Semester 2 Pool Flashcards by Brittany Schreiber

A communication between the ascending aorta and the main pulmonary artery is called:

A. Patent ductus arteriosus
B. Supracristal ventricular septal defect
C. Coarctation of the aorta
D. Aortopulmonary window

D. Aortopulmonary window

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A complete atrioventricular septal defect is ostium primum atrial septal defect with:

A. Canal (inlet)-type ventricular septal defect, patent ductus arteriosus
B. Canal (inlet)-type ventricular septal defect, common atrioventricular valve
C. Cleft mitral valve
D. Coarctation of the aorta

B. Canal (inlet)-type ventricular septal defect, common atrioventricular valve

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A congenital malformation of the tricuspid valve in which one, two or all three leaflets are displaced downward from the annulus with right ventricular dysplasia (atrialization) is known as:

A. Tricuspid atresia
B. Tricuspid stenosis
C. Epstein-Barr anomaly
D. Ebstein’s anomaly

D. Ebstein’s anomaly

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A defect is found in the central portion of the inter-atrial septum. The type of atrial septal defect present is:

A. Coronary sinus
B. Sinus venosus
C. Ostium primum
D. Ostium secundum

D. Ostium secundum

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A membrane stretching from the left side of the interventricular septum to the right side of the anterior leaflet of the mitral valve is called:

A. Discrete subaortic stenosis
B. “Strand” aorta
C. Aortic dissection
D. Hourglass aortic stenosis

A. Discrete subaortic stenosis

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A patient with a long-standing history of systemic hypertension is sent to the emergency room after developing chest pain that radiated to the back. The electrocardiogram demonstrated left ventricular hypertrophy and the chest roentgenogram revealed a widening of the superior mediastinum. A possible diagnosis is:

A. Aortic dissection
B. Pericarditis
C. Acute severe mitral regurgitation
D. Mitral stenosis

A. Aortic dissection

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A possible etiology for aortic aneurysm is:

A. Dilated cardiomyopathy
B. Coronary artery disease
C. Marfan syndrome
D. Aortic regurgitation

C. Marfan syndrome

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A potential complication of patent foramen ovale is:

A. Congestive heart failure
B. Mitral valve stenosis
C. Paradoxical embolus
D. Valvular stenosis

C. Paradoxical embolus

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A redundancy of the mid-portion of the atrial septum which may result in an inter-atrial shunt is called:

A. ASH
B. DSS
C. SAM
D. ASA

D. ASA

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A two-dimensional echocardiographic finding for an aortic intimal flap indicates aortic:

A. Regurgitation
B. Stenosis
C. Dissection
D. Aneurysm

C. Dissection

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All of the following are associated echocardiographic findings for atrial septal defect EXCEPT:

A. Right atrial enlargement
B. Left ventricular enlargement
C. Right ventricular enlargement
D. Paradoxical interventricular septal motion

B. Left ventricular enlargement

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All of the following are associated with pulmonary stenosis EXCEPT:

A. Pulmonary regurgitation
B. Right ventricular hypertrophy
C. Coarctation of the aorta
D. Systolic doming of the pulmonary valve

C. Coarctation of the aorta

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All of the following are true concerning supravalvular aortic stenosis EXCEPT:

A. Associated with proximal coronary artery dilatation
B. Left ventricular volume overload
C. Hourglass type associated with Williams syndrome
D. Parasternal long-axis view allows visualization

B. Left ventricular volume overload

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All of the following surgical repairs for congenital heart disease are correctly matched EXCEPT:

A. Blalock-Taussig: Right subclavian artery to the right
pulmonary artery
B. Modified Glenn: Superior vena cava to the right pulmonary artery
C. Fontan: Single ventricle repair
D. Ross: Surgical ligation of a patent ductus arteriosus

D. Ross: Surgical ligation of a patent ductus arteriosus

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An intimal flap in the aorta is discovered in the parasternal long-axis view, suprasternal long-axis view of the aorta and subcostal long-axis of the abdominal aorta. The type of aortic dissection is DeBakey type:

A. III
B. I
C. II
D. B

B. I

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Associated anomalies of sinus of Valsalva aneurysm include all of
the following EXCEPT:

A. Bicuspid aortic valve
B. Ventricular septal defect
C. Coarctation of the aorta
D. Atrial septal defect

D. Atrial septal defect

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Congenital heart defects strongly associated with Ebstein’s anomaly include:

A. Coarctation of the aorta
B. Atrial septal defect
C. Discrete subaortic stenosis
D. Parachute mitral valve

B. Atrial septal defect

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Defects associated with tetralogy of Fallot in approximately 30% of cases include:

A. Tricuspid atresia
B. Overriding pulmonary artery
C. Right aortic arch
D. Bicuspid aortic valve

C. Right aortic arch

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Echocardiographic criteria for the diagnosis of aortic dissection include all of the following EXCEPT:

A. Pleural effusion
B. Recognition of an intimal flap within the aorta
C. Decrease in aortic dimension
D. Pericardial effusion

C. Decrease in aortic dimension

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Eisenmenger’s syndrome may be associated with all of the following EXCEPT:

A. Ventricular septal defect
B. Patent ductus arteriosus
C. Atrial septal defect
D. Bicuspid aortic valve

D. Bicuspid aortic valve

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For an agitated saline contrast exam, where will contrast appear proving the patient has an atrial septal defect?

A. Right ventricle
B. Main pulmonary artery
C. Right atrium
D. Left atrium

D. Left atrium

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Important factors in evaluating post-surgical repair of tetralogy of Fallot include all of the following EXCEPT:

A. Evaluate right and left ventricular function
B. Rule out residual right ventricular outflow tract obstruction
C. Rule out shunting at the margins of the ventricular septal defect repair
D. Rule out residual shunting at the margins of the atrial septal defect repair

D. Rule out residual shunting at the margins of the atrial septal defect repair

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In a patient with ventricular septal defect the blood pressure is 120/80 mm Hg and the peak systolic velocity of the ventricular septal defect is 5 m/s. The right ventricular systolic pressure and systolic pulmonary artery pressure is:

A. 110 mm Hg
B. 30 mm Hg
C. 20 mm Hg
D. 120 mm Hg

C. 20 mm Hg

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In coarctation of the aorta blood pressure in the legs:

A. Cannot be compared with blood pressure in the right arm
B. Is equal to blood pressure in the right arm
C. Is lower than the right arm
D. Is higher than in the right arm

C. Is lower than the right arm

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Narrowing of the aortic isthmus is:

A. Patent ductus arteriosus
B. Aortic dissection
C. Aortic arch aneurysm
D. Coarctation of the aorta

D. Coarctation of the aorta

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Patent ductus arteriosus results in

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

D. Left ventricular volume overload

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Possible complications of aortic dissection include all of the following EXCEPT:

A. Pericardial effusion
B, Aortic regurgitation
C. Left ventricular inflow tract obstruction
D. Progressive enlargement of the aorta

C. Left ventricular inflow tract obstruction

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Prime characteristics of tetralogy of Fallot include all of the following EXCEPT:

A. Right ventricular outflow tract obstruction
B. Atrial septal defect
C. Right ventricular hypertrophy
D. Malalignment ventricular septal defect

B. Atrial septal defect

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The Doppler finding associated with patent ductus arteriosus is:

A. Increased flow velocity at the aortic isthmus
B. Holodiastolic flow reversal in the descending thoracic aorta
C. Decreased pressure half-time of the mitral valve
D. Systolic flow reversal in the pulmonary veins

B. Holodiastolic flow reversal in the descending thoracic aorta

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The _____________ sinus of Valsalva is the most common sinus involved in sinus of Valsalva aneurysm.

A. All three are equally involved in sinus of Valsalva aneurysm
B. Left
C. Non-coronary
D. Right

D. Right

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The cardiac chambers that are enlarged in ventricular septal defect initially are:

A. Left atrium; left ventricle
B. Right ventricle; left ventricle
C. Right atrium; right ventricle
D. Right atrium; left atrium

A. Left atrium; left ventricle

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The cardiovascular abnormalities
seen with Marfan syndrome include all of the following EXCEPT:

A. Mitral valve prolapse
B. Mitral supravalvular ring
C. Aortic dissection
D. Dilatation of the aortic root, sinuses of Valsalva, ascending aorta

B. Mitral supravalvular ring

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The congenital heart defect most often associated with Down syndrome (trisomy 21) is:

A. Tetralogy of Fallot
B. Coarctation of the aorta
C. Peripheral pulmonary stenosis
D. Atrioventricular septal defect

D. Atrioventricular septal defect

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The four defects that make up tetralogy of Fallot are right ventricular outflow tract obstruction (e.g., pulmonary stenosis), ventricular septal defect, right ventricular hypertrophy and:

A. Coarctation of the aorta
B. Cleft mitral valve
C. Atrial septal defect
D. Deviation of the aorta

D. Deviation of the aorta

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The most common location for aneurysm of the aorta is the:

A. Abdominal aorta
B. Transverse aorta
C. Descending thoracic aorta
D. Ascending aorta

A. Abdominal aorta

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The most common type of ventricular septal defect is:

A. Outlet (supracristal)
B. Inlet
C. Perimembranous
D. Trabecular

C. Perimembranous

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The normal Qp/Qs ratio is:

A. 2:1
B. 1:2
C. 50%
D. 1:1

D. 1:1

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The peak velocity across a patent ductus arteriosus is 4 m/s and the blood pressure is 90/60 mm Hg. The systolic pulmonary artery pressure is:

A. 4 mm Hg
B. 36 m Hg
C. 26 mm Hg
D. 64 mm Hg

C. 26 mm Hg

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The physical finding of cyanosis is most common in:

A. Mitral valve prolapse
B. Pulmonary regurgitation
C. Eisenmenger’s syndrome
D. Patent foramen ovale

C. Eisenmenger’s syndrome

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The type of ventricular septal defect most often associated with ventricular septal aneurysm is:

A. Outlet
B. Perimembranous
C. Inlet
D. Trabecular

B. Perimembranous

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The typical murmur associated with patent ductus arteriosus is:

A. Late systolic murmur
B. Holosystolic murmur
C. Continuous murmur
D. Decrescendo diastolic murmur

C. Continuous murmur

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The view of choice when examining a patient with secundum atrial septal defect is:

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

B. Subcostal four-chamber

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Types of supravalvular aortic stenosis include all of the following EXCEPT:

A. Dissected
B. Hourglass
C. Tunnel
D. Hypertrophic

A. Dissected

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Uhl’s anomaly is:

A. Right ventricular dysplasia
B. Left atrium aneurysm
C. Abnormal displacement of the tricuspid valve
D. Ostium primum atrial septal defect with cleft mitral valve

A. Right ventricular dysplasia

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Valvular lesions with which coarctation of the aorta is strongly associated include:

A. Bicuspid aortic valve
B. Aortic valve flail
C. Tricuspid atresia
D. Aortic valve vegetation

A. Bicuspid aortic valve

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When evaluating atrial septal defect flow with color Doppler, the sonographer should:

A. Invert the color flow map
B. Increase the color Doppler filter
C. Reduce the color velocity scale
D. Invert the color flow map

C. Reduce the color velocity scale

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A common echocardiographic finding in a cardiac surgery patient is:

A. Paradoxical interventricular septal motion
B. Valvular stenosis
C. Pleural effusion
D. Valvular prolapse

A. Paradoxical interventricular septal motion

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A common two-dimensional echocardiographic finding in patients with chronic renal failure is:

A. Pulmonary hypertension
B. Aortic dissection
C. Pericardial effusion
D. Mitral valve prolapse

C. Pericardial effusion

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A dilated coronary sinus is visualized in the parasternal long-axis. An agitated saline contrast study is performed and contrast is noted to appear in the coronary sinus before entering the right atrium. The diagnosis is most likely:

A. Normal
B. Persistent left superior vena cava
C. Inlet ventricular septal defect
D. Inlet ventricular septal defect

B. Persistent left superior vena cava

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A left atrial volume is determined to be 44 ml/m^2. The left atrium is:

A. Enlarged
B. Thrombosed
C. Normal
D. Hyperdynamic

A. Enlarged

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A membrane is visualized in the left atrium and appears to be superior to the fossa ovalis. This finding suggests:

A. Supravalvular mitral ring
B. Mitral stenosis
C. Cor triatriatum
D. Tetralogy of Fallot

C. Cor triatriatum

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A membrane located at the level of the mitral valve annulus is mitral valve:

A. Annular calcification
B. Ring
C. Prolapse
D. Flail

B. Ring

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A string-like structure is seen in the apex of the left ventricle. This finding may be called all of the following EXCEPT:

A. Moderator band
B. Chordal web
C. False tendon
D. Ectopic chordae

A. Moderator band

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All of the following are associated echocardiographic/Doppler finding for the Marfan syndrome EXCEPT:

A. Valvular regurgitation
B. Mitral stenosis
C. Aortic root dilatation
D. Aortic dissection

B. Mitral stenosis

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All of the following are associated findings for pulmonary embolism EXCEPT:

A. Right ventricular dilatation
B. Left ventricular hypertrophy
C. D-shaped left ventricle
D. Tricuspid regurgitation

B. Left ventricular hypertrophy

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All of the following are expected echocardiographic/Doppler finding in the elderly EXCEPT:

A. Aortic valve sclerosis
B. Mitral valve E/A ratio of 1.5
C. Mild left atrial dilatation
D. Mitral annular calcification

B. Mitral valve E/A ratio of 1.5

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All of the following are expected echocardiographic/Doppler findings for atrial fibrillation EXCEPT:

A. Pulmonary vein absent atrial reversal wave
B. Normal mitral valve E/A ratio
C. Reduced left atrial appendage peak velocity
D. Biatrial dilatation

B. Normal mitral valve E/A ratio

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All of the following are findings for ankylosing spondylitis EXCEPT:

A. Dilatation of the sinuses of Valsalva
B. Dilatation of the aortic annulus
C. formula
D. Acute myocardial infarction

D. Acute myocardial infarction

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All of the following are most likely to mimic the findings of mitral
stenosis EXCEPT:

A. Left atrial myxoma
B. Cor triatriatum
C. Infective endocarditis
D. Parachute mitral valve

C. Infective endocarditis

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All of the following are normal characteristics of a normal athlete’s heart EXCEPT:

A. Concentric hypertrophy (< 17 mm)
B. Left atrial dilatation
C. Tissue Doppler E’ peak velocity > 8 cm/s
D. Normal E/A mitral ratio

B. Left atrial dilation

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All of the following are normal findings in cardiac transplantation patients EXCEPT:

A. Mild tricuspid regurgitation
B. Reduced global ventricular systolic function
C. Paradoxical interventricular septal motion
D. Biatrial dilatation

B. Reduced global ventricular systolic function

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All of the following are possible echocardiographic/Doppler findings for Ehlers-Danlos EXCEPT:

A. Ventricular septal defect
B. Mitral stenosis
C. Ascending aortic aneurysm
D. Valvular prolapse

B. Mitral stenosis

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All of the following are possible sources of systemic embolism EXCEPT:

A. Aortic regurgitation
B. Left atrial myxoma
C. Left ventricular apical thrombus
D. Aortic atherosclerotic plaque

A. Atrial regurgitation

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An aortic arteritis associated with marked intimal proliferation and fibrous scarring is:

A. Libman-Sacks
B. Takayasu’s disease
C. Shone’s complex
D. Marfan’s syndrome

B. Takayasu’s disease

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Dilated coronary sinus has been associated with all of the following EXCEPT:

A. Right atrial hypertension
B. Persistent left superior vena cava
C. Mitral regurgitation
D. Coronary atrioventricular fistula with drainage into the coronary sinus

C. Mitral regurgitation

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Electrical pacing of the right ventricle mimics the electrocardiographic and echocardiography findings of:

A. Complete atrioventricular block
B. Right bundle branch block
C. Left bundle branch block
D. Wolff-Parkinson-White syndrome

C. Left bundle branch block

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In normal young patients most ventricular filling occurs during:

A. Diastasis
B. During the PR interval
C. Early ventricular diastole
D. Atrial systole

C. Early ventricular diastole

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In the parasternal short-axis of the mitral valve two separate mitral valve orifices are seen during ventricular diastole. This suggests:

A. Flail mitral valve
B. Cleft mitral valve
C. Mitral valve prolapse
D. Double orifice mitral valve

D. Double orifice mitral valve

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Osler-Weber-Rendu disease is associated with pulmonary arteriovenous fistula. The preferred echocardiographic/Doppler technique to determine the presence of this finding is:

A. M-mode
B. Agitated saline contrast
C. Two-dimensional
D. Color flow Doppler

B. Agitated saline contrast

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Papillary muscle dysfunction usually results from:

A. Rheumatic heart disease
B. Infective endocarditis
C. Ischemic heart disease
D. Dressler’s syndrome

C. Ischemic heart disease

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Penetrating aortic ulcer is considered to be:

A. Aortopulmonary window
B. Aortic dissection
C. Congenital
D. Idiopathic

B. Aortic dissection

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Pulmonary vein stenosis may result in:

A. Left ventricular hypertrophy
B. Mitral regurgitation
C. Pulmonary hypertension
D. Left atrial enlargement

C. Pulmonary hypertension

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Rupture of the vasa vasorum into the media of the aortic wall may result in:

A. Intramural hematoma
B. Supravalvular aortic stenosis
C. Coarctation of the aorta
D. Aortic aneurysm

A. Intramural hematoma

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The classic echocardiographic finding for Pompe’s disease is:

A. Aortic stenosis
B. Coarctation of the aorta
C. Mitral stenosis
D. Left ventricular hypertrophy

C. Mitral stenosis

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The classic echocardiographic findings for Noonan syndrome is:

A. Ventricular septal defect
B. Dilated cardiomyopathy
C. Bicuspid aortic valve
D. Dysplastic pulmonary valve

D. Dysplastic pulmonary valve

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The combination of left ventricular inflow tract obstruction and left ventricular outflow tract obstruction is called:

A. Uhl’s anomaly
B. Takayasu’s disease
C. Shone’s complex
D. Ebstein’s anomaly

C. Shone’s complex

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The echocardiographic/Doppler findings for Friedreich ataxia include:

A. Libman-Sacks endocarditis
B. Aortic stenosis
C. Thickened mitral valve
D. Left ventricular hypertrophy

D. Left ventricular hypertrophy

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The echocardiographic/Doppler findings for cor pulmonale are very similar to:

A. Hemochromatosis
B. Ischemic heart disease
C. Pulmonary hypertension
D. Hypertrophic cardiomyopathy

C. Pulmonary hypertension

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The echocardiographic/Doppler findings for diabetes include:

A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Arrhythmogenic right ventricular cardiomyopathy

A. Dilated cardiomyopathy

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The echocardiographic/Doppler findings for hyperthyroidism is:

A. Mitral stenosis
B. Significant valvular regurgitation
C. Enhanced global left ventricular systolic function
D. Aortic stenosis

C. Enhanced global left ventricular systolic function

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The echocardiographic/Doppler findings for pheochromocytoma include all of the following EXCEPT:

A. Segmental wall motion abnormalities
B. Concentric left ventricular hypertrophy
C. Acute myocarditis
D. Aortic aneurysm

D. Aortic aneurysm

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The echocardiographic/Doppler findings in hypothyroidism include:

A. Reduced global left ventricular systolic function
B. Thickened mitral valve
C. Pericardial effusion
D. Coarctation of the aorta

A. Reduced global left ventricular systolic function

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The expected echocardiographic finding for Fabry’s disease is mitral valve:

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

A. Prolapse

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The expected echocardiographic/Doppler findings for cocaine ingestion include all of the following EXCEPT:

A. Acute aortic dissection
B. Reduced global ventricular systolic function
C. Hypertrophic cardiomyopathy
D. Acute myocardial infarction

C. Hypertrophic cardiomyopathy

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The most common echocardiographic/Doppler finding for scleroderma is:

A. Ebstein’s anomaly
B. Pericardial effusion
C. Pulmonary stenosis
D. Mitral stenosis

B. Pericardial effusion

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The most common echocardiographic/Doppler finding in systemic lupus erythematosus is:

A. Coarctation of the aorta
B. Aortic stenosis
C. Left atrial myxoma
D. Pericardial effusion

D. Pericardial effusion

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The most common reason for congestive heart failure in the United States is:

A. Pressure overload (e.g., systemic hypertension)
B. Diastolic dysfunction
C. Reduced global systolic function due to coronary artery disease
D. Volume overload (e.g., significant mitral regurgitation)

C. Reduced global systolic function due to coronary artery disease

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The motion of a congenitally stenotic aortic valve can be described as:

A. Fluttering
B. Flail
C. Doming
D. Hypokinetic

C. Doming

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The principal echocardiographic feature of left bundle branch block is:

A. Posterior motion of the interventricular septum
B. Hyperkinesis of the lateral wall of the left ventricle
C. Early systolic dip of the interventricular septum
D. Hyperkinesis of the interventricular septum

C. Early systolic dip of the interventricular septum

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Thickening of the aortic valve leaflets with normal systolic excursion with a Doppler peak velocity of less than 2 m/s is the definition for aortic valve:

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

C. Sclerosis

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Tuberous sclerosis is associated with:

A. Fibroma
B. Myxoma
C. Angiosarcoma
D. Rhabdomyoma

D. Rhabdomyoma

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Turner syndrome is associated with:

A. Aortic dissection
B. Mitral valve prolapse
C. Coarctation of the aorta
D. Rhabdomyoma

C. Coarctation of the aorta

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Two ventricular pacing wires are implanted with one placed in the right ventricle and one placed at the left ventricular free wall region via the coronary sinus. This is a description of (a):

A. Conventional pacemaker therapy
B. Left ventricular assist device
C. Cardiac resynchronization therapy
D. Holter monitor

C. Cardiac resynchronization therapy

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Which of the following is NOT associated with concentric left ventricular hypertrophy?

A. Aortic stenosis
B. Discrete subaortic stenosis
C. Supravalvular aortic stenosis
D. Cor pulmonale

D. Cor pulmonale

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Which of the following is strongly associated with syncope?

A. Rheumatic fever
B. Left ventricular outflow tract obstruction
C. Carcinoid heart disease
D. Perimembranous ventricular septal defect

B. Left ventricular outflow tract obstruction

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Which of the following is the most likely finding in Chagas disease?

A. Dilated cardiomyopathy
B. Aortic stenosis
C. Mitral stenosis
D. Hypertrophic cardiomyopathy

A. Dilated cardiomyopathy

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Which of the following mitral valve PW Doppler parameters suggests increased left heart filling pressures in a patient with atrial fibrillation?

A. Increased mitral valve A duration
B. Reduced mitral valve deceleration time (< 130 msec)
C. Absent mitral valve A wave
D. Decreased mitral valve E velocity

B. Reduced mitral valve deceleration time (< 130 msec)

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A 44 year old female presents with dyspnea, no history of smoking or cardiac disease and significantly increased pulmonary artery pressures. The most likely explanation is:

A. Grade I diastolic dysfunction
B. Tricuspid regulation
C. Primary pulmonary hypertension
D. Pulmonary regurgitation

C. Primary pulmonary hypertension

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A dumbbell-shaped configuration of the inter-atrial septum is associated with

A. Sarcoidosis
B. Sarcoma
C. Lipomatous hypertrophy
D. Amyloidosis

C. Lipomatous hypertrophy

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A late peaking dagger shaped
left ventricular outflow tract continuous-wave Doppler flow pattern is obtained in a patient with systemic hypertension. The most likely explanation is:

A. Hypertrophic obstructive cardiomyopathy
B. Left ventricular systolic gradient
C. Coarctation of the aorta
D. Discrete subaortic stenosis

B. Left ventricular systolic gradient

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A patient with chronic systemic hypertension presents to the echocardiography laboratory. The following pulsed-wave Doppler mitral inflow data is acquired: E:A ratio 0.66, deceleration time 290 msec, isovolumic relaxation time 132 msec. The Doppler data suggests the diastolic filling grade of Grade:

A. IV
B. I
C. III
D. II

B. I

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A posterior echo-free space is detected during the systolic phase only by M-mode/two-dimensional echocardiography. This is considered a:

A. Small pericardial effusion
B. Moderate pericardial effusion
C. Large pericardial effusion
D. Normal finding

D. Normal finding

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A thickened, inflamed, adherent or calcific pericardium is associated with:

A. Constrictive pericarditis
B. Cardiac tamponade
C. Mitral stenosis
D. Pulmonary embolism

A. Constrictive pericarditis

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A two-dimensional echocardiographic finding associated with pulmonary hypertension is:

A. Flattening of the interventricular septum during ventricular systole
B. Hyperkinetic interventricular septal motion
C. Interventricular myocardial infarction
D. Atrial septal aneurysm

A. Flattening of the interventricular septum during ventricular systole

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Air in the pericardial sac is known as:

A. Hemopericardium
B. Cardiac tamponade
C. Pneumopericardium
D. Effusive-constrictive pericardium

C. Pneumopericardium

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All of the following are associated M-mode/two-dimensional echocardiography findings for cardiac tamponade EXCEPT:

A. Inferior vena cava plethora
B. Pericardial effusion (usually moderate to large)
C. Right atrial diastolic collapse
D. Right ventricular systolic collapse

D. Right ventricular systolic collapse

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All of the following are associated findings for pericarditis EXCEPT:

A. Pericardial effusion by echocardiography
B. Pericardial friction rub
C. Fever
D. Tachycardia

A. Pericardial effusion by echocardiography

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All of the following are possible etiologies of constrictive pericarditis EXCEPT:

A. Atherosclerosis
B. Tuberculosis
C. Radiation therapy to the chest region
D. Prior pericardiotomy

A. Atherosclerosis

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All of the following may be used to calculate pulmonary artery pressure by cardiac Doppler EXCEPT:

A. Pulmonary regurgitation
B. Mitral regurgitation
C. Right ventricular outflow tract acceleration time
D. Tricuspid regurgitation

B. Mitral regurgitation

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All of the following may result in secondary pulmonary hypertension EXCEPT:

A. Mitral stenosis
B. Tricuspid regurgitation
C. Coronary artery disease
D. Left ventricular failure

B. Tricuspid regurgitation

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An anterior clear space is noted in the parasternal long-axis view. The diagnosis is most likely:

A. Adipose tissue
B. Pericardial effusion
C. Constrictive pericarditis
D. Cardiac tamponade

A. Adipose tissue

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An echocardiographic finding for congenital absence of the pericardium is volume overload of the:

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

B. Right ventricle

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An unattached freely moving thrombus within the left atrium is referred to as a:

A. Sessile thrombus
B. Myxoma
C. Ball-valve thrombus
D. Pedunculated thrombus

C. Ball-valve thrombus

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As the mean pulmonary artery pressure increases, the right ventricular outflow tract acceleration time:

A. Increases
B. Depends upon patient age
C. Remains unchanged
D. Decreases

D. Decreases

Cardiac catheterization findings for constrictive pericarditis include:

A. Increased “v” wave
B. Increased peak-to-peak pressure gradient
C. Absent “a” wave
D. Dip-and-plateau

D. Dip-and-plateau

Complications of a right atrial thrombus include:

A. Pulmonary embolism
B. Patent foramen ovale
C. Valvular prolapse
D. Interatrial septal aneurysm

A. Pulmonary embolism

Doppler evidence of constrictive pericarditis from diastolic hepatic vein flow is:

A. Inspiratory increase
B. Expiratory decrease
C. Systolic flow reversal
D. Expiratory increase

B. Expiratory decrease

Echocardiographic signs associated with constrictive pericarditis include all of the following EXCEPT:

A. Septal bound
B. Increased EPSS
C. Railroad track sign
D. Inferior vena cava plethora

B. Increased EPSS

Fibrin within the pericardial effusion most likely indicates:

A. Acute myocardial infarction
B. Cardiac tamponade
C. Long-standing pericardial effusion
D. Constrictive pericarditis

C. Long-standing pericardial effusion

M-mode findings associated with pulmonary hypertension include:

A. Absent or shallow “a” dip of the pulmonary valve
B. Paradoxical “a” dip of the pulmonic valve
C. Deep “a” dip of the pulmonic valve
D. Reverse “a” dip of the pulmonic valve

A. Absent or shallow “a” dip of the pulmonary valve

Possible echocardiographic findings for pulmonary hypertension include all of the following EXCEPT:

A. Abdominal aortic aneurysm
B. Dilated main pulmonary artery
C. Tricuspid regulation
D. Right ventricular hypertrophy

A. Abdominal aortic aneurysm

Pulsed-wave Doppler evidence of cardiac tamponade from diastolic hepatic vein flow is:

A. Expiratory increase
B. Inspiratory reversal
C. Expiratory decrease
D. Inspiratory increase

C. Expiratory decrease

Pulsed-wave Doppler evidence of cardiac tamponade includes:

A. Inspiratory increase in peak velocity across the mitral valve with an inspiratory decrease in the tricuspid valve
B. Systolic flow reversal in the pulmonary veins
C. Systolic flow reversal in the hepatic veins
D. Inspiratory decrease in peak velocity across the mitral valve with an inspiratory increase in peak velocity across the tricuspid valve

D. Inspiratory decrease in peak velocity across the mitral valve with an inspiratory increase in peak velocity across the tricuspid valve

Pulsed-wave Doppler evidence of constrictive pericarditis includes:

A. Increased peak velocity across the mitral valve with inspiration
B. Increased peak velocity across the mitral valve with expiration
C. Increased peak velocity across the aortic valve with inspiration
D. Increased peak velocity across the tricuspid valve with expiration

B. Increased peak velocity across the mitral valve with expiration

Secondary findings associated with systemic hypertension include all of the following EXCEPT:

A. Left ventricular hypertrophy
B. Increased main pulmonary artery
C. Increased left ventricular mass
D. Left atrial enlargement

B. Increased main pulmonary artery

The best guideline for differentiating pericardial effusion from pleural effusion by two-dimensional echocardiography is

A. Pericardial effusion is located anterior to the descending aorta; pleural effusion is present posterior to the descending aorta.
B. Pericardial effusion is present posterior to the descending aorta; pleural effusion is located anterior to the descending aorta.
C. Pericardial effusion is usually seen as an anterior clear space; pleural effusion is usually seen as a posterior clear space.
D. Pericardial effusion is usually seen as a posterior clear space; pleural effusion is usually seen as an anterior clear space.

A. Pericardial effusion is located anterior to the descending aorta; pleural effusion is present posterior to the descending aorta

The combination of pericardial effusion and constrictive pericarditis is called:

A. Effusive-constrictive pericarditis
B. Cardiac tamponade
C. Pericardial cyst
D. Libman-Sacks

A. Effusive-constrictive pericarditis

The most common etiology of systemic hypertension is:

A. Renal disease
B. Idiopathic processes
C. Coarctation of the aorta
D. Pheochromocytoma

B. Idiopathic processes

The most common intracardiac tumor in adults is (the):

A. Myxoma
B. Rhabdomyoma
C. Metastatic
D. Angiosarcoma

C. Metastatic

The most common location for a pericardial cyst is the:

A. Superior mediastinum
B. Hilum
C. Right costophrenic angle
D. Left costophrenic angle

C. Right costophrenic angle

The most common presenting symptom of acute pericarditis is:

A. Fatigue
B. Cachexia
C. Hemoptysis
D. Chest pain

D. Chest pain

The most common primary benign intracardiac tumor found in children is:

A. Rhabdomyoma
B. Myxoma
C. Papilloma
D. Rhabdomyosarcoma

A. Rhabdomyoma

The most common primary benign valvular tumor in adults is the:

A. Rhabdomyoma
B. Myxoma
C. Fibroelastoma
D. Angiosarcoma

C. Fibroelastoma

The most common primary malignant intracardiac tumor in adults is the:

A. Papillary fibroelastoma
B. Angiosarcoma
C. Myxoma
D. Fibroma

B. Angiosarcoma

The most effective treatment for cardiac tamponade is:

A. Pericardiectomy
B. Bed rest
C. Aspirin
D. Pericardiocentesis

D. Pericardiocentesis

The most likely pulsed-wave Doppler mitral flow pattern in constrictive pericarditis is:

A. Impaired relaxation
B. Normal for age
C. Restrictive
D. Pseudonormal

C. Restrictive

The primary pulsed-wave Doppler mitral valve flow pattern associated with systemic hypertension is Grade:

A. IV
B. III
C. I
D. II

C. I

The pulse associated with cardiac tamponade is:

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

D. Pulsus paradoxus

The swinging heart syndrome is associated with:

A. Pericardial effusion
B. Cardiac trauma
C. Constrictive pericarditis
D. Mitral valve prolapse

A. Pericardial effusion

The tissue Doppler finding for constrictive pericarditis is mitral valve annulus:

A. Increased S’ wave peak velocity
B. Absent A’ wave
C. E’/A’ ratio reversal
D. Normal E’ wave peak velocity

D. Normal E’ wave peak velocity

The tissue Doppler finding of the mitral annulus in constrictive pericarditis is called:

A. Pulsus paradoxus
B. Annulus paradoxus
C. Kussmaul’s sign
D. Beck’s triad

B. Annulus paradoxus

The two layers of the pericardium are:

A. Visceral pericardium; myocardium
B. Epicardium; fibrous pericardium
C. Epicardium; endocardium
D. Myocardium; parietal pericardium

B. Epicardium; fibrous pericardium

A common late complication associated with dilated cardiomyopathy is:

A. Infective endocarditis
B. Systemic emboli
C. Mitral regurgitation
D. Ventricular gallop

B. Systemic emboli

A common mitral valve finding in dilated cardiomyopathy in two-dimensional echocardiography is:

A. Incomplete closure of the mitral valve
B. Decreased E-septal separation
C. Reversed diastolic doming
D. Premature closure of the mitral valve

A. Incomplete closure of the mitral valve

A hallmark M-mode aortic valve finding in patients with hypertrophic obstructive cardiomyopathy is aortic valve:

A. Fine systolic flutter
B. Mid-systolic notching
C. Diastolic flutter
D. Vegetation

B. Mid-systolic notching

A more appropriate name for idiopathic hypertrophic cardiomyopathy (IHSS) is:

A. Aortic tunnel disease (ATD)
B. Discrete subaortic stenosis (DSS)
C. Subaortic hourglass deformity
D. Hypertrophic cardiomyopathy

D. Hypertrophic cardiomyopathy

A speckled or ground-glass appearance of the interventricular septum seen on two-dimensional echocardiography is found is:

A. Hypertrophic cardiomyopathy
B. Constrictive pericarditis
C. Dilated cardiomyopathy
D. Mitral stenosis

A. Hypertrophic cardiomyopathy

A systolic high-velocity, late-peaking, dagger-shaped continuous-wave Doppler signal is obtained. The most likely diagnosis is:

A. Valvular aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Hypertrophic obstructive cardiomyopathy

D. Hypertrophic obstructive cardiomyopathy

All of the following are considered possible pharmacologic treatment for hypertrophic obstructive cardiomyopathy EXCEPT:

A. Disopyramide
B. Digitalis
C. Beta-blockers
D. Calcium-channel blocker (e.g., Verapamil)

B. Digitalis

All of the following maneuvers may induce or enhance the obstruction in hypertrophic cardiomyopathy EXCEPT:

A. Leg raising
B. Inhalation of amyl nitrate
C. v
D. Supine to standing

A. Leg raising

All of the following may be used to treat hypertrophic obstructive cardiomyopathy EXCEPT:

A. Aspirin
B. Alcohol-induced septal ablation
C. Septal myectomy
D. Dual chamber pacemaker

A. Aspirin

Characteristic findings in patients with dilated cardiomyopathy include all of the following EXCEPT:

A. Asymmetric septal hypertrophy
B. Dilated, poorly contracting left ventricle
C. Low cardiac output
D. Increased intracardiac pressures

A. Asymmetric septal hypertrophy

Common two-dimensional echocardiographic findings in hypertrophic obstructive cardiomyopathy include all of the following EXCEPT:

A Asymmetric interventricular septal hypertrophy
B. Systolic anterior motion of the mitral valve
C. Left ventricular enlargement
D. Left atrial enlargement

C. Left ventricular enlargement

Early in the disease stage the usual pulsed-wave Doppler flow of the mitral valve in patients with dilated cardiomyopathy demonstrates a Grade:

A. III
B. IV
C. II
D. I

D. I

Echocardiographic findings in dilated cardiomyopathy include all of the following EXCEPT:

A. Dilated ventricular cavities
B. Preserved ejection fraction
C. Enlarged atrial cavities
D. Apical mural thrombus

B. Preserved ejection fraction

Functional classifications of cardiomyopathy include all the following EXCEPT:

A. Hypertrophic
B. Non-dilated
C. Restrictive
D. Dilated

B. Non-dilated

M-mode findings associated with hypertrophic cardiomyopathy include all of the following EXCEPT:

A. Mid-systolic notching of the pulmonary valve
B. Systolic anterior motion of the mitral valve (SAM)
C. Mid-systolic notching of the aortic valve
D. Asymmetric septal hypertrophy (ASH)

A. Mid-systolic notching of the pulmonary valve

Persistent intramyocardial sinusoids located in the left ventricle are found in:

A. Dilated cardiomyopathy
B. Restrictive cardiomyopathy
C. Hypertrophic cardiomyopathy
D. Noncompaction cardiomyopathy

D. Noncompaction cardiomyopathy

Possible causes of restrictive cardiomyopathy include all of the following EXCEPT:

A. Amyloidosis
B. Hemochromatosis
C. Sarcoidosis
D. Alcohol

D. Alcohol

Possible echocardiographic findings for sarcoid heart disease include:

A. Asymmetric septal hypertrophy
B. Dilatation of the ascending aorta
C. Infero-basal aneurysm
D. Concentric left ventricular hypertrophy

C. Infero-basal aneurysm

Pulsed-wave Doppler and color flow Doppler are useful in hypertrophic cardiomyopathy in all of the following ways EXCEPT:

A. Aid in guiding the continuous-wave Doppler beam
B. Help distinguish left ventricular outflow tract flow from mitral regurgitation
C. Quantitate the severity of the left ventricular outflow tract obstruction
D. Determine the presence and severity of mitral regurgitation

C. Quantitate the severity of the left ventricular outflow tract obstruction

The cardiac involvement associated with acquired immunodeficiency syndrome (AIDS) is:

A. Hypertrophic cardiomyopathy
B. Restrictive cardiomyopathy
C. Dilated cardiomyopathy
D. Arrhythmogenic right ventricular cardiomyopathy

C. Dilated cardiomyopathy

The cardiomyopathy described as presenting with four-chamber enlargement with poor global ventricular systolic function is:

A. Hypertrophic
B. Restrictive
C. Uhl’s
D. Dilated

D. Dilated

The cardiomyopathy with which cardiac hemochromatosis is most commonly associated with is:

A. Hypertrophic
B. Dilated
C. Arrhythmogenic right ventricular cardiomyopathy
D. Idiopathic

B. Dilated

The echocardiographic features of amyloidosis include all of the following EXCEPT:

A. Increased ventricular wall thickness
B. Pericardial effusion
C. Dilation of the ascending aorta
D. Multivalvular regurgitation

C. Dilation of the ascending aorta

The mitral valve finding most strongly associated with hypertrophic obstructive cardiomyopathy is mitral valve:

A. Systolic anterior motion
B. Flail leaflet
C. Fenestration
D. Aneurysm

A. Systolic anterior motion

The most common regurgitation found in patients with dilated cardiomyopathy is:

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

B. Mitral regurgitation

The primary cause of endomyocardial fibrosis is:

A. Alcohol
B. Chemotherapy
C. Intravenous drug abuse
D. Hypereosinophilia

D. Hypereosinophilia

The progressive replacement of right ventricular myocardium with fatty and fibrous tissue is called:

A. HCM
B. DSS
C. IHSS
D. ARVC

D. ARVC

The pulsed-wave Doppler mitral flow pattern most often associated with hypertrophic cardiomyopathy is grade:

A. I
B. IV
C. II
D. III

A. I

All of the following are true statements concerning pulsed-wave (PW) Doppler EXCEPT:

A. Aliasing is a primary disadvantage
B. Range resolution (range discrimination) is the primary advantage
C. Preferred modality to evaluate diastolic function
D. Utilizes two elements

D. Utilizes two elements

A maneuver that will result in tachycardia and a transient decrease in blood pressure is:

A. Standing to supine
B. Straight leg raising
C. Squatting
D. Inhalation of amyl nitrite

D. Inhalation of amyl nitrite

A maneuver which results in a decrease in venous return is:

A. Inspiration
B. Straight leg raising
C. Squatting
D. Valsalva

D. Valsalva

A swirling of transpulmonary contrast is noted at the apex of the left ventricle. The sonographer should:

A. Call the nurse
B. Inject the contrast at a slower rate
C. Use respiratory maneuvers
D. Decrease the transmit gain

D. Decrease the transmit gain

Agitated saline contrast may be used to evaluate all of the following EXCEPT:

A. Aortic regurgitation
B. Left to right atrial septal defect
C. Tricuspid regurgitation
D. Patent foramen ovale

A. Aortic regurgitation

All of the following are primary advantages of transesophageal echocardiography EXCEPT:

A. Excellent temporal resolution
B. Standard sweep speed is 50 mm/s
C. Excellent axial resolution
D. Primary method currently of determining the presence and severity of cardiac pathology

D. Primary method currently of determining the presence and severity of cardiac pathology

All of the following are true statements concerning color flow Doppler EXCEPT:

A. Normal flow does not alias
B. Mean velocity displayed
C. Pulsed-wave Doppler technique
D. Multigate

A. Normal flow does not alias

All of the following are ways in which the sonographer can improve the lateral resolution while imaging EXCEPT:

A. Increase the transducer diameter
B. Utilize harmonic imaging
C. Increase the transmit frequency
D. Increase the number of focuses

A. Increase the transducer diameter

All of the following are ways to increase the color flow Doppler frame rate and improve temporal resolution EXCEPT decrease:

A. Line density
B. Image depth
C. Color gain
D. Field of view

C. Color gain

All of the following cardiac pathologies are best evaluated with cardiac Doppler in the apical views EXCEPT:

A. Atrial septal defect
B. Mitral regurgitation
C. Aortic stenosis
D. Mitral stenosis

A. Atrial septal defect

All of the following decrease with increasing transmit frequency EXCEPT:

A. Spatial pulse length and pulse duration
B. Attenuation
C. Beam width
D. Depth of penetration

B. Attenuation

All of the following may be evaluated using the apical
window EXCEPT:

A. Isovolumic relaxation time
B. Left atrial volume
C. Mitral valve prolapse
D. Pulmonary vein flow

C. Mitral valve prolapse

All of the following are true statements concerning M-mode echocardiography EXCEPT:

A. Excellent temporal resolution
B. Standard sweep speed is 50 mm/s
C. Excellent axial resolution
D. Primary method currently of determining the presence and severity of cardiac pathology

D. Primary method currently of determining the presence and severity of cardiac pathology

All of the following may be evaluated with cardiac Doppler in the apical five-chamber view EXCEPT:

A. Patent foramen ovale
B. Valvular aortic stenosis
C. Hypertrophic cardiomyopathy
D. Discrete subaortic stenosis

A. Patent foramen ovale

All of the following two-dimensional views may be useful when evaluating for the presence of perimembranous ventricular septal defect EXCEPT:

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

B. Subcostal four-chamber

All of the following will increase the frame rate and improve temporal resolution EXCEPT decreasing the:

A. Image depth
B. Field of view
C. Number of focuses
D. Transmit gain

D. Transmit gain

Increasing the pulsed-wave Doppler sample gate length will result in:

A. Increased spectral broadening
B. Better determination of laminar flow
C. Increased peak velocity
D. Lower frame rates

A. Increased spectral broadening

Left ventricular opacification may be accomplished by all of the following contrast agents EXCEPT:

A. Definity
B. Optison
C. Imagent
D. Agitated saline

D. Agitated saline

Multiple echoes equally spaced are called:

A. Refraction
B. Side lobes
C. Reverberation
D. Propagation speed error

C. Reverberation

Of all of the resolutions, which resolution is most difficult for the sonographer to improve during an examination?

A. Contrast
B. Temporal
C. Elevational
D. Spatial (axis resolution; lateral resolution)

C. Elevational

Possible pharmacologic treatments for hypertrophic obstructive cardiomyopathy include:

A. Lasix
B. Epinephrine
C. Propranolol
D. Dobutamine

C. Propranolol

The Doppler high-pass filter eliminates:

A. Window fill-in
B. Spectral broadening
C. Strong amplitude signals
D. Peak velocity flow

C. Strong amplitude signals

The four acoustic windows for transthoracic echocardiography are:

A. Parasternal, long-axis, short-axis, subcostal
B. Parasternal, apical, subcostal, suprasternal
C. Apical, subcostal, short-axis, parasternal
D. Long-axis, short-axis, four-chamber, suprasternal

B. Parasternal, apical, subcostal, suprasternal

The image artifact associated with displaying double images of a structure due to the change in the direction of the sound beam is called:

A. Range ambiguity
B. Acoustic shadowing
C. Reverberation
D. Refraction

D. Refraction

The image artifact which may cause the sonographer to fail to detect prosthetic mitral valve regurgitation from the apical window is:

A. Comet tail
B. Enhancement
C. Grating lobes
D. Shadowing (flow masking)

D. Shadowing (flow masking)

The measurement of the left ventricular outflow tract diameter during early ventricular systole is an important measurement in all of the following calculations EXCEPT:

A. Right ventricular systolic pressure
B. Aortic valve area
C. Stroke volume
D. Mitral valve area

A. Right ventricular systolic pressure

The preferred two-dimensional view for determining the presence of bicuspid aortic valve is the:

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

C. Parasternal short-axis of the aortic valve

The primary advantage of continuous-wave (CW) Doppler is:

A. Range resolution
B. Range ambiguity
C. Aliasing will not occur
D. Range discrimination

C. Aliasing will not occur

The sonographer may avoid pulsed-wave Doppler aliasing by all of the following techniques EXCEPT:

A. Shift the zero baseline
B. Decrease the image depth
C. Decrease the Doppler transmit gain
D. Increase the velocity scale

C. Decrease the Doppler transmit gain

The three two-dimensional planes used to examine the heart with transthoracic echocardiography are:

A. Long-axis, short-axis, five-chamber
B. Parasternal, apical, subcostal
C. Long-axis, short-axis, four-chamber
D. Long-axis, short-axis, apical

C. Long-axis, short-axis, four-chamber

The two-dimensional view of choice for evaluating the inferior vena cava and hepatic veins is the:

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

D. Subcostal four-chamber

The two-dimensional view of choice for the evaluation of coarctation of the aorta is the:

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

B. Suprasternal long-axis of the aorta

Tissue harmonic imaging improves all of the following EXCEPT:

A. Beam width
B. Frame rate
C. Side lobe artifacts
D. Depth of penetration

B. Frame rate

What is the standard sweep speed for M-mode echocardiography and cardiac Doppler?

A. 50 mm/s
B. 150 mm/s
C. 25 mm/s
D. 100 mm/s

A. 50 mm/s

Which Doppler intercept angle will result in the maximum flow velocity?

A. 90
B. 60
C. 30
D. 0

D. 0

Which color flow Doppler map will display the color green to indicate turbulent flow?

A. Intensity
B. Directional
C. Variance
D. Hue

C. Variance

Which instrument control directly affects the dynamic range?

A. TGC
B. Image depth
C. Compression
D. Transmit gain

C. Compression

Which of the following may lead to a misdiagnosis for the presence of aortic dissection with transesophageal echocardiography?

A. Thickened mitral valve
B. Mirror-Image
C. Aberrant right subclavian artery
D. Linear Artifact

B. Mirror-Image
C. Aberrant right subclavian artery
D. Linear Artifact

Which transmit frequency would most likely be useful for an adult echocardiogram?

A. 2.5 MHz
B. 3.5 MHz
C. 5.0 MHz
D. 7.5 MHz

A. 2.5 MHz

Which two-dimensional view is likely to be LEAST useful when evaluating for atrial septal defect with cardiac Doppler?

A. Subcostal four-chamber
B. Apical two-chamber view
C. Parasternal short-axis of the aortic valve with color flow Doppler
D. Apical four-chamber with color flow Doppler

B. Apical two-chamber view

Which two-dimensional view would be most useful to use when evaluating pulmonary stenosis and pulmonary regurgitation?

A. Parasternal long-axis of the left ventricle
B. Suprasternal long-axis
C. Parasternal short-axis at the aortic valve
D. Apical four-chamber

C. Parasternal short-axis at the aortic valve

A patient with a history of intravenous drug abuse presents to the echocardiography laboratory with complaints of fever, night sweats and weight loss. The most likely explanation is:

A. Congestive heart failure
B. Infective endocarditis
C. Coronary artery disease
D. Kawasaki disease

B. Infective endocarditis

A prosthetic heart valve that is associated with a relatively high rate of outlet strut fracture and disc embolism is the:

A. Bjork-Shiley
B. Carpentier-Edwards
C. Omniscience
D. Starr-Edwards

A. Bjork-Shiley

A pulmonic valve relocated to the aortic valve position is called a(n):

A. Heterograft
B. Allograft
C. Autograft
D. Xenograft

C. Autograft

Abnormal rocking motion of a prosthetic valve by two-dimensional echocardiography indicates prosthetic valve:

A. Stenosis
B. Thrombus
C. Vegetation
D. Dehiscence

D. Dehiscence

All of the following are bioprosthetic (tissue) valves EXCEPT:

A. Starr-Edwards
B. Medtronic Intact
C. Edwards Perimount
D. Hancock

A. Starr-Edwards

All of the following are mechanical valves EXCEPT:

A. Hancock
B. CarboMedics
C. Starr-Edwards
D. St. Jude

A. Hancock

All of the following are true statements concerning prosthetic valves EXCEPT:

A. Velocities depend upon the size and type of prosthetic valve
B. A baseline study should be obtained post-surgery
C. Prosthetic valve regurgitation is always abnormal
D. Prosthetic valve peak velocities are generally higher as compared to normal native valves

C. Prosthetic valve regurgitation is always abnormal

All of the following are types of prosthetic valve types EXCEPT:

A. Native
B. Homograft (allograft)
C. Bioprosthetic (tissue)
D. Mechanical (metal)

A. Native

All of the following should be determined when evaluating a prosthetic valve with cardiac Doppler EXCEPT:

A. Shunt ratio
B. Mean pressure gradient
C. Peak velocity
D. Effective orifice area

A. Shunt ratio

Cardiac Doppler evaluation of a prosthetic mitral valve should include all of the following EXCEPT:

A. Pressure half-time
B. Peak and mean pressure gradients
C. Effective orifice area
D. Peak mitral valve A wave velocity

D. Peak mitral valve A wave velocity

Complications associated with prosthetic valve dysfunction include all of the following EXCEPT:

A. Leaflet degeneration
B. Dehiscence
C. Thrombosis
D. Tumor

D. Tumor

Infective endocarditis is a greater risk in patients with:

A. Coronary artery disease
B. Atrial fibrillation
C. Prosthetic heart valve
D. Left ventricular aneurysm

C. Prosthetic heart valve

The best Doppler formula for calculating the effective orifice area (EOA) in a patient with mitral valve replacement is:

V22, velocity across the obstruction; V12, velocity proximal to the obstruction; CSALVOT, cross-sectional area of left ventricular outflow tract; VTILVOT, velocity time integral of left ventricular outflow tract; VTIMV, velocity time integral of mitral valve

A. 4 x (V22 – V12)
B. 220 ÷ pressure half-time
C. 4 x (V2)2
D. (CSALVOT x VTILVOT) ÷ VTIMV

D. (CSALVOT x VTILVOT) ÷ VTIMV

The best Doppler method for evaluating aortic valve replacement is probably:

A. Deceleration slope
B. Maximum peak instantaneous pressure gradient
C. Velocity ratio
D. Pressure half-time

C. Velocity ratio

The classic manifestation of infective endocarditis is cardiac valve:

A. Tumor
B. Doming
C. Sclerosis
D. Vegetation

D. Vegetation

The complications of infective endocarditis include all of the following EXCEPT:

A. Congestive heart failure
B. Embolization
C. Annular calcification
D. Valve ring abscess

C. Annular calcification

The determination of prosthetic mitral valve regurgitation and prosthetic tricuspid valve regurgitation is made difficult by the artifact called:

A. Shadowing
B. Enhancement
C. Slice thickness
D. Mirroring

A. Shadowing

The essential two-dimensional echocardiographic finding of valve ring abscess secondary to infective endocarditis may be best described as:

A. Pedunculated
B. Mural
C. Sessile
D. Echolucent

D. Echolucent

The excessive ingrowth of tissue for a prosthetic valve is called:

A. Thrombus
B. Dehiscence
C. Pannus
D. Vegetation

C. Pannus

The most common ball and cage valve is the:

A. Starr-Edwards
B. Omniscience
C. Medtronic-Hall
D. St. Jude

A. Starr-Edwards

The most common bileaflet tilting disc valve is the:

A. Starr-Edwards
B. Medtronic-Hall
C. Omniscience
D. St. Jude

D. St. Jude

The most common symptom of infective endocarditis is:

A. Chest pain
B. Orthopnea
C. Fever
D. Dyspnea

C. Fever

The primary disadvantage of the bioprosthetic (tissue) valve is:

A. Dehiscence
B. Lack of durability
C. Pannus formation
D. Thrombus formation

B. Lack of durability

The primary disadvantage of the mechanical valve is:

A. Dehiscence
B. Thrombogenicity
C. Durability
D. Pannus ingrowth

B. Thrombogenicity

The test of choice for diagnosing the presence of vegetation and the complications of infective endocarditis is:

A. Transesophageal echocardiography
B. Cardiac catheterization
C. Transthoracic echocardiography
D. Cardiac magnetic resonance imaging

A. Transesophageal echocardiography

The usual site of attachment for vegetations on the mitral valve and tricuspid valve is the:

A. Ventricular surface of the valve leaflets
B. Atrial side of the valve leaflets
C. Annulus
D. Papillary muscles

B. Atrial side of the valve leaflets

The vegetation diameter as determined by two-dimensional echocardiography that is most often associated with systemic emboli is:

A. 3 mm
B. 5 mm
C. 10 mm
D. 7 mm

C. 10 mm

Valve ring abscess is usually caused by:

A. Infective endocarditis
B. Rheumatic fever
C. Valvular prolapse
D. Valvular regurgitation

A. Infective endocarditis

Which of the following pressures can be predicted when measuring the pulmonary regurgitation end-diastolic velocity?

A. Pulmonary artery end-diastolic pressure
B. Systolic pulmonary artery pressure
C. Right ventricular systolic pressure
D. Mean pulmonary artery pressure

A. Pulmonary artery end-diastolic pressure

Which of the following pressures may be calculated when measuring the peak velocity of pulmonary regurgitation?

A. Mean pulmonary artery pressure
B. Right ventricular systolic pressure
C. Systolic pulmonary artery pressure
D. Pulmonary wedge pressure

A. Mean pulmonary artery pressure

Which two cardiac valves need to be evaluated carefully in a patient with the Ross procedure?

A. Aortic valve; tricuspid valve
B. Mitral valve; aortic valve
C. Aortic valve; pulmonary valve
D. Mitral valve; tricuspid valve

C. Aortic valve; pulmonary valve

A pericardial effusion develops in a patient two weeks post-myocardial infarction. This suggests ______ syndrome.

A. Marfan
B. Down
C. Williams
D. Dressler’s

D. Dressler’s

A positive stress echocardiogram consists of:

A. Improved ejection fraction
B. Normal wall motion pre and post exercise
C. Normal wall motion to akinesis
D. Normal left atrial dimension peak exercise

C. Normal wall motion to akinesis

A possible etiology for pericardial effusion is:

A. Mitral valve prolapse
B. Mitral valve stenosis
C. Acute myocardial infarction
D. Pulmonary regurgitation

C. Acute myocardial infarction

A pulsed-wave Doppler tracing of the mitral valve inflow at the leaflet tips is obtained with the following information: E/A ratio is 0.7; deceleration time is 320 msec; a tissue Doppler at the mitral annulus demonstrated an E’ peak velocity of 6 cm/s and an E/E’ ratio is calculated to be 7. The diastolic grade is:

A. I
B. III or IV
C. Normal diastolic function
D. II

A. I

A pulsed-wave Doppler tracing of the mitral valve inflow at the leaflet tips is obtained with the following information: E/A ratio is 2.3, deceleration time is 123 msec, Valsalva maneuver demonstrated no change in the E/A ratio, tissue Doppler of the mitral valve annulus demonstrates an E’ wave peak velocity of 3 cm/s and an E/E’ ratio of 33 is calculated. The diastolic grade is grade:

A. II
B. I
C. IV
D. III

C. IV

A pulsed-wave Doppler tracing of the mitral valve inflow at the leaflet tips is obtained with the following information: E/A ratio is 1.2, deceleration time is 200 msec, tissue Doppler of the mitral annulus peak E’ wave velocity is 7 cm/s, E’/A’ ratio is .6 and a E/E’ ratio of 12 is calculated. The diastolic grade is Grade:

A. III
B. IV
C. I
D. II

D. II

A systolic wall motion score of 3 is assigned to a certain segment of left ventricular muscle indicates:

A. Normal
B. Hypokinetic
C. Akinetic
D. Dyskinetic

C. Akinetic

A thrombus shape that is associated with embolization is:

A. Flat
B. Eccentric
C. Spherical
D. Pedunculated

D. Pedunculated

A wall segment of the heart that is without systolic wall thickening is best described as:

A. Hyperkinetic
B. Akinetic
C. Dyskinetic
D. Hypokinetic

B. Akinetic

An ejection fraction of 42% is determined with two-dimensional echocardiography. This indicates _________ global left ventricular systolic function.

A. Severely abnormal
B. Moderately abnormal
C. Normal
D. Mildly abnormal

B. Moderately abnormal

An increased mitral valve E point to septal-separation (EPSS) may indicate:

A. Pulmonary hypertension
B. Reduced ejection fraction
C. Increased left ventricular end-diastolic pressure
D. Left atrial myxoma

B. Reduced ejection fraction

Echocardiographic findings in the post-myocardial infarction patient include:

A. Valvular stenosis
B. Mitral annular calcification
C. Mural thrombus
D. Ventricular septal aneurysm

C. Mural thrombus

Echocardiography differentiates a pseudoaneurysm from a true ventricular aneurysm by the:

A. Diastolic motion of the aneurysm
B. Width of the neck of the aneurysm
C. Length of the aneurysm
D. Width of the border of the aneurysm

B. Width of the neck of the aneurysm

For exercise echocardiography the images post-exercise need to be acquired within ______ from the time the patient exercise is completed.

A. 5 minutes
B. 60 seconds
C. 60 minutes
D. 3 hours

B. 60 seconds

Hibernating myocardium is:

A. Viable myocardium at rest but not functioning with exercise
B. Reperfused viable myocardium that is functioning
C. Viable myocardium that is nonfunctioning because of chronic ischemia
D. Myocardium that is hyperkinetic post-myocardial infarction

C. Viable myocardium that is nonfunctioning because of chronic ischemia

In determining the size of myocardial infarction echocardiography generally:

A. Underestimates recent myocardial infarction and overestimates old myocardial infarction
B. Predicts the exact size of infarct
C. Overestimates recent myocardial infarction and underestimates old myocardial infarction
D. Is unpredictable

C. Overestimates recent myocardial infarction and underestimates old myocardial infarction

In patients with dilated cardiomyopathy, the index of myocardial performance (IMP) will be:

A. Increased
B. Decreased
C. Normal
D. Dependent on blood pressure

A. Increased

Patients with increased diastolic filling pressures post-exercise will demonstrate:

A. Normal tricuspid regurgitation peak velocity
B. E/E’ ratio > 10
C. Increased mitral deceleration time
D. Normal mitral E/A ratio

B. E/E’ ratio > 10

Possible mechanisms in the development of mitral regurgitation following acute myocardial infarction include all of the following EXCEPT:

A. Mitral valve stenosis
B. Incomplete closure of the mitral valve
C. Papillary muscle rupture
D. Fibrosis of the papillary muscle

A. Mitral valve stenosis

Stress echocardiography methods that may be used to detect hibernating myocardium include:

A. Handgrip
B. Low-dose dobutamine
C. Cold pressure
D. Treadmill

B. Low-dose dobutamine

The correct term for describing decreased ventricular systolic wall thickening is:

A. Hyperkinetic
B. Hypokinetic
C. Dyskinetic
D. Akinetic

B. Hypokinetic

The definition of stunned myocardium is:

A. Myocardium after electrical cardioversion
B. Myocardium that is hyperkinetic post-myocardial infarction
C. Myocardium after cardiopulmonary resuscitation
D. Reperfused viable myocardium that is not functioning

D. Reperfused viable myocardium that is not functioning

The echocardiographic appearance of necrotic myocardium secondary to myocardial infarction includes all of the following EXCEPT:

A. Wall motion score of 1
B. Thin ventricular wall
C. Echogenic wall segment
D. Akinetic wall segment

A. Wall motion score of 1

The expected Doppler finding in a patient with ventricular septal rupture is:

A. Turbulent high-velocity flow in systole on the right side of the interventricular septum
B. Laminar low-velocity flow during diastole on the left side of the interventricular septum
C. Laminar high-velocity flow in diastole on the right side of the septum
D. Turbulent high-velocity flow in diastole on the right side of the septum

A. Turbulent high-velocity flow in systole on the right side of the interventricular septum

The formula used to determine ejection fraction is:

EDV, end-diastolic volume; ESV, end-systolic volume;EDD, end-diastolic dimension; ESD, end-systolic dimension, CSA, cross-sectional area, VTI, velocity time integral

A. (EDD – ESD) ÷ EDD x 100
B. EDV – ESV
C. (EDV – ESV) ÷ EDV x 100
D. CSA x VTI

C. (EDV – ESV) ÷ EDV x 100

The formula used to determine fractional shortening is:

EDV, end-diastolic volume; ESV, End-systolic volume; EDD, end-diastolic dimension; ESD, end-systolic dimension; CSA, cross-sectional area; VTI, velocity time integral

A. (EDD – ESD) ÷ EDD x 100
B. EDV – ESV
C. CSA x VTI
D. (EDV – ESV) ÷ EDV x 100

A. (EDD – ESD) ÷ EDD x 100

The formula used to determine stroke volume by Doppler is:

EDV, end-diastolic volume; ESV, end-systolic volume; EDD, end-diastolic dimension; ESD, end-systolic dimension, CSA, cross-sectional area; VTI, velocity time integral

A. (EDV – ESV) ÷ EDV x 100
B. (EDD – ESD) ÷ EDD x 100
C. CSA x VTI
D. EDV – ESV

C. CSA x VTI

The four most common two-dimensional views acquired during a stress echocardiogram are the parasternal long-axis, parasternal short-axis of the left ventricle at the level of the papillary muscles, the apical four-chamber view and the:

A. Apical five-chamber
B. Apical long-axis
C. Apical two-chamber
D. Subcostal short-axis at the cardiac base

C. Apical two-chamber

The infarction most commonly associated with left ventricular aneurysm is:

A. Lateral
B. True posterior
C. Anterior
D. Inferior

C. Anterior

The most common etiology for ischemic heart disease is coronary artery:

A. Aneurysm
B. Atherosclerosis
C. Spasm
D. Embolus

B. Atherosclerosis

The most common medication used in performing pharmacological stress echocardiography is:

A. Adenosine
B. Dipyridamole
C. Propranolol
D. Dobutamine

D. Dobutamine

The most specific echocardiographic finding for ischemic heart muscle is:

A. Normal systolic wall motion
B. Normal diastolic wall motion
C. Alterations in systolic wall thickening
D. Abnormal diastolic wall motion at the ischemic segment

C. Alterations in systolic wall thickening

The normal response of non-infarcted myocardium in a patient with acute myocardial infarction is:

A. Dyskinesis
B. Hyperkinesis
C. Akinesis
D. Hypokinesis

B. Hyperkinesis

The primary indication for stress echocardiography is:

A. Evaluation for coronary artery disease
B. Assessment of cardiac valve abnormalities
C. Evaluation of ejection fraction
D. Diagnosis of shunt lesions

A. Evaluation for coronary artery disease

The principal echocardiographic/Doppler findings of right ventricular infarction include all of the following EXCEPT:

A. Right ventricular hypertrophy
B. Tricuspid regurgitation
C. Abnormal motion of the right ventricular free wall
D. Right ventricular dilatation

A. Right ventricular hypertrophy

The rate at which the left ventricular pressure rises in ventricular systole is referred to as:

A. dv/dt
B. dP/dt
C. dd/tP
D. dt/dP

B. dP/dt

The type of myocardial infarction which most often involves the right ventricle is:

A. Inferior
B. Anterolateral
C. Anterior
D. Lateral

A. Inferior

Which maneuver is most useful to use when trying to determine the presence of Grade II (pseudonormalization) or when determining between Grade III (reversible restrictive) and Grade IV (fixed restrictive):

A. Mueller
B. Squatting
C. Valsalva
D. Leg raising

C. Valsalva

Which of the following methods is recommended to determine left ventricular volumes?

A. Biplane area-length
B. Biplane Simpson’s method of discs
C. Cubed
D. Teichholtz

B. Biplane Simpson’s method of discs

Which of the following mitral valve flow patterns provides risk stratification post-myocardial infarction?

A. Impaired relaxation (Grade I)
B. Normal for age
C. Pseudonormal (grade II)
D. Restrictive (Grade III-IV)

D. Restrictive (Grade III-IV)

Which of the following pharmacologic agents increases contractility and increases heart rate?

A. Propranolol
B. Dobutamine
C. Digitalis
D. Verapamil

B. Dobutamine

________ is a direct measure of myocardial contractile function.

A. E-F slope
B. Deceleration time
C. EPSS
D. Strain

D. Strain

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