High Yield PTEeXAM Review Part 18-20

Question 1

What is the cause of persistent left superior vena cava?

Answer 1

Persistent left superior vena cava results when the left superior cardinal vein caudal to the innominate vein fails to regress.

Said another way

Failure of the fusion of the cardinal veins

Question 2

What is the equation for determining pulmonary artery mean pressure? (PAMP)

Answer 2

PAMP = 4 (V_{early PI})² + CVP

Question 3

What is the equation for determining pulmonary artery diastolic pressure? (PADP)?

Answer 3

PAMP = 4 (V_{late PI})² + CVP

Question 4

Bicuspid Aortic Valve most common associated with what congenital abnormality?

Answer 4

Coarctation of the Aorta

Question 5

Which bicuspid valve orientation has a greater propensity to develop aortic stenosis?

Vertical* orientation vs. *Horizontal orientation?

Answer 5

Horizontal > Vertical to develop aortic stenosis

Question 6

For Systolic flow reversal in the pulmonary veins

Does the presence rule in severe MR?

Does the absence rule out severe MR?

Answer 6

Systolic flow reversal in the pulmonary veins = Specific for MR

Systolic flow reversal in the pulmonary veins = Not sensitive for MR

(You can still have severe MR with no systolic flow reversal in the pulmonary veins)

Question 7

What is most influential on wave S1 in pulmonary veins?

Answer 7

LA relaxation during ventricular systole

Question 8

What is most influential on wave S2 in pulmonary veins?

Answer 8

Left Atrial filling during RV systole

Question 9

What is S1 wave in pulmonary veins determined by?

Answer 9

Left Atrial Relaxation during ventricular systole

Question 10

What is S2 wave in pulmonary veins determined by?

Answer 10

RV stroke volume

LA Compliance

Descent of MV annulus which lowers LA pressure

Question 11

What is A wave in pulmonary veins due to?

Answer 11

Left Atrial Contraction

Question 12

What is a way using pulmonary vein velocities can you tell Normal Mitral Valve inflow from Pseudonormal?

Answer 12

Normal = Systolic Dominant

Pseudonormal = Systolic Blunting

Question 13

What is a normal value of deceleratime time?

Answer 13

< 220 ms

Question 14

What is a normal tissue doppler ot he lateral annulus of the mitral valve?

Answer 14

>8.0 cm/sec

Question 15

What does the matching layer in the transducer do?

Answer 15

Matches acoustic impedence of the skin to increase penetration of sound waves

Question 16

Which echo index is the most reliable to measure AI severity?

Answer 16

Vena Contracta

Question 17

Answer the question below

Answer 17

1. SBP + Pressure across LV = LV pressure
2. Pressure across LV = Change in P (Peak Velocity across AV)² = 4 (2)² = 16 mmHg

Therefore 148 + 16 = 164

3. Use End Peak Velocity of AI (4 m/s) to get LVEDP

Question 18

What is the equation for MVA when given deceleration time?

Answer 18

MVA = 760/DT

Question 19

How do we grade Mitral Stenosis in terms of mean gradient across the valve?

What about pressure half time?

Answer 19

Mean Gradients

<5 and >10 is mild and severe

For PHT

30-89 = Normal ,90-150 = Mild, >220 = severe

Question 20

What is the deceleration time actually mean?

Answer 20

TIme taken for the pressure to decline to zero from the peak pressure

Question 21

What are 3 ways to decrease aliasing?

Answer 21

1. Increase PRF (Decrease depth of the sample volume)
2. Decrease Ft, this lowers (Change in Freq) making Change in Freq less than 1/2 PRF
3. Use CWD

Question 22

What is the difference between normal, excessive, and restrictive leaflet motion?

Answer 22

Normal = Central jet with annular dilation

Excessive = Jet that goes away from diseased leaflet

Restrictive = Jet that goes toward diseased leaflet

Question 23

When is Type 3a restrictive?

What is the classic example of Type 3a motion?

Answer 23

During systole and diastole

3a = Rheumatic Heart Disease

Question 24

When is Type 3b restrictive?

What is the classic example of Type 3b motion?

Answer 24

3b = Restrictive in systole only

Ex: Dilated CM, Ischemic Heart Disease

Question 25

What is billowing of the MV leaflets?

What is prolapse of the MV leaflets?

What is flail of the MV leaflets?

Answer 25

Billowing = Leaflet tips are below the annulus

Prolapsed = Leaflet tips are above the annular plane

Flail = Ruptured chord

Question 26

Label the 17 wall segments that the LAD perfuses

Answer 26

**NOTE, the IS wall in the TG Mid Pap is the RCA not the LAD per new guideliens**

Question 27

Label the 17 wall segments that the RCA perfuses

Answer 27

**NOTE, the IS wall in the TG Mid Pap is the RCA not the LAD per new guideliens**

RCA in Blue

Question 28

Label the 17 wall segments that the LCX perfuses

Answer 28

**NOTE, the IS wall in the TG Mid Pap is the RCA not the LAD per new guideliens**

Question 29

What is normal % of radial shortening?

Answer 29

>30%

Question 30

What is radial shortening % for mild hypokinesis?

Answer 30

10-30%

Question 31

What is radial shortening % for severe hypokinesis?

Answer 31

>0% and <10%

Question 32

What radial shortening % is akinesis?

Answer 32

0

Question 33

What radial shortening % is dyskinesis?

Answer 33

Presence of systolic thinning

Question 34

Answer the question of the photo below

Answer 34

C = Pulmonic Infufficiency

Question 35

Answer the question

Answer 35

Aortic Stenosis and Aortic Regurgitatation

Question 36

Answer question using the photo below

Answer 36

Aortic stenosis

Aortic Regurgitation

Mitral Regurgitation