High Yield PTEeXAM Review Part 12 - 14

Question 1

How does chamber quantifications change when comparing M-Mode to 2D echo?

Answer 1

M mode measures slightly higher LV dimensions as compared to 2D echo for the same LV

Question 2

The recommended view for RV chamber quantification by TEE is what view?

Answer 2

ME 4 chamber view (RV focused)

Question 3

The recommended view for measurement of the RVOT by TEE is what view?

Answer 3

ME RV Inflow Outflow

Question 4

Mitral Valve Area formula for mitral valve when using PHT is what?

Answer 4

MVA = 220 / PHT

Question 5

What are the mean pressure gradients when evaluating mitral stenosis to determine mild, moderate, and severe?

Answer 5

Mild <5 mmHg

Moderate 5- 10 mmHg

Severe > 10 mmHg

Question 6

MVA formula for mitral valve when using Deceleration time is what?

Answer 6

MVA = 760 / Deceleration TIme

Question 7

How would aortic regurgitation affect Mitral Stenosis evaluation using PHT method?

Answer 7

Severe A.I. will lead to an underestimation of Mitral Stenosis using PHT method

Why?

Severe A.I. –> Rapid increase in in LV pressure. rapid increase will decrease your PHT and result in an overestimation of the mitral valve area

Question 8

How would diastolic dysfunction affect your PHT methods when evaluating for mitral stenosis?

Answer 8

Diastolic Dysfunction would increase LVEDP which would decrease your PHT

You would therefore underestimate your mitral stenosis with diastolic dyfunction

Question 9

What phase is at the arrow in the photo?

Answer 9

M mode Vp Late atrial contraction

Question 10

When should left atrial size be measured in relation to the cardiac cycle?

Answer 10

End-Ventricular Systole when it achieves its greatest dimension

Question 11

When would you want to measure left atrial dimensions?

Answer 11

Quantify and follow response to therapy in diastolic dysfunction

Question 12

What resolution(s) does the focal point have?

Answer 12

Best Lateral and Elevational Resolution

Question 13

How will the focal point change when you increase the beam diameter?

Answer 13

Deeper focal point

Question 14

What are the vena contracta cutoffs for TR grading?

Answer 14

Mild ?

Mod ?

Severe > 7mm

Question 15

What are the vena contracta cutoffs for MR?

Answer 15

Mild < 3 mm

Mod 3-7 mm

Severe > 7 mm

Question 16

What are the vena contracta cutoffs for AI?

Answer 16

Mild < 3 mm

Mod 3-6 mm

Severe > 6mm

Question 17

How does systolic flow reversal in the pulmonary veins on PWD affect your decision to deem severe MR or not?

Answer 17

Positive (+) Systolic flow reversal = Severe MR

Negative (-) systolic flow reversal does not rule out Severe MR because of false positives

1. The jet can be pointed away
2. The LA can be dilated
3. Atrial Fibrillation (Blunting)

Question 18

the vena contracta is independent of what two things when looking at MR?

Answer 18

Independent of flow and rate

Question 19

What is the narrowest portion of the MR jet when you measure vena contracta “Equivalent to”?

Answer 19

Regurgitant Orifice Area

Question 20

Where is the vena contracta of MR best measured?

Answer 20

ME LAX

• Highest “Axial Resolution”
• Perpendicular to the jet
• Zoom mode
• Narrow sector
• Minimum depth

Perpendicular to the scan plane

Question 21

How do you calculate dP/dT Calculation for the LV?

Answer 21

1. Optimize MR jet
2. CWD on MR jet
3. Two points from 1-3 m/sec Then calculate the slope here!

Divide 32 mmHg / Time it takes to get from 1 to 3 m/sec

Normal = ~>1200 - 1600

Question 22

Normal FAC values of the RV are greater than What %

What is abnormal?

Answer 22

Remember this is the percentage of area change not the RV ejection fraction. Normal FAC values are greater than 35%.

Anything below 35% is abnormal.

Question 23

Normal values for fractional shortening are “A” %

Normally, the a FAC is > “B” %

Answer 23

FS = > 30%

FAC > 50%

Question 24

How does FAC correlate to EF?

Answer 24

FAC 10% –> 15% EF

FAC 20% –> 29% EF

FAC 30% –> 42% EF

FAC 40% –> 54% EF

FAC 50% –> 66%

FAC 60% –> 75%

Question 25

What mitral leaflet scallop is closes to the left atrial appendage?

Answer 25

P1 scallop

Question 26

If you place a CWD in DEEP TG 5 chamber or TG LAX, you could get MR jet and AS jet in same plane. What differentiates them?

Answer 26

*_MR occurs during isovolumetric contraction because LV pressure exceeds LA pressure_* **Aortic Outflow (Aortic Stenosis) starts after IVCT is over and ejection starts**

Question 27

In the CWD profile of AR jet, the time interval indicated by the Boled Arrow is the the:

Answer 27

Pressure half time

Question 28

Name 3 other causes of holo-diastolic reversal of flow in the abdominal aorta other than severe AI.

Answer 28

1. PDA 2. Aortic Dissection 3. Aortic Aneurysm

Question 29

The ultrasound modality with the highest thermal index (TI) i.e. the ability to raise the body tissue temperataure is:

Answer 29

Pulse Wave Doppler

Question 30

How does the Reynolds number change when you increase the diameter?

Answer 30

**Increase the Reynolds number** Less chance of turbulent flow

Question 31

During catheterization, when do they measure peak AV gradients during the "Pull back"?

Answer 31

1. LVOT 2. Sino-tubular Junction

Question 32

When using continuity equation, what is the biggest form of error when quantifying AV area?

Answer 32

Diameter at Point A | (Because the measurement is squared)

Question 33

When you put CWD across the aortic valve, how does that pressure compare to the gradient obtained in cath lab?

Answer 33

**CWD gradient** \> **Cath gradient due to pressure recovery** - Decreased in blood velocity in ascending aorta and increase in pressure resulting in a lower peak gradient across the AV

Question 34

What does S1 wave correlate to? S2? D? A?

Answer 34

Systolic wave which has an early-systolic component **(S1)** A larger mid- and late-systolic component **(S2)** **F**ollowed by a **diastolic component (D)** During **atrial contraction**, there is slight flow reversal (Ar)

Question 35

What will affect **S1** wave pulmonary venous waveform?

Answer 35

Atrial Relaxation in early systole

Question 36

What will affect **S2** wave pulmonary venous waveform? (3)

Answer 36

RV stroke volume LA compliance Descent of MV annulus which lowers LA pressure

Question 37

Tissue doppler signals have: 1. What amplitude? 2. What velocity?

Answer 37

Amplitude = High Velocity = Low

Question 38

What is tenting height and when would it be applicable?

Answer 38

Used for **ischemic MR** ## Footnote **- Measures severity of leaflet restriction**

Question 39

Which of the following is the most common location of a papillaray fibroelastoma?

Answer 39

Aortic Valve