Dewitt 1-4 Test Flashcards by Rebekah Greenway

Your patient is a 42 year old female whose physician has ordered an echocardiogram for evaluation of shortness of breath. Her LVIDd measures 4.5cm. This qualifies as…

normal or abnormal?

normal

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Your patient is a 77 year old person whose physician ordered an echocardiogram for shortness of breath. You measure the peak tricuspid regurgitation velocity at 4m/s. What is the pressure gradient using the simplified Bernoulli equation?

a) 20
b) 16
c) 12
d) 64

d) 64

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The normal left ventricular diastolic wall thickness is_____________.

a) 6-10 mm (men)
b) 6-10 mm (women)
c) 6-12 mm (women)
d) 6-12 mm (men)

a) 6-10mm (men)

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Typically, the transducer is oriented toward the patient’s left shoulder during the ______________.

a) A4C
b) LAX RVIT
c) A3C
d) PSAX

d) PSAX

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Which of the following statements are true regarding the right ventricle? Choose 2.

a) it is the most anterior chamber
b) it has thick walls compared to the LV
c) it is trabeculated
d) it is larger than the LV
e) it is the most posterior chamber

a) it is the most anterior chamber
c) it is trabeculated

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At what point in the cardiac cycle are measurements of the LVOT diemeter taken?

a) mid-systole
b) end-systole
c) onset of systole
d) peak- systole

a) mid-systole

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Your patient is a 35 year old male. The main pulmonary artery measures 2.9cm in the parasternal short axis view. This measurement is _____________.

a) normal
b) mildly dilated
c) moderately dilated
d) severely dilated

a) normal

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Which view is the best to evaluate the thickness of the RV wall?

a) Parasternal long axis
b) Subcostal 4 chamber
c) Apical 4 chamber
d) Parasternal short axis

b) Subcostal 4 chamber

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Identify this echocardiography view and level.

SAX Mid or Papillary level

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What vessel is being sampled in this image? Be specific.

Descending Aorta

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Choose all structures that can be visualized in the PSAX view at the level of the aorta.

pulmonary artery
interatrial septum
sinus of valsalva
acending aorta
mitral valve

Sinus of Valsalva
Interatrial septum
Pulmonary artery

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What is the position of the indicator notch when acquiring a subcostal 4 chamber view?

The indicator notch should be towards the patient’s left side when acquiring a subcostal 4 chamber view.

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The _____________ and ________________ tricuspid valve leafletes are visualized in the LAX RVIT.

a) anterior/medial
b) anterior/inferior
c) medial/posterior
d) anterior/posterior

d) anterior/posterior

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T/F A normal range of LV ejection fraction for individuals age 20 and over is 85-100%.

FALSE

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Which view is best for doppler evaluation of the pulmonary valve.

a) subcostal 4 chamber
b) parasternal short axis
c) apical 4 chamber
d) suprasternal notch

b) parasternal short axis

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Which number(s) below are part of the interventricular septum?

3&8

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What structure is being identified at the yellow arrow in this apical 4 chamber view of the right heart?

a) foramen ovale
b) SVC
c) coronary sinus
d) eustacian valve

c) coronary sinus

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The measurement arrow is in the ______ in this _____.

IVC, Subcostal

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What view is being demonstrated?

a) Apical 2
b) Apical 4
c) Apical 3
d) Apical 5

c) Apical 3

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End systole is captured when the _________.

a) left ventricle is at its smallest dimension
b) mitral valve just opened
c) aortic valve just opened and mitral valve just closed
d) left ventricle is at its largest dimension

a) left ventricle is at its smallest dimension

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When visualizing a normal IVC you should be able to detect a __________ collapse with inspiration.

a) 50%
b) 30%
c) 75%
d) 25%

a) 50%

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Identify the structure at the gold arrow.

a) LVPW
b) AMVL
c) Pericardium
d) PMVL

d) PMVL

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What structure in this image is being evaluated with color flow Doppler?

a) RVOT
b) RVIT
c) LVIT
d) LVOT

a) RVOT

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Explain the significance of measuring LV ejection fraction in cardiac sonography.

LV ejection fraction is an important parameter that indicates how well the heart is functioning by showing the percentage of blood pumped out of the left ventricle with each heartbeat. It helps in assessing cardiac performance and identifying potential heart conditions.

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List 2 ways to increase the frame rate of a color Doppler image.

Decrease sector width write zoom decrease depth

Which is the best method to calculate the left ventricular ejection fraction? a) Visual Estimate b) Modified Simpson's rule c) Modified Bernoulli d) Teicholtz Method

b) Modified Simpson's rule

What structure is denoted by number 4?

anterior leaflet

Which of the following measurments is taken with a leading edge to leading edge technique. a) LVOT b) LA c) RVOT d) Aortic Valve Annulus

b) LA

Chordae tendineae a) Fibrous cords that connect the papillary muscles to the tricuspid and mitral valves. b) Carries deoxygenated blood from the right ventricle to the lungs. c) Valve that allows blood to flow from the left ventricle into the aorta. d) The outermost layer of the heart.

a) Fibrous cords that connect the papillary muscles to the tricuspid and mitral valves.

Pulmonary artery a) Fibrous cords that connect the papillary muscles to the tricuspid and mitral valves. b) Carries deoxygenated blood from the right ventricle to the lungs. c) Valve that allows blood to flow from the left ventricle into the aorta. d) The outermost layer of the heart.

b) Carries deoxygenated blood from the right ventricle to the lungs.

Aortic valve a) Fibrous cords that connect the papillary muscles to the tricuspid and mitral valves. b) Carries deoxygenated blood from the right ventricle to the lungs. c) Valve that allows blood to flow from the left ventricle into the aorta. d) The outermost layer of the heart.

c) Valve that allows blood to flow from the left ventricle into the aorta.

Epicardium a) Fibrous cords that connect the papillary muscles to the tricuspid and mitral valves. b) Carries deoxygenated blood from the right ventricle to the lungs. c) Valve that allows blood to flow from the left ventricle into the aorta. d) The outermost layer of the heart.

d) The outermost layer of the heart.

Your patient is a 53 year old female. Her IVC measures 2.5cm and does not collapse with inspiration. What is her estimated right atrial pressure? a) 15mmHg b) 3mmHg c) 8mmHg

a) 15mmHg

What is the minimum acceptable frame rate for color Doppler imaging echocardiography? a) 10Hz b) 15Hz c) 20Hz d) 30Hz

c) 20Hz

Which cardiac window provides the best opportunity to evaluate blood flow across the interatrial septum? a) Subcostal b) Parasternal c) Right sternal border d) Apical

a) Subcostal

When measuring an element of time on spectral Doppler, what is the minimum acceptable setting for the sweep speed? a) 75 b) 150 c) 100 d) 50

c) 100

Identify this view

Apical Long (A3C)

Identify this view

Parasternal Short Axis

Identify this view

Subcostal

Identify this view

Suprasternal Notch

What echocardiographic window is used to create this image?

Suprasternal Notch (SSN)

Choose all of the views that can be imaged in the subcostal window. (Choose 4) RVIT long axis descending aorta IVC short axis 4 chamber

descending aorta IVC 4 chamber

What is the normal range of LV ejection fraction for age 20 and over? a) 60-100% b) 53-73% c) 25-55% d) 80-100%

b) 53-73%

Choose measurements that are taken at end diastole. Choose 3. RV width Ascending aorta LVOT LA internal dimension LV internal dimension

LV internal dimension RV width Ascending aorta

Calculate the ejection fraction with the following data: End diastolic volume 75mL End systolic volume 30mL

(75-30) / 75 * 100 = 60%

The normal mean left atrial pressure is comparable to the __________________. a) left ventricle diastolic pressure b) pulmonary artery systolic pressure c) aorta systolic pressure d) left ventricular systolic pressure

a) left ventricle diastolic pressure

Where do the coronary arteries originate? a) sinus of valsalva b) ascending aorta c) left ventricular outflow tract d) coronary sinus

a) sinus of valsalva

Steerable with a sample gate and the potential for aliasing describes__________. a) pulsed wave doppler b) non-imaging CW doppler. c) non-imaging pulsed wave doppler d) continuous wave doppler

a) pulsed wave doppler

label anatomy

During ______________________,all four valves are closed and the ventricular pressure is at it's lowest. a) isovolumic relaxation b) diastole c) systole d) isovolumic contraction

a) isovolumic relaxation

The _____________ is the main pumping mechanism of the heart. a) endocardium b) myocardium c) pericardium d) epicardium

b) myocardium

The volume of blood the left ventricle pumps each minute is ______________. a) heart rate b) stroke volume c) cardiac output d) cardiac index

c) cardiac output

The optimal angle for doppler of cardiac bloodflow is __________. a) 60 degrees b) 45 degrees c) 0 degrees d) 30 degrees

c) 0 degrees

Which phase of the cardiac cycle is represented within the yellow brackets? a) ventricular diastole b) vetricular systole c) atrial diastole d) atrial systole

d) atrial systole

Identify the cardiac cycle indicated by the letter C. a) isovolumic relaxation time b) end-systole c) isovolumic contraction time d) end diastole

a) isovolumic relaxation time

The left atrium is the most ______ chamber of the heart and delivers ______of the left ventricle filling. a) posterior / 15-30% b) medial / 22.5% c) anterior / 20-30% d) inferior / 15-30%

a) posterior / 15-30%

The largest volume in the heart during the cardiac cycle is known as the ___________. a) end-systolic volume b) rapid early filling c) early-diastolic volume d) end-diastolic volume

d) end-diastolic volume

What is the normal mean right atrial pressure and O2 saturation. a) 4-12 mmHg 50% b) 2-8 mmHg, 50% c) 2-8 mmHg , 75% d) 4-12 mmHg, 75%

c) 2-8 mmHg , 75%

During early diastole, the left ventricular pressure is at it's ________ and the ventricles experience __________. a) lowest / rapid filling b) lowest / rapid ejection c) highest / rapid filling d) highest / rapid ejection

a) lowest / rapid filling

The EKG p wave represents____________. a) mechanical ventricular systole b) electrical ventricular diastole c) ventricular depolarization d) electrical atrial systole (depolarization)

d) electrical atrial systole (depolarization)

List 5 indications for an adult transthoracic echocardiogram.

valvular heart disease ischemic heart disease, cardiomyopathy, heart failure, infective endocarditis, source of embolus, prosthetic valve, myocaditis, pericarditis, pericardial effusion, myxoma, disorder of the aorta, congenital heart disease

What is identified by the letter K on this image?

interventricular septum

Which ventricle operates at a lower pressure?

Right

_____________ is the volume of blood ejected from the heart. a) Cardiac output b) Stroke volume c) Cardiac index d) Body surface area

b) Stroke volume

The PEDOF probe is a __________ probe used to identify ___________. a) non-imaging CW / high velocities b) non-imaging CW / low velocities c) non-imaging PW / high velocities d) non-imaging PW/ low velocities

a) non-imaging CW / high velocities

What structure is identified at arrow # 4 ?

left main coronary artery

What is the normal pressure in the Aorta? a) 15-25 mmHg b) 60-110 mmHg c) 90-150 mmHg d) 80-120 mmHg

d) 80-120 mmHg

This image of the heart is a _______view taken from the _________ of the heart.

PSAX/base

Calculate the stroke volume End diastolic volume 105mL End systolic volume 35mL Heart Rate 70bpm

70mL/sec

The volume of blood in the heart at end-diastole is ______________. a) cardiac ejection fraction b) afterload c) preload d) cardiac volume

c) preload

Which color represents toward the probe flow on echocardiography?

Red

What structure is identified at the red arrow? a) chordae tendineae b) anterior tricuspid leaflet c) anterior mitral valve leaflet d) posterior mitral valve leaflet

c) anterior mitral valve leaflet

The inner layer of the heart which also lines the cardiac valves is the_______________. a) pericardium b) epicardium c) endocardium d) myocardium

c) endocardium

What structure receives most of the venous blood from the heart muscle and empties into the right atrium? a) coronary sinus b) great cardiac vein d) coronary arteries e) pulmonary veins

a) coronary sinus

The _________is the primary pacemaker of the heart and is located at the border of the ____________. a) SA node / superior vena cava and right atrium b) AV node / inferior vena cava and right atrium c) AV node/ superior vena cava and right atrium d) SA node / inferior vena cava and right atrium

a) SA node / superior vena cava and right atrium

What is directly regulated by the autonomic nervous system? a) blood volume b) heart rate c) ejection fraction d) rapid filling

b) heart rate

Identify the echocardiographic window at the letter D. a) epigastric b) suprahepatic c) subcostal d) substernal

c) subcostal

Which valve(s) are open during systole? a) tricuspid and pulmonic b) aortic valve only c) aortic and pulmonic d) aortic and mitral

c) aortic and pulmonic

The range of frequecies for transthoracic cardiac imaging of adults is_______________. a) 3-7 MHz b) 2-5 MHz c) 2-10 MHz d) 5-10 MHz

b) 2-5 MHz

Pick the best descriptor of this image. a) B-Mode Color Map b) Color velocity c) Spectral scale d) Variance color map

d) Variance color map

A steerable mode capable of detecting both low and high velocity flow, that acquires data all along the ultrasound beam. This definition best fits which term? a) Color flow Doppler b) Continuous wave doppler c) B-Mode imaging d) Pulsed wave doppler

b) Continuous wave doppler

Normally the dominant pacemaker of the heart is the__________________. a) Purkinje fibers b) bundle His c) SA node d) AV node

c) SA node

The coronary sinus is positioned along the ________________. a) middle cardiac vein b) posterior atrioventricular groove c) great cardiac vein d) anterior atrioventricular groove

b) posterior atrioventricular groove

The left heart is a___________________. a) pulmonary circulatory system b) high resistance system c) low oxygen saturation system d) low pressure system

b) high resistance system

The ______________ is another name for the right ventricular outflow tract. a) tricuspid apparatus b) right ventricular canal c) infundibulum d) moderator band

c) infundibulum

What's the pressure for chamber or vessel: Q

<120/<80 mmHg

What's the pressure for chamber or vessel: R

2-8 mmHg

What's the pressure for chamber or vessel: S

15-25/ 4-12 mmHg

What's the pressure for chamber or vessel: T

2-12 mmHg

What's the pressure for chamber or vessel: U

15-25/2-8 mmHg

What's the pressure for chamber or vessel: V

<120/3-12 mmHg

the Cardiac Cycle Component: G

AV valves close / first heart sound

the Cardiac Cycle Component: D

Mechanical ventricular diastole

the Cardiac Cycle Component: I

Rapid early filling/ third heart sound

the Cardiac Cycle Component: E

SL valves open/ systole

The blood travels from the aorta to the _______. a) veins, venules, capillaries, arteries, arterioles b) ateries, arterioles, capillaries, venules, veins c) cappillaries, arterioles, venules, veins d) arterioles, arteries, venules, veins

b) ateries, arterioles, capillaries, venules, veins

The anterior surface of the heart is made up of almost entirely of the ___________. a) right ventricle b) left atrium c) right atrium d) left ventricle

a) right ventricle

The largest volume in the heart during the cardiac cycle is known as the _____________. a) early-diastolic volume b) end-systolic volume c) end-diastolic volume d) rapid early filling

c) end-diastolic volume

Differentiate between the systemic circulatory system and the pulmonary circulatory system and describe how they work together.

While they are different, they work together to ensure the body with enough oxygen and nutrients while taking away the wastes in order to keep the body functioning properly through a unique circulatory fashion. The systemic circulatory system carries oxygenated blood from the heart through the body after the exchange in the capillaries it then becomes part of the pulmonary system where deoxygenated blood is then carried back to heart which then pushes it to the lungs to gather oxygen just to start the circulatory all over again.

The normal mean left atrial pressure is comparable to the __________________. a) left ventricular systolic pressure b) pulmonary artery systolic pressure c) left ventricle diastolic pressure d) aorta systolic pressure

c) left ventricle diastolic pressure

List the 4 heart wall layers from inner to outer layer.

endocardium, myocardium, epicardium, pericardium

The heart is enclosed in the _______, a fluid filled sac that protects it against infection and trauma. a) endocardium b) pericardium c) myocardium d) epicardium

b) pericardium

What is being measured at line #3? At what point in the cardiac cycle is this measurement performed?

RV length end diastole

Which two aortic valve leaflets are visualized in the apical 5 chamber view? a) LCC & RCC b) RCC & NCC c) NCC & LCC

b) RCC & NCC

Identify the level of the LV at the blue box, yellow box and red box.

basal-blue Mid-yellow Apical-red

What view is being demonstrated? a) Apical 5 b) Apical 3 c) Apical 4 d) Apical 2

b) Apical 3

Identify the anatomy.

1. IVS 2. LV APEX 3. RA

What structure in this image is being evaluated with color flow Doppler? a) LVOT b) RVOT c) LVIT d) RVIT

a) LVOT

How would you manipulate the transducer to get from an Apical 4 chamber view to this view? a) tilt the transducer toward the left side b) move to another window c) rotate 45 degrees clockwise d) rotate 60-90 degrees counter-clockwise

d) rotate 60-90 degrees counter-clockwise

When assessing the ascending aortic flow in the suprasternal notch view, which direction will the be? a) Toward the probe, above the baseline b) Toward the probe, below the baseline c) Away from the probe, above the baseline d) Away from the probe, below the baseline

a) Toward the probe, above the baseline

The right sternal border view best evaluates which structure? a) Ascending aorta b) Descending aorta c) Abdominal aorta d) Left atrium

a) Ascending aorta

What is being assessed with color flow Doppler in this image? a) Interatrial septum b) Interventricular septum c) Tricuspid valve d) Aortic valve

c) Tricuspid valve