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I & M II > Echography/Echocardiography > Flashcards

Echography/Echocardiography Flashcards

1
Q

What occurs to amplitude of a sound wave as distance from the sound source increases?

A

Amplitude (diagonal line) diminishes with distance from the sound source.

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2
Q

What is amplitude in ultrasound a measure of?

A

tissue compression

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3
Q

Sound waves generated from the pizoelectric crystals in the transducer are transmitted into the surrounding medium at what rate?

A

proportional to the speed of sound in that medium

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4
Q

What can be determined from the time required of the sound wave to travel from the transducer to the object and back?

A

distance of object from transducer

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5
Q

Label

A
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6
Q

What occurs to ultrasound waves as they strike an interface between two different tissue types? (5)

A
  • Specular reflection
  • Refraction
  • Absorption
  • Scatter
  • Acoustic impedance
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7
Q

_________ type transducers aid in placement of peripheral lines.

A

Linear array

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8
Q

In a linear array transducer, what are the near and far fields?

A

Near field is the columnar portion of the beam.

Far field is the diverging segment.

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9
Q

What MHz is needed to see a baby for instance?

What MHz is needed to see a vessel?

A

Less MHz, ~3.5

Higher MHz, ~8

Note: See picture to help visualize.

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10
Q

As an object approaches, the apparent frequency increases as object moves toward you. This is known as the _________.

A

Doppler effect

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11
Q

What are 3 characteristics of the waveforms as an object approaches a person, for example?

A

increased frequency

increased pitch

compressed wavelength

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12
Q

What are 3 characteristics of the waveforms as an object moves away from a person, for example?

A

decreased frequency

decreased pitch

elongated wavelength

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13
Q

The movement of red blood cells, frequency transmitted by a tranducer, velocity of RBCs, and speed of ultrasound in blood is known as:

A

Doppler shift

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14
Q

The doppler shift is directly proportional to the ________.

A

velocity of the moving target

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15
Q

If the target is stationary, what will frequency reflected (fr) and frequency transmitted (ft) be?

A

fr = ft

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16
Q

If the target is moving toward the transducer, what will ft and fr be?

A

fr > ft

Note: r is reflected, t is transmitted.

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17
Q

If the target is moving away from the transducer, what will fr and ft be?

A

fr < ft

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18
Q

How do you calculate doppler shift?

A

fr - ft

frequency (reflected - transmitted)

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19
Q

Accurate measurement of blood flow velocity utilizing the Doppler effect requires careful alignment of the interrogating beam __________ to the direct of blood flow.

A

parallel

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20
Q

What are the two types of Doppler?

A

_continuous _

pulsed wave

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21
Q

Why were pulsed wave transducers developed?

A

Continuous wave failed to provide information on distance of target to the transducer.

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22
Q

How does a pulsed wave transducer operate?

A

The transmitter beam (ft) is emitted in short bursts and the returning echoes (fr) are received by the same transducer.

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23
Q

Because the speed of sound in tissues is nearly constant, the area of interest for pulsed wave Doppler can be selected by what?

A

time gating the returning signals–only accepting echo information that required the “correct” amount of time to return from the target

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24
Q

What is the main drawback to pulsed wave Doppler?

A

higher blood flow velocities cannot be accurately measured

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25
Q

When must continuous wave doppler be used?

A

To accurately measure high peak blood flow velocities through a valvular lesion like aortic stenosis, for example.

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26
Q

How is cross sectional area of a vessel calculated?

A

gated doppler

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27
Q

Ultrasonic waves pass poorly through _____ and are nearly entirely reflected by ________.

A

air

dense tissues–such as bone, calcium deposits, and metal

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28
Q

What does near total reflection of transmitted echo signals result in?

A

Objects beyond the reflecting boundary such as bone, calcium, and metal will not be imaged resulting in “echo shadowing”

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29
Q

How can the resolution of objects be improved by ultrasound imaging?

A

higher frequency sound waves

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30
Q

What occurs as a result of increasing the frequency of sound waves to improve resolution?

A

The depth of tissue penetration is a trade-off.

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31
Q

Label the echo image of the heart:

A
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32
Q

Sound travels faster in water than in blood or bone. True or false?

A

False

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33
Q

Depth of penetration is directly proportional to _________.

A

wavelength

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34
Q

What does 1 depict?

A

Plane 1 depicts the parasternal long-axis view

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35
Q

What view is depicted?

In what state is the heart in?

Identify the chambers.

A

parasternal long axis view

LV in diastole, atrial systole

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36
Q

What is depicted?

A

fetus

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37
Q

What is depicted?

A

LV systole, or, atrial diastole

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38
Q

What are the types of ultrasound resolutions? (4)

A

Axial

Lateral

Temporal

Contrast

39
Q

Which resolution distinguishes blood/bone?

Velocity?

A

contrast

temporal

40
Q

What is TGC?

A

time gain compensation

Since the signal weakens with distance in tissue, time-gain can be used to improve the image by making it brighter.

41
Q

What are the different echography image formats? (4)

A

A-mode

M-mode

B-mode

Doppler

42
Q

What is echography format A-mode?

A

It is the simplest form of interpretation where wave is sent along a single scan line.

Used in opthalmology to assess axial length of the eye.

43
Q

What is ultrasound format M-mode?

A

motion mode

Assesses function of moving parts of the heart.

44
Q

What is ultrasound format B-mode?

A

brightness mode

Gives 2-D representations of slices of tissue by summation of the returns from multiple scan lines. Good for guiding invasive procedures.

45
Q

What is Doppler mode?

A

Assesses velocities of blood flow

Helps with line placement, for example.

46
Q

What mode is depicted?

What does an increase in amplitude indicate?

A

A Mode

Strong specular reflection

47
Q

What mode is depicted?

A

B Mode

2-Dimensional image is composed of pixels

48
Q

Identify the arrows:

A

LV in systole is the shorter arrow

LV in diastole is the longer arrow

49
Q

What mode is being utilized?

A

B-mode (2-D mode)

50
Q

What did contrast echo formally utilize to produce images?

A

Air, but now use oil

51
Q

What is depicted?

In what motions can the probe move?

A

Transesophageal echo

Flexion, rotation

52
Q

What part of the TEE is the arrow pointing to?

A

transducer that contains a round phased array of pizoelectric crystals

53
Q

What does piezo-electric mean?

A

pressure-electric

54
Q

What type of array is depicted and in what type of equipment is it used in?

A

Phased array

TEE which alows it to undergo shape changes.

55
Q

What is this picture telling us about phased array TEE?

A

sweeping motion even though moved in a linear array

56
Q

A phased array TEE scanning from left to right and back enable what to be imaged?

A

a volume of tissue

57
Q

A ____________ is produced by phased excitation of the transducers in a phased array TEE.

A

focused beam

58
Q

The phased array TEE projects a _________.

A

3-dimensional beam

59
Q

What flexing motions can the TEE undergo?

A

Anteflex
Retroflex
Flex to left
Flex to right

60
Q

What is the flex angulation the TEE can achieve?

What is the rotation angulation the TEE can achieve?

A

90º

180º

61
Q

Label the TEE probes and identify the arrows

A

T = transverse plane

L=longitudinal

62
Q

What part of the heart will be captured in the apex of the image sector?

Will the image be in the transverse or longitudinal plane?

A

The apex of the sector will project the inferior portion of the heart.

transverse

63
Q

What are the following positions called?

I
II
III

A

I. Basal short-axis

II. Four-chamber (long-axis)

III. Transgastric short-axis

64
Q

What position is the TEE with this view of the heart?

A

I. basil short-axis

65
Q

What position is the TEE with this view of the heart?

A

II. Four-chamber long axis

66
Q

What position is the TEE with this view of the heart?

A

III. Transgastric short-axis

67
Q

What position is the TEE with this view?

A

I. with longitudinal axis

68
Q

What position is the TEE with this view?

A

II. in longitudinal view

69
Q

What position is the TEE with this view?

A

III with longitudinal view

70
Q

What view is achieved by advancing the probe 1-2cm further from the four-chamber view and retroflexing 10-30º?

Will the probe be higher or lower in the esophagus?

A

A four-chamber view that can better identify arrhythmias, atrial dilation, and thrombi.

Higher

71
Q

Short or long axis?

A

Long

72
Q

Short or long axis?

A

Long

73
Q

Short or long axis?

A

Short

74
Q

Short or long axis?

A

Short

75
Q

Short or long axis?

A

Short

76
Q

What can be evaluated with respect to cardiac function with a TEE? (7)

A

Cardiac Output and Stroke Volume
Ejection Fraction
Contractility
Wall Thickness
Wall Motion
Preload
Pulmonary Blood Flow

77
Q

What equation can be used to get the pressure gradient across any restrictive orifice?

A

Bernoulli

78
Q

What type of tracing is depicted from an echocardiogram?

A

Pulsed wave

79
Q

How does echo determine stroke volume?

A

Volumetric flow can be determined from a combination of area and volume measurements.

80
Q

Blood flowing away from the transducer is coded _____.

Blood flowing toward the transducer is coded ______.

A

blue

red

Note: BART is on boards.

81
Q

What are the advantages and disadvantages of pulsed wave flow echo?

A

Measures velocities at selected areas

Cannot measure fast blood flow > 1m/sec

Note: Measures well in low flow areas of the heart such as pulmonary veins and mitral valve.

82
Q

What are the advantages and disadvantages of continuous wave echo?

A

Detects BF velocities up to 7m/sec

Cannot identify location of the peak velocity

Note: Used to measure flow in the aorta, aortic valve, stenotic lesions, and regurgitant flow.

83
Q

What are the disadvantages of color flow?

A

Like pulsed wave, cannot measure fast flow well.

Note: Used to better recognize valvular abnormalities, intracardiac shunts, and aortic dissections.

84
Q

TEE is more sensitive than PA catheter or ECG for detecting ischemia. True or false?

A

True.

85
Q

The extent of wall motion abnormaility relates to the severity of coronary insufficiency to the affected area. True or false?

A

True.

86
Q

What is normal radial shortening of the heart walls and wall thickening?

A

>30%

+++

87
Q

Mild hypokinesis is characterized by:

_____ radial shortening
_____wall thickening

A

10-30%

++

88
Q

Severe hypokinesis is characterized by:

______ radial shortening
________ wall thickening

A

0-10%

+

89
Q

Dykinesis is characterized by:

_______ radial shortening
_________ thickening

A

no shortening, LENGTHENING

0

90
Q

How is systolic wall thickening determined?

A

Computerized division of the LV wall during systole and diastole and thickness of 8-32 segments are analyzed.

91
Q

What are category I indications for TEE?

Note: Category I means that it is supported by strongest evidence.

A
  • Acute persistent hemodynamic changes
  • All types of valve surgery
  • Congenital heart surgery
  • Repair of hypertrophic obstructive cardiomyopathy
  • Endocarditis
  • Thoracic aneurysm, dissection
  • Pericardial window
92
Q

What are category II indications for TEE?

Note: Category II is supported by weaker evidence and better outcome is less certain.

A
  • Increased risk of MI
  • Repair of cardiac aneurysms
  • Removal of foreign bodies
  • Detection of air emboli
  • Evaluation of anastamoses after heart transplant
  • Monitoring placement of cardiac assist devices
93
Q

What are category III indications for TEE?

Note: III has little scientific support.

A
  • Evaluation of cardiac perfusion
  • Monitoring for emboli during ortho cases
  • Evaluation of pleuropulmonary diseases
  • Placement of intra-aortic balloon or PA cath
  • Monitoring cardioplegia administration

I & M II (21 decks)

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