
A. Low cardiac output
B. Anemia
C. Significant aortic regurgitation
D. Doppler intercept angle of 0 degrees
```
A. Low cardiac output
89
```
The LEAST common value regurgitation found in normal patients is:
A. Aortic regurgitation
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Pulmonary regurgitation
```
A. Aortic regurgitation
90
The echocardiographer may differentiate between the similar systolic flow patterns seen in coexisting severe aortic valve stenosis and mitral regurgitation by all the following EXCEPT:
A. Aortic ejection time is shorter that the mitral regurgitation time
B. Mitral diastolic filling profile should be present during recording of the mitral regurgitation, whereas no diastolic flow is observed in aortic valve stenosis
C. Mitral regurgitation flow always lasts until mitral valve opening, whereas aortic valve stenosis
D. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis
D. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis
91
```
The pulse that is characteristic of significant valvular aortic stenosis is:
A. Pulsus paradoxus
B. Pulsus parvus et tardus
C. Pulsus bisferiens
D. Pulsus alternans
```
B. Pulsus parvus et tardus
92
```
Significant chronic pulmonary regurgitation is associated with:
A. Right ventricular volume overload
B. Right atrial hypertrophy
C. Left ventricular volume overload
D. Right ventricular hypertrophy
```
A. Right ventricular volume overload
93
```
Holodiastolic flow reversal in the descending thoracic aorta and/or the abdominal aorta may be present in each of the following EXCEPT:
A. Aortopulmonary window
B. Severe mitral regurgitation
C. Severe aortic regurgitation
D. Patent dictus arteriosus
```
C. Severe mitral regurgitation
94
The typical 2D echocardiographic findings in rheumatic tricuspid stenosis include all of the following EXCEPT:
A. Diastolic doming of the anterior tricuspid valve leaflet
B. Leaflet thickening especially at the leaflet tips and chordae tendinae
C. Systolic bowing of the posterior tricuspid valve leaflet
D. Right atrial dilatation
C. Systolic bowing of the posterior tricuspid valve leaflet
95
The severity of aortic regurgitation may best be determined with color flow doppler by all of the following methods EXCEPT:
A. Measuring the aortic regurgitation jet aliasing area in PLAX
B. Comparing the aortic regurgitation jet width with the left ventricular outflow tract width in the PLAX
C. Measuring the vena contracta in the PLAX
D. Determining the presence of holodiastolic flow reversal in the descending thoracic aorta and/or abdominal aorta
A. Measuring the aortic regurgitation jet aliasing area in PLAX
96
M-mode and 2D echocardiographic findings for the chronic tricuspid regurgitation include:
A. Right ventricular hypertrophy
B. Paradoxical interventricular septal motion
C. Protected right ventricle
D. Left ventricular volume overload
B. Paradoxical interventricular septal motion
97
```
All of the following are dilated in significant chronic tricuspid regurgitation EXCEPT:
A. Hepatic veins
B. Pulmonary veins
C. Inferior vena cava
D. Right atrium
```
B. Pulmonary veins
98
```
All of the following are considered useful quantitative measurements to determine the severity of aortic regurgitation EXCEPT:
A. Regurgitant fraction
B. Regurgitant volume
C. Effective regurgitant orifice
D. Peak velocity of aortic regurgitation
```
D. Peak velocity of aortic regurgitation
99
The CW Doppler signal of aortic regurgitation may be differentiated from the CW Doppler signal of mitral stenosis by the following guideline:
A. Cannot be differentiated by CW Doppler
B. If the diastolic flow pattern commences after mitral valve opening then the signal is due to aortic regurgitation
C. If the diastolic flow pattern commences before mitral valve opening then the signal is due to aortic regurgitation
D. The doppler flow velocity pattern of mitral valve stenosis is laminar while the Doppler flow pattern of aortic regurgitation
C. If the diastolic flow pattern commences after mitral valve opening then the signal is due to aortic regurgitation
100
The M-mode/2D echocardiography parameters that have been proposed as an indicator for aortic valve replacement in severe chronic aortic regurgitation are left ventricular:
A. End-systolic dimension greater or equal to 55mm and fractional shortening of less than or equal to 25%
B. End-diastolic dimension is greater than or equal to 55 mm and fractional shortening of less than equal to 25%
C. End-diastolic dimensions of less than or equal to 55 mm and fractional shortening of greater than or equal to 25%
D. End-diastolic dimensions greater than or equal to 70 mm and left atrial dimension greater than or equal to 55 mm
A. End-systolic dimension greater than or equal to 55mm and fractional shortening of less than or equal to 25%
101
```
Severe aortic regurgitation is diagnosed with CW Doppler by all of the following criteria EXCEPT:
A. A PHT of < 200 msec
B. A max velocity of 4 m/s
C. Increased jet density
D. Steep deceleration slope
```
B. A maximum velocity of 4 m/s
102
Cardiac doppler findings associated with significant chronic tricuspid regurgitation include all of the following EXCEPT:
A. Concave late systolic configuration of the regurgitation signal
B. Systolic flow reversal in the pulmonary vein
C. Systolic flow reversal in the hepatic vein
D. Increased E velocity of the tricuspid valve
B. Systolic flow reversal in the pulmonary vein
103
```
The mitral valve PW Doppler flow pattern often associated with severe acute aortic regurgitation is grade:
A. Normal for age
B. II (pseudomormal)
C. III or IV (restrictive)
D. I (impaired relaxation)
```
C. III or IV (restrictive)
104
The murmur of tricuspid regurgitation is best described as:
A. Holodiastolic murmur heard best at the lower left sternal border
B. Pansystolic murmur heard best at the cardiac apex with radiation to the axilla
C. Systolic ejection murmur heard best at the upper right sternal border
D. Pansystolic murmur best heard at the lower left sternal border
D. Pansystolic murmur best heard at the upper right sternal border
105
```
Echocardiographic evidence of severe acute aortic regurgitation includes all of the following EXCPET:
A. Premature opening of the mitral valve
B. Reverse doming of the AMVL
C. Premature closure of the mitral valve
D. Premature opening of the aortic valve
```
A. Premature opening of the mitral valve
106
An intracardiac pressure that may be determined from the CW Doppler tricuspid regurgitation signal is:
A. Pulmonary artery end diastolic pressure
B. Mean pulmonary artery pressure
C. Systolic pulmonary artery pressure
D. Systemic vascular resistance
C. Systolic pulmonary artery pressure
107
```
The M-mode finding that indicates severe acute aortic regurgitation is premature aortic valve:
A. Closure
B. Systolic flutter
C. Mid-systolic closure
D. Opening
```
D. Opening
108
```
The pulmonary vein atrial reversal wave may be ____ in peak velocity and duration in a patient with severe acute aortic regurgitation.
A. Decreased
B. Increased
C. Unchanged
D. Reversed
```
B. Increased
109
Methods for determining the severity of tricuspid regurgitation with PW Doppler include all of the following EXCEPT:
A. Peak velocity of the tricuspid regurgitant jet
B. Laminar flow of the tricuspid regurgitant jet
C. Holosystolic flow reversal of the hepatic vein
D. Increased E wave velocity of the tricuspid valve
A. Peak velocity of the tricuspid regurgitant jet
110
```
Premature closure of the mitral valve is associated with all of the following EXCEPT:
A. Acute severe aortic regurgitation
B. Loss of sinus rhythm
C. First-degree atrioventricular block
D. Acute severe mitral regurgitation
```
D. Acute severe mitral regurgitation
111
```
The most common cause of chronic tricuspid regurgitation is:
A. Tricuspid valve prolapse
B. Ebstein's anomaly
C. Rheumatic heart disease
D. Pulmonary hypertension
```
D. Pulmonary hypertension
112
```
Posterior displacement of the aortic valve leaflet(s) into the left ventricle outflow tract during ventricular diastole is called aortic valve:
A. Prolapse
B. Perforation
C. Stenosis
D. Sclerosis
```
A. Prolapse
113
```
The most common etiology of pulmonary regurgitation is:
A. Pulmonary hypertension
B. Rheumatic heart disease
C. Carcinoid heart disease
D. Infective endocarditis
```
A. Pulmonary hypertension
114
In significant chronic aortic regurgitation, M-mode and 2D evidence includes all of the following EXCEPT:
A. Hyperkinesis of the posterior (inferolateral) wall of the left ventricle
B. Left ventricular dilatation
C. Paradoxical interventricular septal motion
D. Hyperkinesis of the interventricular septum
C. Paradoxical interventricular septal motion
115
```
A tricuspid regurgitation peak velocity of 3.0 m/s is obtained. This indicates:
A. Pulmonary hypertension
B. Severe tricuspid regurgitation
C. Mild tricuspid regurgitation
D. Moderate tricuspid regurgitation
```
A. Pulmonary hypertension
116
All of the following are cardiac doppler findings for tricuspid valve stenosis EXCEPT:
A. Decreased PHT
B. Decreased tricuspid valve area
C. Increased MPG
D. Increased tricuspid valve E wave velocity
A. Decreased PHT
117
```
The most common etiology of tricuspid stenosis is:
A. Rheumatic fever
B. Carcinoid heart disease
C. Right atrial myxoma
D. Infective endocarditis
```
A. Rheumatic fever
118
```
In a patient with severe acute aortic regurgitation the left ventricular end-diastolic pressure increases rapidly. This pathophysiology will affect which of the following?
A. Closure of the mitral valve
B. Closure of the pulmonary valve
C. Left ventricular dimension
D. Systolic ejection period
```
A. Closure of the mitral valve
119
```
Signs of significant tricuspid regurgitation include all of the following EXCEPT:
A. Pulsus paradoxus
B. Right ventricular heart failure
C. Jugular venous distension
D. Hepatomegaly
```
A. Pulsus Paradoxus
120
```
Possible echocardiographic and cardiac Doppler findings in a patient with carcinoid heart disease include all of the following EXCEPT:
A. Pulmonary regurgitation
B. Tricuspid regurgitation
C. Tricuspid valve prolapse
D. Tricuspid stenosis
```
C. Tricuspid valve prolapse
121
```
Causes of anatomic tricuspid regurgitation include all of the following EXCEPT:
A. Infective endocarditis
B. Pulmonary hypertension
C. Carcinoid heart disease
D. Ebstein's anomaly
```
B. Pulmonary hypertension
122
All of the following color flow doppler findings indicate significant pulmonary regurgitation EXCEPT:
A. Wide jet width at origin
B. Jet width/Right ventricular outflow tract width >70%
C. Peak velocity of < 1.0 m/s
D. Holodiastolic flow reversal in the main pulmonary artery
C. Peak velocity of < 1.0 m/s
123
```
Cardiac doppler evaluation of a prosthetic mitral valve should include all of the following EXCEPT:
A. Peak mitral valve A wave velocity
B. Effective orifice area
C. Peak and mean pressure gradients
D. Pressure half-time
```
A. Peak mitral valve A wave velocity
124
```
Abnormal rocking motion of a prosthetic valve by 2D echocardiography indicates prosthetic valve:
A. Thrombus
B. Vegetation
C. Dehiscence
D. Stenosis
```
C. Dehiscence
125
```
All of the following should be determined when evaluating a prosthetic valve with cardiac doppler EXCEPT:
A. Mean pressure gradient
B. Effective orifice area
C. Peak velocity
D. Shunt ratio
```
D. Shunt ratio
126
```
A patient with a history of intravenous drug abuse presents to the echocardiography lab with complaints of fever, night sweats and weight loss. The most likely explanation is:
A. Infective endocarditis
B. Congestive heart failure
C. Coronary artery disease
D. Kawasaki disease
```
A. Infective endocarditis
127
Which of the following pressures can be predicted when measuring the pulmonary regurgitation end-diastolic velocity?
A. Pulmonary artery end-diastolic pressure
B. Mean pulmonary artery pressure
C. Systolic pulmonary artery pressure
D. Right ventricular systolic pressure
A. Pulmonary artery end-diastolic pressure
128
The best doppler method for evaluating aortic valve replacement is probably:
A. Deceleration slope
B. Velocity ratio
C. Max peak instantaneous pressure gradient
D. Pressure half-time
B. Velocity ratio
129
```
The classic manifestation of infective endocarditis is cardiac valve:
A. Doming
B. Vegetation
C. Sclerosis
D. Tumor
```
B. Vegetation
130
```
The test of choice for diagnosing the presence of the vegetation and the complications of infective endocarditis is:
A. Transesophageal echocardiography
B. Cardiac catheterization
C. Cardiac MRI
D. Transthoracic echocardiography
```
A. Transesophageal echocardiography
131
```
The most common ball and cage valve is the:
A. Omniscience
B. Medtronic-Hall
C. Starr-Edwards
D. St. Jude
```
C. Starr-Edwards
132
```
Which of the following pressures may be calculated when measuring the peak velocity of pulmonary regurgitation?
A. Pulmonary wedge pressure
B. Right ventricular systolic pressure
C. Systolic pulmonary artery pressure
D. Mean pulmonary artery pressure
```
D. Mean pulmonary artery pressure
133
```
All of the following are mechanical valves EXCEPT:
A. Hancock
B. CarboMedics
C. St. Jude
D. Starr-Edwards
```
A. Hancock
134
```
The vegetation diameter as determined by 2D echocardiography that is most often associated with symmetric emboli is:
A. 3 mm
B. 5 mm
C. 10 mm
D. 7 mm
```
C. 10 mm
135
All of the following are true statements concerning prosthetic valves EXCEPT:
A. Prosthetic valve peak velocities are generally higher as compared to normal native valves
B. Velocities depend upon the size and type of prosthetic valve
C. Prosthetic valve regurgitation is always normal
D. A baseline study should be obtained post-surgery
C. Prosthetic valve regurgitation is always abnormal
136
```
The best doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is:
A. 4 x (V2)2
B. (CSALVOT X VTILVOT) / VTIMV
C. 4 x (V22 - V12)
D. 220 / PHT
```
B. (CSALVOT X VTILVOT) / VTIMV
137
```
The best doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is:
A. 4 x (V2)2
B. (CSALVOT X VTILVOT) / VTIMV
C. 4 x (V22 - V12)
D. 220 / PHT
```
B. (CSALVOT X VTILVOT) / VTIMV
138
```
All of the following are bioprosthetic (tissue) valves EXCEPT:
A. Medtronic intact
B. Hancock
C. Edwards Perimount
D. Starr-Edwards
```
D. Starr-Edwards
139
The usual site of attachment for vegetations on the mitral valve and tricuspid valve is the:
A. Papillary muscles
B. Annulus
C. Ventricular surface of the valve leaflets
D. Atrial side of the valve leaflets
D. Atrial side of the valve leaflets
140
```
The essential 2D echocardiographic finding of valve ring abscess secondary to infective endocarditis may best be described as:
A. Echolucent
B. Pedunculated
C. Sessile
D. Mural
```
A. Echolucent
141
```
Infective endocarditis is a greater risk in patients with:
A. Atrial fibrillation
B. Coronary artery disease
C. Prosthetic heart valve
D. Left ventricular aneurysm
```
C. Prosthetic heart valve
142
```
The most common symptom of infective endocarditis is:
A. Chest pain
B. Fatigue
C. Orthopnea
D. Fever
```
D. Fever
143
```
Which two cardiac valves need to be evaluated carefully in a patient with the Ross procedure?
A. Mitral valve, Aortic valve
B. Mitral valve, tricuspid valve
C. Aortic valve, tricuspid valve
D. Aortic valve, pulmonary valve
```
D. Aortic valve, Pulmonic valve
144
```
The most common bileaflet tilting disc valve is the:
A. Medtronic-Hall
B. Omniscience
C. St. Jude
D. Starr-Edwards
```
C. St Jude
145
```
The primary disadvantage of the bioprosthetic (tissue) valve is:
A. Lack of durability
B. Dehiscence
C. Pannus formation
D. Thrombus formation
```
A. Lack of durability
146
```
This excessive ingrowth of tissue for a prosthetic valve is called:
A. Vegetation
B. Dehiscence
C. Thrombus
D. Pannus
```
D. Pannus
147
```
The complications of infective endocarditis include all of the following EXCEPT:
A. Embolization
B. Valve ring abscess
C. Congestive heart failure
D. Annular calcification
```
D. Annular calcification
148
```
Valve ring abscess is usually caused by:
A. Infective endocarditis
B. Rheumatic fever
C. Valvular prolapse
D. Valvular regurgitation
```
A. Infective endocarditis
149
```
Complications associated with prosthetic valve dysfunction include all of the following EXCEPT:
A. Leaflet degeneration
B. Dehiscence
C. Thrombosis
D. Tumor
```
D. Tumor
150
```
A prosthetic heart valve that is associated with a relatively high rate of outlet strut fracture and disc embolism is the:
A. Starr-Edwards
B. Omniscience
C. Bjork-Shirley
D. Carpentier-Edwards
```
C. Bjork-Shirley
151
```
A pulmonic valve relocated to the aortic valve position is called a(n):
A. Allograft
B. Autograft
C. Xenograft
D. Heterograft
```
B. Autograft
152
```
The determination of prosthetic mitral valve regurgitation and prosthetic tricuspid valve regurgitation is made difficult by the artifact called:
A. Enhancement
B. Slice thickness
C. Shadowing
D. Mirroring
```
C. Shadowing
153
```
The primary disadvantage of the mechanical valve is:
A. Pannus ingrowth
B. Thrombogenicity
C. Durability
D. Dehiscence
```
B. Thrombogenicity
