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PTE Masters + A Practical Approach to Transesophageal Echocardiography > High Yield PTEeXAM Review Part 1 & 2 (a-c) > Flashcards

High Yield PTEeXAM Review Part 1 & 2 (a-c) Flashcards

1
Q

How does color M-mode flow propagation velocity (Vp) change with preload in all patients?

A

Increases Vp with increases in preload in all patients

(Sensitive with loading conditions)

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2
Q

Is the mitral annular tissue doppler early velocity (e’) load dependent or load independent?
Is this for all patients, or selected only for diastolic dysfunction?

A

Load independent

Only in patients with diastolic dysfunction

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3
Q

What is the normal e’ velocity?

A

e’ >10 cm/sec

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4
Q

When is E/e’ unreliable?

A

Normal patients

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5
Q

What is seen here?

A

Septal Tricuspid Valve Leaflet

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6
Q

What is the most load independent of systolic function?

A

End Systolic Elastance

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7
Q

Other than End-Systolic elastance, name 3 other relatively load independent indexes of contractility.

A

1. Preload recuitable stroke work

2. Strain rate

3. Preload adjusted max power

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8
Q

What is the end systolic elastance?

A

The slope of a line through the end-systolic pressure-volume point (the left upper corner of the P-V loop) is termed End-Systolic Elastance (Ees) and is a measure of ventricular contractility.

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9
Q

What is the slope of the line where you have

Y-axis = Stroke Work

X-axis = End Diastolic Volume

A

Preload Recruitable Stroke Work = True Index of contractility

Y-axis = Stroke Work

X-axis = End Diastolic Volume

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10
Q

What is the formula for Preload Adjusted Max Power?

(Hint; There are 2 of them)

A

Preload Adjusted Max Power = Stroke Work / EDV2

Preload Adjusted Max Power = Stroke Work / EDA(3/2)

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11
Q

Preload Adjusted Max Power

Load dependent or load independent?

A

Load independent

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12
Q

How do you obtain tissue doppler peak systolic velocity?

A

Put PWD gate on the lateral annulus of the 4 chamber view

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13
Q

What are the 4 measures of systolic function that are load independent?

A
  1. End Systolic Elastance
  2. Preload Recruitable Stroke Work
  3. Strain Rate
  4. Preload Adjusted Max Power
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14
Q

What is the formula for Strain?

A

Strain = (L2-L1) / L1

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15
Q

What is the formula for Strain Rate?

A

Strain / Change in time = [(L2-L1) / L1] / Change in time

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16
Q

How do you logistically measure strain ratae of the LV on Echo?

A

Measure V1 Tissue Doppler

Measure V2 Tissue Doppler

measure “x” = Distance between the 2 velocities

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17
Q

Is speckle tracking angle independent or dependent?

A

Speckle Tracking = Angle Independent

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18
Q

What is strain rate dependent on?

(Reason why people don’t use this)

A

Angle

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19
Q

What is the normal value for strain rate of the LV or RV?

A

Anything more negative than -20.

Anything that is “more positive” than -20, is abnormal

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20
Q

What is this?

A

Papillary Fibroelastoma

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21
Q

Where do fibroelastomas develop (Be specific)?

A

Downstream side of the Valve

(LV side of the MV or Aortic side of the AV)

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22
Q

What is the function of the backing material in an ultrasound transducer?

A

Decreases the quality factor

23
Q

Draw an ultrasound transducer with these three pieces of equipment.

1. Backing material

2. Matching Layer

3. Piezoelectric Crystal

A

Matching layer in front

PZT crytals behind

Backing material in back of that

24
Q

What is the Q factor?

A

Unitless number that represents the transducers ability to emit a clean ultrasound pulse with a narrow bandwidth

25
Q

What is the Q factor formula?

A

Resonance frequency / Bandwidth

26
Q

What is the optimal thickness of matching layer to the wavelength?

A

1/4 of wavelength thickness

27
Q

What is the purpose of the matching layer?

A

Facilitates transfer of ultrasound through the tissues

Prevents a large echo interface of the transducer and the body

28
Q

What is the optimal thickness of the crystal relative to the wavelength?

A

1/2 of wavelength

29
Q

How does the backing material improve axial resolution

A
  1. Functions to shorten SPL (Shorter pulse)

Prevents excess vibration of the crystals

- Less vibration = Shorter SPL = Improved axial resolution

  1. Equation Axial resolution = 1/2 SPL therefore if you decrease this, you improve axial resolution

Decreases ringing of the crystal

“Cloth that covers a wine glass” - DINGGGGGGG
then you grab it with a cloth

30
Q

What material is the piezoelectric crystal made out of ?

A

Lead Zirconate Titanate

31
Q

What is the piezoelectric effect?

A

Conversion of sound to electrical signal

32
Q

What is the reverse piezoelectric effect?

A

Conversion of electrical signal to sound

33
Q

What is another term for backing material?

A

Damping element

34
Q

What is bandwidth of an ultrasound?

A

Range, or differences between the highest and lowest frequencies in the pulse

35
Q

A transducer has a main frequency of 5 MHz. The range of frequncies is from 2 to 8 MHz.

What is the bandwith?

A

Bandwidth = 8-2 MHz = 6 MHz

36
Q

How does the backing material affect:

  1. Bandwidth
  2. Q factor?
A

Higher bandwidth

Lower Q factor

37
Q

What is a duty factor?

And relate it to an drawing illustration.

A

Fraction of time which an ultrasound transmits a wave

Ex: CWD Duty factor = 100%

38
Q

What is the expected Mitral E/A Ratio for :

Normal diastolic function?

A

>/= 0.8

39
Q

What is the expected Mitral E/A Ratio for :

Grade I diastolic dysfunction?

A

= 0.8

40
Q

What is the expected Mitral E/A Ratio for :

Grade II diastolic dysfunction?

A

>0.8 to <2

41
Q

What is the expected Mitral E/A Ratio for :

Grade 3 diastolic dysfunction?

A

>2

42
Q

What is the expected E/e’ for :

Normal Diastology Function?

A

< 10

43
Q

What is the expected E/e’ for :

Grade 1 Diastology Dysfunction?

A

<10 e/e’

44
Q

What is the expected E/e’ for :

Grade II Diastolic Dysfunction?

A

10 - 14

45
Q

What is the expected E/e’ for :

Grade III Diastology Dysfunction?

A

>14

46
Q

What is the expected Peak TR Velocity (m/sec) for :

Normal Diastology Function?

A

< 2.8 m/s

47
Q

What is the expected Peak TR Velocity (m/sec) for :

Grade I Diastolic Dysfunction?

A

< 2.8 m/sec

48
Q

What is the expected Peak TR Velocity (m/sec) for :

Grade II Diastolic Dysfunction?

A

> 2.8 m/sec

49
Q

What is the expected Peak TR Velocity (m/sec) for :

Grade III Diastolic Dysfunction?

A

> 2.8 m/s

50
Q

What is a normal deceleration time for normal diastolic dysfunction?

A

<220 ms

51
Q

What is a deceleration time for Grade I Diastolic Dysfunction?

A

>220 ms

52
Q

What is a deceleration time for Grade II Diastolic Dysfunction?

A

150 - 200 ms

53
Q

What is a deceleration time for Grade III Diastolic Dysfunction?

A

<150 ms

PTE Masters + A Practical Approach to Transesophageal Echocardiography (55 decks)

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