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Cardiac theory sem 1 > fall 2023 MC final > Flashcards

fall 2023 MC final Flashcards

1
Q

According to the electrocardiogram (EKG), electrical systole is:

A. Onset of the QRS to the onset of the T wave
B. End of the T wave to the onset of the QRS complex
C. Onset of the T wave to the onset of the P wave
D. Onset of the QRS complex to the end of the T wave

A

D. Onset of the QRS complex to the end of the T wave

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2
Q

All of the following are components of a pulsed-wave Doppler of a pulmonary vein EXCEPT:

A. AR
B. E
C. S2
D. S1

A

B. E

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3
Q

All of the following are considered a part of normal ventricle diastole EXCEPT?

A. Atrial systole
B. Isovolumic relaxation
C. Ventricular depolarization
D. Early passive filling

A

C. Ventricular depolarization

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4
Q

All of the following are true statements concerning the left ventricle EXCEPT:

A. Contains two papillary muscle groups
B. Top normal thickness is approximately 1 cm
C. Bullet shaped (truncated ellipsoid)
D. Heavily trabeculated

A

D. Heavily trabeculated

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5
Q

All of the following are true statements concerning the right ventricle EXCEPT:

A. Most anterior positioned cardiac chamber
B. Normally form the cardiac apex
C. Normal wall thickness is 0.3 to 0.5 cm
D. Heavily trabeculated

A

B. Normally forms the cardiac apex

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6
Q

All of the following left ventricular wall segments may be evaluated in the parasternal long-axis view EXCEPT:

A. Basal anterior inter ventricular septum
B. Mid-anterior inter ventricular septum
C. Cardiac apex

A

C. Cardiac apex

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7
Q

All of the following left ventricular wall segments may be evaluated in the parasternal short-axis of the left ventricle at the level of the papillary muscles EXCEPT:

A. Cardiac apex
B. Anterior wall
C. Anterolateral
D. Anterior interventricular septum

A

A. Cardiac apex

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8
Q

All of the following structures are located in the right atrium EXCEPT:

A. Thebesian valve
B. Moderator band
C. Crista terminalis
D. Eustachian valve

A

B. Moderator band

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9
Q

All of the following ventricular wall segments may be supplied by the right coronary artery EXCEPT:

A. Basal and mid-anterior interventricular septum
B. Lateral wall of the right ventricle
C. Basal and mid-inferolateral walls of the left ventricle
D. Basal and mid-inferior walls of the left ventricle

A

A. Basal and mid-anterior interventricular septum

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10
Q

All of the following wall segments may be visualized in the apical four-chamber view EXCEPT:

A. Anterolateral wall
B. Lateral wall of the right ventricle
C. Cardiac apex
D. Anterior interventricular septum

A

D. Anterior interventricular septum

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11
Q

All of the following wall segments may be visualized in the apical two-chamber view EXCEPT:

A. Cardiac apex
B. Inferior wall
C. Anterior wall
D. Right ventricular outflow tract

A

D. Right ventricular outflow tract

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12
Q

Normal pressure values in millimeters of mercury (mm Hg) for the listed cardiac chambers or great vessels include all of the following EXCEPT:

A. Right ventricle: 15 to 30 systolic; 2 to 8 diastolic
B. Pulmonary artery: 15 to 30 systolic; 2 to 12 mean diastolic
C. Aorta: 100 to 140 systolic; 3 to 12 end-diastolic
D. Right atrial pressure: 2 to 8 mean

A

C. Aorta: 100 to 140 systolic; 3 to 12 end-diastolic

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13
Q

Structures of the mitral valve apparatus include all of the following EXCEPT:

A. Mitral valve annulus
B. Papillary muscles
C. Chordae tendineae
D. Sinuses of Valsalva

A

D. Sinuses of Valsalva

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14
Q

The Chiari network is found in the:

A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle

A

B. Right atrium

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15
Q

The boundaries of the functional left ventricular outflow tract are best described as extending from the:

A. Anterior aortic valve annulus to the posterior aortic valve annulus
B. Anteromedial position of the tricuspid valve annulus to the pulmonic valve annulus
C. Tips of the left ventricular papillary muscles to the edge of the anterior mitral valve leaflet
D.Free edge of the anterior mitral valve leaflet to the aortic valve annulus

A

D.Free edge of the anterior mitral valve leaflet to the aortic valve annulus

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16
Q

The coronary sinus can be differentiated from the descending thoracic aorta with pulsed-wave Doppler because coronary sinus flow is predominantly diastolic while aortic flow is:

A. equiphasic
B. predominantly diastolic
C. predominantly systolic
D. phasic

A

C. predominantly systolic

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17
Q

The correct order for the branches of the transverse aorta (aortic arch) is:

A. Right brachiocephalic; left brachiocephalic, left common carotid
B. Left subclavian, right subclavian, left common carotid
C. Right brachiocephalic, left common carotid, left subclavian
D. Sinus of Valsalva, right innominate, left innominate

A

C. Right brachiocephalic, left common carotid, left subclavian

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18
Q

The crista terminalis is found in the:

A. Left ventricle
B. Right ventricle
C. Right atrium
D. Left atrium

A

C. Right atrium

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19
Q

The eustachian valve is found in the:

A. Right atrium
B. Right ventricle
C. Left ventricle
D. Left atrium

A

A. Right atrium

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20
Q

The imaginary boundaries that define the mid-left ventricle are the:

A. Mitral annulus to the tip of the papillary muscles
B. Base of the papillary muscles to the cardiac apex
C. Tip of the papillary muscles to the base of the papillary muscles
D. Aortic annulus to the edge of the mitral valve

A

C. Tip of the papillary muscles to the base of the papillary muscles

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21
Q

The left anterior descending coronary artery supplies blood to all of the following EXCEPT:

A. Apical cap
B. Inferior wall of the left ventricle
C. Anterior interventricular septum
D. Anterior wall of the left ventricle

A

B. Inferior wall of the left ventricle

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22
Q

The moderator band is always located in the:

A. Left ventricle
B. Right ventricle
C. Right atrium
D. Left atrium

A

B. Right ventricle

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23
Q

The most likely explanation of main pulmonary artery dilatation is:

A. Pulmonary hypertension
B. Bicuspid aortic valve
C. Truncus arteriosus
D. Carcinoid heart disease

A

A. Pulmonary hypertension

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24
Q

The name of the aortic segment located between the left subclavian artery and the insertion of the ligamentum arteriosum is the:

A. Transverse aorta
B. Sino-tubular junction
C. Aortic isthmus
D. Aortic root

A

C. Aortic isthmus

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25
Q

The names of the two left ventricular papillary muscle groups are:

A. Medial ; lateral
B. Anterolateral ; posteromedial
C. Anterior ; posterior
D. Superior ; inferior

A

B. Anterolateral ; posteromedial

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26
Q

The most common cause of chronic tricuspid regurgitation is:

A. Tricuspid valve prolapse
B. Rheumatic heart disease
C. Pulmonary hypertension
D. Ebstein’s anomaly

A

C. Pulmonary hypertension

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27
Q

The most common etiology of pulmonary regurgitation is:

A. Rheumatic heart disease
B. Pulmonary hypertension
C. Carcinoid heart disease
D. Infective endocarditis

A

B. Pulmonary hypertension

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28
Q

The most common etiology of tricuspid stenosis is:

A. Right atrial myxoma
B. Rheumatic fever
C. Carcinoid heart disease
D. Infective endocarditis

A

B. Rheumatic fever

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29
Q

The murmur of tricuspid regurgitation is best described as a:

A. Pansystolic murmur heard best at the lower left sternal border
B. Pansystolic murmur heard best at the cardiac apex with radiation to the axilla
C. Holodiastolic murmur heard best at the lower left sternal border
D. Systolic ejection murmur heard best at the upper right sternal border

A

A. Pansystolic murmur heard best at the lower left sternal border

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30
Q

The pulmonary vein atrial reversal wave may be _______ in peak velocity and duration in a patient with severe acute aortic regurgitation.

A. Decreased
B. Unchanged
C. Increased
D. Reversed

A

C. Increased

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31
Q

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 the parasternal long-axis view
B. Measuring the vena contracta in the parasternal long-axis view
C. Comparing the aortic regurgitation jet width with the left ventricular outflow tract width in the parasternal long-axis view
D. Determining the presence of holodiastolic flow reversal in the descending thoracic aorta and/or abdominal aorta

A

A. Measuring the aortic regurgitation jet aliasing area in the parasternal long-axis view

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32
Q

The typical two-dimensional echocardiographic findings in rheumatic tricuspid stenosis include all of the following EXCEPT:

A. Systolic bowing of the posterior tricuspid valve leaflet
B. Right atrial dilatation
C. Diastolic doming of the anterior tricuspid valve leaflet
D. Leaflet thickening especially at the leaflet tips and chordae tendineae

A

A. Systolic bowing of the posterior tricuspid valve leaflet

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33
Q

When two-dimensional 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. Sclerosis
B. Regurgutation
C. Stenosis
D. Prolapse

A

A. Sclerosis

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34
Q

A tricuspid regurgitation peak velocity of 3.0 m/s is obtained. This indicates:

A. Severe tricuspid regurgitation
B. Pulmonary hypertension
C. Moderate tricuspid regurgitation
D. Mild tricuspid regurgitation

A

B. Pulmonary hypertension

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35
Q

All of the following are cardiac Doppler findings for tricuspid valve stenosis EXCEPT:

A. Increased mean pressure gradient
B. Decreased pressure half-time
C. Decreased tricuspid valve area
D. Increased tricuspid valve E wave velocity

A

B. Decreased pressure half-time

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36
Q

All of the following are considered useful quantitative measurements to determine the severity of aortic regurgitation EXCEPT:

A. Regurgitant volume
B. Effective regurgitant orifice
C. Peak velocity of aortic regurgitation
D. Regurgitant fraction

A

C. Peak velocity of aortic regurgutation

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37
Q

All of the following are dilated in significant chronic tricuspid regurgitation EXCEPT:

A. Pulmonary veins
B. Inferior vena cava
C. Right atrium
D. Hepatic veins

A

A. Pulmonary veins

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38
Q

All of the following color flow Doppler findings indicate significant pulmonary regurgitation EXCEPT:

A. Holodiastolic flow reversal in the main pulmonary artery
B. Jet width/Right ventricular outflow tract width > 70%
C. Wide jet width at origin
D. Peak velocity of < 1.0 m/s

A

D. Peak velocity of < 1.0 m/s

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39
Q

An intracardiac pressure that may be determined from the continuous-wave Doppler tricuspid regurgitation signal is:

A. Pulmonary artery end-diastolic pressure
B. Systemic vascular resistance
C. Systolic pulmonary artery pressure
D. Mean pulmonary artery pressure

A

C. Systolic pulmonary artery pressure

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40
Q

Cardiac Doppler findings associated with significant chronic tricuspid regurgitation include all of the following EXCEPT:

A. Systolic flow reversal in the pulmonary vein
B. Systolic flow reversal in the hepatic vein
C. Increased E velocity of the tricuspid valve
D. Concave late systolic configuration of the regurgitation signal

A

A. Systolic flow reversal in the pulmonary vein

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41
Q

Causes of anatomic tricuspid regurgitation include all of the following EXCEPT:

A. Ebstein’s anomaly
B. Carcinoid heart disease
C. Infective endocarditis
D. Pulmonary hypertension

A

D. Pulmonary hypertension

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42
Q

Echocardiographic evidence of severe acute aortic regurgitation includes all of the following EXCEPT:

A. Premature closure of the mitral valve
B. Premature opening of the aortic valve
C. Premature opening of the mitral valve
D. Reverse doming of the anterior mitral valve leaflet

A

C. Premature opening of the mitral valve

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43
Q

Holodiastolic flow reversal in the descending thoracic aorta and/or the abdominal aorta may be present in each of the following EXCEPT:

A. Severe mitral regurgitation
B. Severe aortic regurgitation
C. Patent ductus arteriosus
D. Aortopulmonary window

A

A. Severe mitral regurgitation

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44
Q

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. Left ventricular dimension
B. Closure of the pulmonary valve
C. Systolic ejection period
D. Closure of the mitral valve

A

D. Closure of the mitral valve

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45
Q

In significant chronic aortic regurgitation, M-mode and two-dimensional evidence includes all of the following EXCEPT:

A. Hyperkinesis of the interventricular septum
B. Paradoxical interventricular septal motion
C. Left ventricular dilatation
D. Hyperkinesis of the posterior (inferolateral) wall of the left ventricle

A

B. Paradoxical interventricular septal motion

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46
Q

M-mode and two-dimensional echocardiographic findings for chronic tricuspid regurgitation include:

A. Right ventricular hypertrophy
B. Left ventricular volume overload
C. Protected right ventricle
D. Paradoxical interventricular septal motion

A

D. Paradoxical interventricular septal motion

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47
Q

Methods for determining the severity of tricuspid regurgitation with pulsed-wave Doppler include all of the following EXCEPT:

A. Holosystolic flow reversal of the hepatic vein
B. Peak velocity of the tricuspid regurgitant jet
C. Laminar flow of the tricuspid regurgitant jet
D. Increased E wave velocity of the tricuspid valve

A

B. Peak velocity of the tricuspid regurgitant jet

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48
Q

Possible echocardiographic and cardiac Doppler findings in a patient with carcinoid heart disease include all of the following EXCEPT:

A. Tricuspid regurgitation
B. Tricuspid stenosis
C. Pulmonary regurgitation
D. Tricuspid valve prolapse

A

D. Tricuspid valve prolapse

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49
Q

Posterior displacement of the aortic valve leaflet(s) into the left ventricle outflow tract during ventricular diastole is called aortic valve:

A. Stenosis
B. Prolapse
C. Sclerosis
D. Perforation

A

B. Prolapse

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50
Q

Premature closure of the mitral valve is associated with all of the following EXCEPT:

A. Loss of sinus rhythm
B. Acute severe aortic regurgitation
C. Acute severe mitral regurgitation
D. First-degree atrioventricular block

A

C. Acute severe mitral regurgitation

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51
Q

Severe aortic regurgitation is diagnosed with continuous-wave Doppler by all of the following criteria EXCEPT:

A. Steep deceleration slope
B. Increased jet density
C. A maximum velocity of 4 m/s
D. A pressure half-time of < 200 msec

A

C. A maximum velocity of 4 m/s

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52
Q

Significant chronic pulmonary regurgitation is associated with:

A. Left ventricular volume overload
B. Right ventricular volume overload
C. Right atrial hypertrophy
D. Right ventricular hypertrophy

A

B. Right ventricular volume overload

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53
Q

Signs of significant tricuspid regurgitation include all of the following EXCEPT:

A. Pulsus paradoxus
B. Jugular vein distention
C. Hepatomegaly
D. Right ventricular heart failure

A

A. Pulsus paradoxus

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54
Q

The M-mode finding that indicates severe acute aortic regurgitation is premature aortic valve:

A. Opening
B. Systolic flutter
C. Closure
D. Mid-systolic closure

A

A. Opening

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55
Q

The M-mode/two-dimensional 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 ≥ 55 mm and fractional shortening of ≤ 25%
B. End-diastolic dimension ≥ 55 mm and fractional shortening ≤ 25%
C. End-diastolic dimension ≤ 55 mm and fractional shortening of ≥ 25%
D. End-diastolic dimension ≥ 70 mm and left atrial dimension ≥ 55 mm

A

A. End-systolic dimension ≥ 55 mm and fractional shortening of ≤ 25%

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56
Q

The continuous-wave Doppler signal of aortic regurgitation may be differentiated from the continuous-wave Doppler signal of mitral stenosis by the following guideline:

A. If the diastolic flow pattern commences after mitral valve opening then the signal is due to aortic regurgitation
B. The Doppler flow velocity pattern of mitral valve stenosis is laminar while the Doppler flow pattern of aortic regurgitation is turbulent.
C. If the diastolic flow pattern commences before mitral valve opening then the signal is due to aortic regurgitation
D. Cannot be differentiated by continuous-wave Doppler.

A

C. If the diastolic flow pattern commences before mitral valve opening then the signal is due to aortic regurgitation

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57
Q

The mitral valve pulsed-wave Doppler flow pattern often associated with severe acute aortic regurgitation is grade:

A. II (pseudonormal)
B. I (impaired relaxation)
C. III or IV (restrictive)
D. normal for age

A

C. III or IV (restrictive)

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58
Q

All of the following represents possible etiologies for acute aortic regurgitation EXCEPT:

A. Aortic valve sclerosis
B. Trauma
C. Aortic dissection
D. Infective endocarditis

A

A. Aortic valve sclerosis

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59
Q

An effect of significant aortic valve stenosis on the left ventricle is:

A. Asymmetrical septal hypertrophy
B. Protected in significant aortic valve stenosis
C. Eccentric left ventricular hypertrophy
D. Concentric left ventricular hypertrophy

A

D. Concentric left ventricular hypertrophy

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60
Q

Aortic valve with reduced systolic excursion. On physical examination there was a crescendo-decrescendo systolic ejection murmur and a diastolic decrescendo murmur heard. The most likely diagnosis is aortic valve:

A. Stenosis and mitral valve prolapse
B. Flail
C. Regurgutation
D. Stenosis and regurgutation

A

D. Stenosis and regurgutation

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61
Q

Cardiac Doppler parameters used to assess the severity of valvular aortic stenosis include all the following EXCEPT:

A. Aortic velocity ratio
B. Peak aortic valve velocity
C. Aortic pressure half-time
D. Mean pressure gradient

A

C. Aortic pressure half-time

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62
Q

Cardiac magnetic resonance imaging provides all of the following information in a patient with aortic regurgitation EXCEPT:

A. Detailed resolution of the aortic valve
B. Left ventricular volumes
C. Effective regurgutant orifice
D. Regurgutant volume

A

A. Detailed resolution of the aortic valve

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63
Q

In the parasternal long-axis view, severe aortic valve stenosis is defined as an aortic valve leaflet separation that measures:

A. ≤ 12 mm
B. ≥ 14 mm
C. ≤ 8 mm
D. ≤ 10 mm

A

C. ≤ 8 mm

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64
Q

Of the transvalvular pressure gradients that can be measured in the echocardiography laboratory, the most useful in examining aortic valve stenosis is probably:

A. Peak-to-peak gradient
B. Mean systolic gradient
C. Mean diastolic gradient
D. Peak instantaneous pressure gradient

A

B. Mean systolic gradient

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65
Q

Pathologies that may result in a left ventricular pressure overload include all the following EXCEPT:

A. Valvular aortic stenosis
B. Discrete subaortic stenosis
C. Systemic hypertension
D. Mitral valve stenosis

A

D. Mitral valve stenosis

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66
Q

Possible two-dimensional echocardiographic findings in significant aortic valve stenosis include all the following EXCEPT:

A. Post-stenotic dilatation of the descending aorta
B. Left ventricular hypertrophy
C. Post-stenotic dilatation of the ascending aorta
D. Aortic valve calcification

A

A. Post-stenotic dilatation of the descending aorta

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67
Q

Reverse diastolic doming of the anterior mitral valve leaflet is associated with:

A. Flail mitral valve
B. Papillary muscle dysfunction
C. Rheumatic mitral valve stenosis
D. Severe aortic regurgitation

A

D. Severe aortic regurgitation

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68
Q

Secondary echocardiographic findings associated with severe valvular aortic stenosis include all the following EXCEPT:

A. Left ventricular hypertrophy
B.Right ventricular hypertrophy
C. Post-stenotic dilatation of the ascending aorta
D. Decreased left ventricular systolic function (late in course)

A

B.Right ventricular hypertrophy

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69
Q

The Doppler maximum peak instantaneous pressure gradient in a patient with aortic stenosis is 100 mm Hg. The cardiac catheterization peak-to-peak pressure gradient will most likely be:

A. Dependent upon respiration
B. Higher than 100 mm Hg
C. Lower than 100 mm Hg
D. Equal to 100 mm Hg

A

C. Lower than 100 mm Hg

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70
Q

The LEAST common valve regurgitation found in normal patients is:

A. Aortic regurgitation
B. Mitral regurgitation
C. Pulmonary regurgitation
D. Tricuspid regurgitation

A

A. Aortic regurgitation

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71
Q

The aortic valve area considered severe aortic valve stenosis is:

A. < 3 cm^2
B. ≤ 1.0 cm^2
C. < 2 cm^2
D. < 1.5 cm^2

A

B. ≤ 1.0 cm^2

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72
Q

The characteristic M-mode findings for aortic valve stenosis include all the following EXCEPT:

A. Diastolic flutter of the aortic valve leaflets
B. A lack of systolic flutter of the aortic valve leaflets
C. Reduced leaflet separation in systole
D. Thickening of the aortic valve leaflets

A

A. Diastolic flutter of the aortic valve leaflets

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73
Q

The characteristic feature of the murmur of chronic aortic regurgitation is a:

A. Diastolic decrescendo murmur heard best along the left sternal border
B. Diastolic rumble following an opening snap
C. Harsh systolic ejection murmur heard best at the right upper sternal border
D. Diastolic crescendo-decrescendo murmur heard best along the left upper sternal border

A

A. Diastolic decrescendo murmur heard best along the left sternal border

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74
Q

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. Mitral diastolic filling profile should be present during recording of the mitral regurgitation, whereas no diastolic flow is observed in aortic valve stenosis.
B. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis.
C. Mitral regurgitation flow always lasts until mitral valve opening, whereas aortic valve stenosis flow does not.
D. Aortic ejection time is shorter that the mitral regurgitation time

A

B. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic valve stenosis.

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75
Q

The hallmark M-mode finding for aortic regurgitation is:

A. Fine diastolic flutter of the anterior mitral valve leaflet
B. Coarse diastolic flutter of the anterior mitral valve leaflet
C. Chaotic diastolic flutter of the mitral valve
D. Systolic flutter of the aortic valve

A

A. Fine diastolic flutter of the anterior mitral valve leaflet

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75
Q

The most common etiology of chronic aortic regurgitation is:

A. Infective endocarditis
B. Trauma
C. Dilatation of the aortic root and aortic annulus
D. Marfan’s syndrome

A

C. Dilatation of the aortic root and aortic annulus

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75
Q

The murmur associated with severe aortic regurgitation is:

A. Austin-Flint
B. Carvallo’s
C. Still’s
D. Graham-Steell

A

A. Austin-Flint

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76
Q

The murmur of aortic stenosis is described as:

A. Diastolic rumble
B. Systolic ejection murmur heard best at the right upper sternal border
C. Holosystolic murmur heard best at the cardiac apex
D. Holodiastolic decrescendo murmur heard best at the right sternal border

A

B. Systolic ejection murmur heard best at the right upper sternal border

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77
Q

The onset of flow to peak aortic velocity continuous-wave Doppler tracing in severe valvular aortic stenosis is:

A. Increased
B. Increased with inspiration
C. Decreased
D. Decreased with expiration

A

A. Increased

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78
Q

The pulse that is characteristic of significant valvular aortic stenosis is:

A. Pulsus parvus et tardus
B. Pulsus bisferiens
C. Pulsus paradoxus
D. Pulsus alternans

A

A. Pulsus parvus et tardus

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79
Q

The severity of aortic valve stenosis may be underestimated if only the maximum velocity measurement is used in the following condition:

A. Low cardiac output
B. Doppler intercept angle of 0°
C. Significant aortic regurgitation
D. Anemia

A

A. Low cardiac output

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80
Q

The two-dimensional view which best visualizes systolic doming of the aortic valve leaflets is the:

A. Parasternal long-axis view
B. Subcostal short-axis view of the aortic valve
C. Parasternal short-axis view of the aortic valve
D. Apical five-chamber view

A

A. Parasternal long-axis view

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81
Q

Flail mitral valve can be differentiated from severe mitral valve prolapse on two-dimensional echocardiography because flail mitral valve leaflet demonstrates:

A. A thicker mitral valve
B. Chronic mitral regurgitation
C. Leaflet tip that points toward the left ventricle
D. Leaflet tip that points toward the left atrium

A

D. Leaflet tip that points toward the left atrium

82
Q

In patients with severe acute mitral regurgitation, the continuous-wave Doppler peak velocity of the regurgitant jet is:

A. Dependent largely upon left ventricular global systolic function
B. Unaffected
C. Decreased
D. Increased

A

C. Decreased

83
Q

In patients with significant mitral regurgitation, the continuous-wave Doppler tracing of the regurgitant lesion may demonstrate a(n):

A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display
B. Jet duration of < 85 msec
C. Symmetrical shape of the mitral regurgitation flow velocity spectral display
D. Jet area of < 20%

A

A. Asymmetrical shape of the mitral regurgitation flow velocity spectral display

84
Q

In patients with significant mitral regurgitation, the isovolumic relaxation time may be:

A. Decreased
B. Affected by respiration
C. Increased
D. Unaffected

A

A. Decreased

85
Q

In patients with significant pure mitral regurgitation, the E velocity of the mitral valve pulsed-wave Doppler tracing is:

A. Decreased
B. Increased
C. Unaffected
D. Increased with inspiration

A

B. Increased

86
Q

Mitral valve chordal rupture usually results in:

A. Tricuspid regurgitation
B. Pulmonary regurgitation
C. Aortic regurgitation
D. Mitral regurgitation

A

D. Mitral regurgitation

87
Q

On M-mode and two-dimensional echocardiography dense echoes are noted posterior to normal mitral valve leaflets. The probable diagnosis is mitral valve:

A. Annular calcification
B. Papilloma
C. Aneurysm
D. Vegetation

A

A. Annular calcification

88
Q

Quantitative approaches to determine the severity of mitral regurgitation include all of the following EXCEPT:

A. Regurgitant volume
B. Regurgitant jet area
C. Effective regurgitant orifice
D. Regurgitant fraction

A

B. Regurgitant jet area

89
Q

Secondary causes of mitral valve prolapse include all of the following EXCEPT:

A. Primary pulmonary hypertension
B. Atrial septal defect
C. Cardiac tamponade
D. Bicuspid aortic valve

A

D. Bicuspid aortic valve

90
Q

The associated auscultatory findings for mitral valve prolapse include:

A. Ejection click
B. Pericardial knock
C. Mid-systolic click
D. Friction rub

A

C. Mid-systolic click

91
Q

The cardinal symptoms of valvular aortic stenosis include all the following EXCEPT:

A. Anasarca
B. Congestive heart failure
C. Syncope
D. Angina pectoris

A

A. Anasarca

92
Q

The complications of mitral valve prolapse include all of the
following EXCEPT:

A. Valvular stenosis
B. Increased risk of infective endocarditis
C. Mitral valve repair and replacement
D. Significant mitral regurgitation

A

A. Valvular stenosis

93
Q

The effect significant mitral regurgitation has on the pulsed-wave Doppler tracing of the pulmonary veins may be described as:

A. S wave increases, D wave decreases
B. S wave increases, D wave decreases
C. Unaffected
D. S wave reverses, D wave increase

A

D. S wave reverses, D wave increase

94
Q

The etiology of aortic valve stenosis includes all the following EXCEPT:

A.Congenital
B. Bacterial
C. Degenerative
D.Rheumatic

A

B. Bacterial

95
Q

The gold standard two-dimensional echocardiographic view recommended to diagnose the presence of mitral valve prolapse is:

A. Subcostal five-chamber
B. Parasternal short-axis of the mitral valve
C. Parasternal long-axis
D. Apical four-chamber

A

C. Parasternal long-axis

96
Q

The most common symptoms of mitral valve prolapse include all of the following EXCEPT:

A. Syncope
B. Ascites
C. Atypical chest pain
D. Palpitations

A

B. Ascites

97
Q

The most likely etiology of aortic valve stenosis in a 47-year-old patient is:

A. Annular
B. Endocarditis
C. Congenital
D. Degenerative

A

C. Congenital

98
Q

The peak mitral regurgitation velocity as determined with continuous-wave Doppler reflects the:

A. Maximum pressure difference between the left atrium and left ventricle
B. Etiology of the mitral regurgitation
C. Severity of the mitral regurgitation
D. Direction of the regurgitant jet

A

A. Maximum pressure difference between the left atrium and left ventricle

99
Q

The term myxomatous degeneration is associated with mitral valve:

A. Prolapse
B. Vegetation
C. Flail
D. Stenosis

A

A. Prolapse

100
Q

There is posterior mitral valve prolapse present. With color flow Doppler on, which direction will the mitral regurgitation jet be baffled?

A. Posterior
B. Inferior
C. Cephalad
D. Anterior

A

D. Anterior

101
Q

Which of the following is most commonly associated with mitral valve prolapse?

A. Left heart pressure overload
B. Right heart volume overload
C. Left heart volume overload
D. Right heart pressure overload

A

C. Left heart volume overload

102
Q

A Doppler mean pressure gradient of 18 mm Hg is calculated in a patient with valvular aortic stenosis. The severity of the aortic stenosis is:

A. Severe
B. Moderate
C. Mild
D. Moderately severe

A

C. Mild

103
Q

All of the following are associated with significant chronic aortic regurgitation EXCEPT:

A. Holosystolic murmur heard best at the cardiac apex
B. Wide pule pressure
C. Congestive heart failure
D. Angina pectoris

A

A. Holosystolic murmur heard best at the cardiac apex

103
Q

All of the following are two-dimensional echocardiography findings in a patient with significant chronic aortic regurgitation EXCEPT:

A. Hyperkinetic left ventricular wall motion
B. Left ventricular enlargement
C. Left atrial enlargement
D. Abnormal aortic valve or aortic root

A

C. Left atrial enlargement

104
Q

All of the following may be measured in the cardiac catheterization laboratory when evaluating aortic stenosis EXCEPT:

A. Peak velocity
B. Mean pressure gradient
C. Peak-to-peak pressure gradient
D. Maximum peak instantaneous pressure gradient

A

A. Peak velocity

105
Q

Secondary echocardiographic/Doppler findings in patients with rheumatic mitral stenosis include all the following EXCEPT:

A. Left ventricular dilatation
B. Increased tricuspid regurgitant jet velocity
C. Abnormal interventricular septal wall motion
D. Increase right heart dimension

A

A. Left ventricular dilatation

106
Q

Signs and symptoms of mitral stenosis secondary to rheumatic heart disease include:

A. Vertigo
B. Pulmonary hypertension
C. Cyanosis
D. Angina pectoris

A

B. Pulmonary hypertension

107
Q

Systolic bowing of the inter-atrial septum toward the right atrium throughout the cardiac cycle may be an indication of:

A. Tricuspid regurgitation
B. Tricuspid atresia
C. Tricuspid stenosis
D. Mitral regurgitation

A

D. Mitral regurgitation

108
Q

The abnormal mitral valve pressure half-time for patients with mitral valve stenosis is:

A. 60 to 90 msec
B. 30 to 60 msec
C. 90 to 400 msec
D. 0 to 30 msec

A

C. 90 to 400 msec

109
Q

The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are:

A. Tricuspid, mitral, pulmonic, aortic
B. Aortic, pulmonic, tricuspid, mitral
C. Mitral, aortic, tricuspid, pulmonic
D. Pulmonic, aortic, tricuspid, mitral

A

C. Mitral, aortic, tricuspid, pulmonic

110
Q

The classic cardiac Doppler features of mitral valve stenosis include all the following EXCEPT:

A. Increased E velocity
B. Increased mitral valve area
C. Increased pressure half-time
D. Turbulent flow

A

B. Increased mitral valve area

111
Q

The classic description of the murmur of chronic mitral regurgitation is:

A. Continuous machinery-like murmur
B. Systolic ejection murmur heard best at the right upper sternal border
C. Diastolic decrescendo murmur heard best at the left sternal border
D. Holosystolic murmur heard best at the apex radiating to the axilla

A

D. Holosystolic murmur heard best at the apex radiating to the axilla

112
Q

The equation used in the cardiac catheterization laboratory to determine mitral valve area and aortic valve area is the:

A. Continuity
B. Gorlin
C. Doppler
D. Bernoulli

A

B. Gorlin

113
Q

The most accurate method for determining the severity of mitral valve stenosis is:

A. Measuring the E-F slope of the anterior mitral valve leaflet by M-mode
B. Determining the maximum velocity across the mitral valve by pulsed-wave Doppler
C. Measuring the thickness of the mitral valve leaflets
D. Performing planimetry of the mitral valve orifice by two-dimensional echocardiography

A

D. Performing planimetry of the mitral valve orifice by two-dimensional echocardiography

114
Q

The most common etiology of mitral stenosis in adults is:

A. Severe mitral annular calcification
B. Left atrial myxoma
C. Congenital
D. Rheumatic fever

A

D. Rheumatic fever

115
Q

The most common presenting symptom of significant chronic mitral regurgitation is:

A. Hemoptysis
B. Ascites
C. Dyspnea
D. Systemic embolization

A

C. Dyspnea

116
Q

The most likely heart sound to be heard in patients with significant chronic pure mitral regurgitation is:

A. Fixed split S2
B. S3
C. Loud S1
D. Ejection click

A

B. S3

117
Q

Two-dimensional echocardiographic examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.8 m/s with a pressure half-time of 180 msec in an elderly patient. The most likely diagnosis is:

A. Rheumatic mitral stenosis
B. Aortic regurgitation
C. Abnormal relaxation of the left ventricle
D. Moderate to severe mitral annular calcification

A

D. Moderate to severe mitral annular calcification

118
Q

Two-dimensional echocardiographic findings for rheumatic mitral stenosis include all of the following EXCEPT

A. Increased left atrial dimension
B. Hockey-stick appearance of the anterior mitral valve leaflet
C. Reverse doming of the anterior mitral valve leaflet
D Thickened mitral valve leaflets and subvalvular apparatus

A

C. Reverse doming of the anterior mitral valve leaflet

119
Q

Typical echocardiographic findings in a patient with isolated rheumatic mitral stenosis include all of the following EXCEPT:

A. Left atrial thrombus
B. Dilated left ventricle
C. D-shaped left ventricle
D. Left atrial enlargement

A

B. Dilated left ventricle

120
Q

A color flow Doppler method for semi-quantitating mitral regurgitation is regurgitant jet:

A. Area
B. Turbulence
C. Height
D. Length

A

A. Area

121
Q

A common finding associated with a regurgitant murmur in
the elderly is:

A. Mitral annular calcification
B. Aortic valve stenosis
C. Mitral valve stenosis
D. Mitral valve vegetation

A

A. Mitral annular calcification

122
Q

A key word that is often used to describe the characteristics of the valve leaflets in mitral valve prolapse is:

A. Sclerotic
B. Dense
C. Redundant
D. Doming

A

C. Redundant

123
Q

All of the following are associated with mitral valve prolapse EXCEPT:

A. Mitral regurgitation
B. Aortic valve prolapse
C. Pulmonary atresia
D. Tricuspid valve prolapse

A

C. Pulmonary atresia

124
Q

All of the following are true statements concerning mitral regurgitation EXCEPT:

A. Mitral regurgitation may be acute, chronic or intermittent
B. Severity of mitral regurgitation is not affected by afterload
C. Regurgitant jet area, vena contracta width and proximal isovelocity surface area are recommended when determining severity
D. Mitral regurgitation may result in an increase in preload

A

B. Severity of mitral regurgitation is not affected by afterload

125
Q

All of the following are useful color-flow Doppler techniques in the evaluation of mitral regurgitation EXCEPT:

A. Peak velocity
B. Jet area
C. PISA diameter
D. Vena contracta width

A

A. Peak velocity

126
Q

An accepted method for determining the severity of mitral regurgitation by continuous-wave Doppler is spectral:

A. Jet density
B. Length
C. Width
D. Velocity

A

A. Jet density

127
Q

Cardiac Doppler evidence of severe mitral regurgitation includes all of the following EXCEPT:

A. Pulmonary vein systolic flow reversal
B. Mitral valve E wave velocity < 1.0 m/sec
C. Regurgitant jet area/left atrial area ratio > 40%
D. Dense, triangular continuous-wave Doppler tracing

A

B. Mitral valve E wave velocity < 1.0 m/sec

128
Q

Diastolic mitral regurgitation is associated with:

A. Severe tricuspid regurgitation
B. Severe aortic regurgitation
C. Flail mitral valve
D. Mitral valve prolapse

A

B. Severe aortic regurgitation

129
Q

Echocardiographic characteristics of mitral valve prolapse include all of the following EXCEPT:

A. Thickened, redundant, myxomatous leaflets
B. Systolic bowing of the mitral valve leaflets towards the left atrium
C. Diastolic doming of the mitral valve leaflets
D. Increased mitral valve annulus diameter

A

C. Diastolic doming of the mitral valve leaflets

130
Q

The pulsed-wave Doppler mitral valve peak E wave velocity is 100 cm/s. The lateral wall mitral annulus tissue Doppler imaging E’ wave is 5 cm/s. The diastolic filling pressure is assumed to be:

A. Dependent upon respiration
B. Decreased
C. Normal
D. Increased

A

D. Increased

131
Q

The simplified Bernoulli equation disregards all of the following factors EXCEPT:

A. Proximal velocity
B. Velocity at the site of obstruction
C. Flow acceleration
D. Viscous friction

A

B. Velocity at the site of obstruction

132
Q

The stroke volume is 63 mL. The heart rate is 100 beats per minutes. The cardiac output is:

A. 63 mL
B. 63000 Lpm
C. 6.3 Lpm
D. 6.3 bpm

A

C. 6.3 Lpm

133
Q

The top normal peak velocity for the aortic valve is:

A. 2.0 m/s
B. 0.7 m/s
C. 1.7 m/s
D. 0.9 m/s

A

C. 1.7 m/s

134
Q

The tricuspid regurgitation peak velocity is 2.0 m/s. The right ventricular outflow tract velocity time integral is 20 cm. The pulmonary vascular resistance is:

A. Decreased
B. Equal to the peak velocity of the tricuspid regurgitation
C. Increased
D. Normal

A

D. Normal

135
Q

The tricuspid regurgitation peak velocity is determined to be 3.2 m/s. The inferior vena cava is normal in dimension (< 1.7 cm) and collapsed with a sniff by more than 50%. The right ventricular systolic pressure and systolic pulmonary artery pressure is:

A. 56 mmHg
B. 49 mmHg
C. 44 mmHg
D. 41 mmHg

A

C. 44 mmHg

136
Q

The use of the continuity equation in patients with aortic stenosis is based on the premise that:

A. Left ventricular outflow tract flow is greater than flow across the aortic valve
B. Flow volume in the left ventricular outflow tract equals the flow volume across the aortic valve
C. As the aortic stenosis progresses, V2 decreases
D. As the aortic stenosis progresses, V1 increases

A

B. Flow volume in the left ventricular outflow tract equals the flow volume across the aortic valve

137
Q

When evaluating valvular stenosis all of the following are useful Doppler parameters EXCEPT:

A. Peak velocity
B. Peak instantaneous pressure gradient
C. Chamber dimensions
D. Mean pressure gradient

A

C. Chamber dimensions

138
Q

Which of the following represent the lengthened Bernoulli equation?

A. EDV-ESV
B. 4 x V2 2 – V1 2
C. 4 x V22
D. CSA x VTI

A

B. 4 x V2 2 – V1 2

139
Q

With aortic valve stenosis and poor global left ventricular systolic function the severity of aortic stenosis by the Doppler pressure gradient may be:

A. Underestimated
B. Overestimated
C. Unpredictable
D. Unaffected

A

A. Underestimated

140
Q

With aortic valve stenosis and significant aortic regurgitation the severity of the aortic stenosis by the Doppler pressure gradient may be:

A. Unaffected
B. Overestimated
C. Unpredictable
D. Underestimated

A

B. Overestimated

141
Q

A Doppler mean pressure gradient across a stenotic mitral valve of 22 mm Hg is obtained. The severity of the mitral stenosis is:

A. Severe
B. Mild
C. Moderately severe
D. Moderate

A

A. Severe

142
Q

A deceleration time of 800 msec was obtained by continuous-wave Doppler in a patient with rheumatic mitral valve stenosis. The pressure half-time is:

A. 232 msec
B. 400 msec
C. 800 msec
D. 220 msec

A

A. 232 msec

143
Q

A strong indication for mitral stenosis on two-dimensional echocardiography is an anterior mitral valve leaflet that exhibits:

A. Reverse doming
B. Coarse, chaotic diastolic motion
C. Systolic bowing
D. Diastolic doming

A

D. Diastolic doming

144
Q

All of the following are causes for chronic mitral regurgitation EXCEPT:

A. Rheumatic heart disease
B. Mitral annular calcification
C. Ruptured papillary muscle
D. Cleft mitral valve

A

C. Ruptured papillary muscle

145
Q

All of the following are possible etiologies of anatomic mitral regurgitation EXCEPT:

A. Ruptured chordae tendineae
B. Mitral valve prolapse
C. Dilated cardiomyopathy
D. Mitral annular calcification

A

C. Dilated cardiomyopathy

146
Q

Cardiac magnetic resonance imaging provides all of the following information in the evaluation of mitral regurgitation EXCEPT:

A. Left ventricular mass
B. Left ventricular volumes
C. Regurgitant volume
D. Detailed visualization of the mitral valve apparatus

A

D. Detailed visualization of the mitral valve apparatus

147
Q

Chronic significant mitral regurgitation may result in all of the following EXCEPT:

A. Left ventricular volume overload pattern
B. Mitral annular calcification
C. Left atrial enlargement
D. Left ventricular enlargement

A

B. Mitral annular calcification

148
Q

Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral stenosis include:

A. Left atrial myxoma
B. Aortic stenosis
C. Ventricular septal defect
D. Pericardial effusion

A

A. Left atrial myxoma

149
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. Right ventricle
D. Left ventricle

A

B. Left atrium

150
Q

Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to:

A. 1.5 to 2.5 cm^2
B. 1.0 to 1.5 cm^2
C. < 1.0 cm^2
D. 2.5 to 3.5 cm^2

A

C. < 1.0 cm^2

151
Q

M-mode and two-dimensional findings associated with significant chronic mitral regurgitation include all of the following EXCEPT:

A. Left ventricular enlargement
B. Fine diastolic flutter of the mitral valve
C. Left atrial enlargement
D. Left ventricular volume overload pattern

A

B. Fine diastolic flutter of the mitral valve

152
Q

Mitral stenosis is considered to be severe by all the following criteria EXCEPT:

A. Mean pressure gradient ≥ 10 mm Hg
B. Mitral valve Doppler A wave peak velocity > 1.3 m/s
C. Mitral valve area ≤ 1.0 cm^2
D. Pressure half-time > 220 msec

A

B. Mitral valve Doppler A wave peak velocity > 1.3 m/s

153
Q

Patients with mitral stenosis, left atrial enlargement and atrial fibrillation are at increased risk for the development of:

A. Left ventricular thrombus
B. Left ventricular dilatation
C. Left atrial myxoma
D. Left atrial thrombus

A

D. Left atrial thrombus

154
Q

Possible signs and symptoms associated with acute severe mitral regurgitation include:

A. Anasarca
B. Systemic embolization
C. Hemoptysis
D. Pulmonary edema

A

D. Pulmonary edema

155
Q

Predict the tissue Doppler imaging E/E’ ratio in a patient with known pseudonormalization of the mitral valve inflow pattern.

A. Increased E’/A’ ratio
B. Normal E’/A’ ratio
C. Dependent upon respiration
D. Decreased E’A’ ratio

A

D. Decreased E’A’ ratio

156
Q

Pressure recovery may explain discrepancies between the pressure gradient measurements acquired in the cardiac catheterization laboratory and the pressure gradient measurements acquired in the echocardiography laboratory (e.g., aortic stenosis, prosthetic aortic valve). Pressure recovery occurs at the:

A. Vena contracta
B. distal to the vena contracta and turbulent region
C. Flow convergence region (PISA)
D. Turbulent region

A

B. distal to the vena contracta and turbulent region

157
Q

Pulmonary regurgitation as detected by Doppler in structurally normal hearts is:

A. Dependent upon respiration
B. A rare finding
C. A common finding
D. An abnormal finding

A

C. A common finding

158
Q

Right ventricular systolic pressure may be calculated when the following condition is present:

A. Mitral regurgitation
B. Aortic regurgitation
C. Pulmonary regurgitation
D. Tricuspid regurgitation

A

D. Tricuspid regurgitation

159
Q

The S’ wave of the mitral valve annulus is determined to be 3 cm/s in peak velocity. This suggests:

A. Hyperdynamic global left ventricular systolic function
B. Normal global left ventricular systolic function
C. Reduced global left ventricular systolic function
D. Dependent upon respiration

A

C. Reduced global left ventricular systolic function

160
Q

The blood pressure in a patient with a patent ductus arteriosus is 124/68 mm Hg. The peak velocity across the patent ductus arteriosus as determined by continuous-wave Doppler is 5 m/s. The systolic pulmonary artery pressure is:

A. 34 mm Hg
B. 24 mm Hg
C. 124 mm Hg
D. 100 mm Hg

A

B. 24 mm Hg

161
Q

The blood pressure in a patient with a ventricular septal defect is 114/77 mm Hg. The peak velocity across the ventricular septal defect as determined with continuous-wave Doppler is 4 m/s. The right ventricular systolic pressure and systolic pulmonary artery pressure is:

A. 114 mm Hg
B. 50 mm Hg
C. 55 mm Hg
D. 64 mm Hg

A

B. 50 mm Hg

162
Q

The blood pressure is 120/80 mm Hg. The peak velocity of mitral regurgitation is 5 m/s. The left atrial pressure is:

A. 120 mm Hg
B. 20 mm Hg
C. 100 mm Hg
D. 5 mm Hg

A

B. 20 mm Hg

163
Q

The continuous-wave Doppler maximum aortic regurgitation velocity reflects the:

A. Maximum instantaneous systolic pressure gradient between the aorta and left ventricle
B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle
C. Mean diastolic pressure gradient between the aorta and left ventricle
D. Mean systolic pressure gradient between the aorta and the left ventricle

A

B. Maximum peak instantaneous diastolic pressure difference between the aorta and the left ventricle

164
Q

The difference between the transmitted frequency and the reflected frequency is known as the:

A. Doppler principle
B. Doppler shift
C. Gorlin equation
D. Bernoulli equatio

A

B. Doppler shift

165
Q

The equation which relates the pressure drop across an area of narrowing is the:

A. Doppler equation
B. Continuity equation
C. Bernoulli equation
D. Velocity ratio equation

A

C. Bernoulli equation

166
Q

The expected continuous-wave Doppler peak velocity of tricuspid regurgitation assuming normal intracardiac pressures is:

A. 3.3 m/s
B. 2.2 m/s
C. 1.0 m/s
D. 0.5 m/s

A

B. 2.2 m/s

167
Q

The following data is obtained in a patient with a prosthetic mitral valve: left ventricular outflow tract diameter is 2.0 cm, the left ventricular outflow tract velocity time integral is 15 cm and the prosthetic mitral valve velocity time integral is 47 cm. The mitral valve area by the continuity equation is:

A. 30 cm2
B. 1.0 cm2
C. 2.0 cm2
D. 3.14 cm2

A

B. 1.0 cm2

168
Q

The following data is obtained in a patient with aortic stenosis: left ventricular outflow tract diameter is 2.0 cm, peak left ventricular outflow tract velocity integral is 20 cm, the aortic valve time velocity integral is 40 cm. The aortic valve area is:

A. 0.75 cm2
B. 3.14 cm2
C. 1.57 cm2
D. 0.3 cm2

A

C. 1.57 cm2

169
Q

The following data is obtained in a patient with aortic stenosis: left ventricular outflow tract velocity time integral is 20 cm and the aortic valve velocity time integral is 40 cm. The velocity ratio is:

A. 0.5
B. 800
C. 40
D. 20

A

A. 0.5

170
Q

The following data is obtained: left ventricular outflow tract diameter is 2.2 cm, left ventricular outflow tract peak systolic velocity is 1.1 m/s and the peak systolic aortic valve velocity is 5 m/s. The aortic valve area is:

A. 0.75 cm2
B. .83 cm2
C. 2.14 cm2
D. 100 cm2

A

B. .83 cm2

171
Q

The formula that is used to calculate the peak pressure gradient in coarctation of the aorta is:

A. 4 (V2 2)
B. 4 (V2 2 – V1 2)
C. CSA x VTI
D. 220 ÷ PHT

A

B. 4 (V2 2 – V1 2)

172
Q

The formula used to estimate left ventricular end-diastolic pressure (LVEDP) from continuous-wave Doppler recording of aortic regurgitation is LVEDP is equal to:

LVEDP, left ventricular end-diastolic pressure; BPs, systolic blood pressure; Vmax, maximum velocity of aortic regurgitation; AR, aortic regurgitation; BPd, diastolic blood pressure; EDV, end-diastolic velocity.

A. BPd – Vmax AR
B. BPs – Vmax AR
C. BPd – 4 x EDV AR
D. BPd – 4 x EDV AR2

A

D. BPd – 4 x EDV AR2

173
Q

The laminar core of a turbulent jet is called the:

A. Flow convergence region (PISA)
B. Relaminarization
C. Vena contracta
D. Turbulent region

A

C. Vena contracta

174
Q

The left ventricular outflow tract diameter in early ventricular systole as measured in the parasternal long-axis is 2.0 cm. The left ventricular outflow tract time velocity integral is 20 cm. The Doppler stroke volume is:

A. 20 mL
B. 63 mL
C. 3.14 cm
D. 2 mL

A

B. 63 mL

175
Q

The mitral valve area can be determined by Doppler with the following formula:

A. 220 ÷ deceleration time
B. Pressure half-time ÷ 220
C. 220 ÷ pressure half-time
D. Deceleration time ÷ pressure half-time

A

C. 220 ÷ pressure half-time

176
Q

The peak velocity across a patent foramen ovale (PFO) is determined to be 1.0 m/s. The right atrial pressure (RAP) is determined to be 5 mm Hg by examination of the characteristics of the inferior vena cava. The left atrial pressure (LAP) is equal to:

A. 9 mm Hg
B. 1 mm Hg
C. 4 mm Hg
D. 14 mm Hg

A

A. 9 mm Hg

177
Q

The peak velocity of pulmonary regurgitation is determined to be 3 m/s. The RAP is 3 mmHg. The mean pulmonary artery pressure is:

A. 39 mm Hg
B. 44 mm Hg
C. 9 mm Hg
D. 3 mm Hg

A

A. 39 mm Hg

178
Q

The pressure drop between two-chambers may be calculated by the formula:

A. 4 x V2 2
B. 220 ÷ pressure half-time
C. Transmitted frequency – received frequency
D. CSA x VTI

A

A. 4 x V2 2

179
Q

The pulmonary regurgitation end velocity is determined to be 2.0 m/s. The inferior vena cava is normal in dimension (< 1.7 cm) and collapses with a sniff by greater than 50%. The pulmonary artery end-diastolic pressure is equal to:

A. 16 mm Hg
B. 19 mm Hg
C. 21 mm Hg
D. 7 mm Hg

A

B. 19 mm Hg

180
Q

The normal mitral valve area is:

A. 4 to 6 cm2
B. 3 to 5 cm2
C. 3.5 to 4.5 cm2
D. 5 to 8 cm2

A

A. 4 to 6 cm2

181
Q

The normal volume of clear serous fluid in the pericardial sac is:

A. 200 to 500 mL
B. 20 to 50 mL
C. 10 to 50 mL
D. 200 to 500 L

A

C. 10 to 50 mL

182
Q

The outpouching behind each aortic valve leaflet is called the:

A. Aortic isthmus
B. Sinuses of Valsalva
C. Ductus arteriosus
D. Ligamentum arteriosum

A

B. Sinuses of Valsalva

183
Q

The potential space behind the left atrium where pericardial effusion could accumulate is the:

A. Transverse sinus
B. Sinus of Valsalva
C. Pleural potential space
D. Oblique sinus

A

D. Oblique sinus

184
Q

The section of the aorta that is located between the diaphragm and the iliac arteries is called the:

A. Aortic isthmus
B. Abdominal aorta
C. Transverse aorta
D. Descending thoracic aorta

A

B. Abdominal aorta

185
Q

When should the left atrium be measured?

A. Diastasis
B. End systole
C. Early diastole
D. Late diastole

A

B. End systole

186
Q

Which left ventricular wall segment is LEAST likely to be supplied by the circumflex coronary artery?

A. Anterolateral wall of the left ventricle
B. Basal inferior wall of the left ventricle
C. Inferolateral wall of the left ventricle
D. Lateral wall of the cardiac apex

A

B. Basal inferior wall of the left ventricle

187
Q

Which two-dimensional view is recommended when measuring the right atrium?

A. Subcostal four-chamber
B. Parasternal right ventricular inflow tract
C. Parasternal short-axis of the aortic valve
D. Apical four-chamber

A

D. Apical four-chamber

188
Q

A patient with known aortic stenosis presents for evaluation. The ejection fraction is 22%. The peak velocity across the aortic valve as determined by continuous-wave Doppler is 2.3 m/s. The peak instantaneous pressure gradient is 21 mm Hg. The mean pressure gradient is 14 mm Hg. The severity of the aortic stenosis is:

A. Requires more information
B. Severe
C. Mild
D. Moderate

A

A. Requires more information

189
Q

A peak velocity of 2 m/s is obtained in a patient with rheumatic mitral stenosis. The peak (maximum) instantaneous pressure gradient is:

A. 16 mm Hg
B. 26 mm Hg
C. 4 mm Hg
D. 2 mm Hg

A

A. 16 mm Hg

190
Q

All of the following are simplified PISA methods for determining the severity of mitral regurgitation EXCEPT:

PISA, proximal isovelocity surface area; ERO, effective regurgitant orifice; r, radius of PISA; RV, regurgitant volume

A. ≥ 0.9 cm PISA radius that is holosystolic indicates significant mitral regurgitation
B. 220 ÷ pressure half-time
C. RV (mL) = 2 x r2 x aliasing velocity (cm/s)
D. ERO (cm2) = r2 ÷ 2

A

B. 220 ÷ pressure half-time

191
Q

As a valve orifice narrows because of stenosis pressure proximal to the stenosis will:

A. Increase with inspiration, decrease with expiration
B. Increase
C. Decrease
D. Equilibrate

A

B. Increase

192
Q

Assuming normal intracardiac pressures, predict the peak systolic velocity for a patent ductus arteriosus.

A. 3 m/s
B. 1 m/s
C. 5 m/s
D. 0.5 m/s

A

C. 5 m/s

193
Q

Assuming normal intracardiac pressures, predict the peak velocity of atrial septal defect.

A. 1 m/s
B. 3 m/s
C. 5 m/s
D. 0.5 m/s

A

A. 1 m/s

194
Q

Assuming normal intracardiac pressures, the expected continuous-wave Doppler peak velocity of mitral regurgitation would be:

A. 5 m/s
B. 3 m/s
C. 7 m/s
D. 1 m/s

A

A. 5 m/s

195
Q

Assuming normal intracardiac pressures, the expected peak systolic velocity of a ventricular septal defect would be:

A. 0.5 m/s
B. 3 m/s
C. 5 m/s
D. 1 m/s

A

C. 5 m/s

196
Q

Assuming normal intracardiac pressures, the expected peak velocity of pulmonary regurgitation is:

A. 1 m/s
B. 3 m/s
C. 2 m/s
D. 4 m/s

A

A. 1 m/s

197
Q

Components of the Doppler equation include all the following EXCEPT:

A. The angle between the ultrasound beam and the direction of blood flow must be known for accurate measurement of blood flow.
B. The transmitted ultrasound frequency is an important determinant of the Doppler shift detected.
C. The cosine of 0° is 1 and it is assumed in echocardiography that the recorded velocity has been obtained at a near-parallel intercept angle.
D. Propagation speed of sound changes relative to the velocity of the red blood cells.

A

D. Propagation speed of sound changes relative to the velocity of the red blood cells.

198
Q

Determine the Qp/Qs for an atrial septal defect with the following data: RVOTd = 3.0 cm; RVOTVTI = 20 cm; LVOTd = 2.0 cm; LVOTVTI = 10 cm

RVOTd, right ventricular outflow tract diameter; RVOTVTI, right ventricular outflow tract velocity time integral; LVOTd, left ventricular outflow tract diameter; LVOTVTI, left ventricular outflow tract velocity time integral

A. 3.3:1
B. 4.5:1
C. 2:1
D. 10:1

A

B. 4.5:1

199
Q

Determine the mitral effective regurgitant orifice and regurgitant volume using the PISA method:

Radius: 1.0 cm

Aliasing velocity: 40 cm/s

Mitral regurgitation peak velocity: 500 cm/s

Mitral regurgitation velocity time integral: 110 cm

A. 55 cm2; 50 mL
B. 1 cm2; 50 mL
C. 0.50 cm2; 55 mL
D. 0.40 cm2; 110 mL

A

C. 0.50 cm2; 55 mL

200
Q

Determine the mitral regurgitant volume, regurgitant fraction and effective regurgitant orifice using the following information:

LVOT diameter: 2.0 cm, LVOTVTI: 10 cm,
Mitral valve annulus diameter: 3.0 cm,
Mitral valve annulus VTI: 15 cm, Mitral regurgitation VTI: 200 cm
LVOT, left ventricular outflow tract; VTI, velocity time integral

A. 2 mL; 100%; 2 cm2
B. 74 mL; .70%; 37 cm2
C. 34 mL; 17%; .17 cm2
D. 200 mL; 50%; .75 cm2

A

B. 74 mL; .70%; 37 cm2

201
Q

Formulas that may be used to calculate the cross-sectional area of an orifice or vessel through which blood is flowing include all the following EXCEPT:

r, radius; D, diameter

A. p x (D ÷ 2)2
B. p x (D2 ÷ 4)
C. 0.785 x D2
D. 2 x p x r2

A

D. 2 x p x r2

202
Q

In a patient with aortic stenosis the continuous-wave Doppler recordings demonstrate a maximum peak systolic velocity across the aortic valve of 5 m/s. The peak (maximum) instantaneous pressure gradient is:

A. 25 mm Hg
B. 100 mm Hg
C. 5 mm Hg
D. 110 mm Hg

A

B. 100 mm Hg

203
Q

In patients with aortic valve stenosis the pressure gradients measured by Doppler include:

A. Peak-to-mean gradient
B. Peak (maximum) instantaneous pressure gradient and peak-to-peak gradient
C. Peak (maximum) instantaneous pressure gradient
D. Peak-to-peak pressure gradient

A

C. Peak (maximum) instantaneous pressure gradient

204
Q

Minor degrees of tricuspid regurgitation and mitral regurgitation detected by Doppler in structurally normal hearts:

A. Are a rare finding
B. Are a common finding
C. Vary greatly from one echocardiography laboratory to another
D. Depend on respiration

A

B. Are a common finding

Cardiac theory sem 1 (2 decks)

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