Standard Sonographic Views Flashcards
What describes a fetal heart that is situated in the fetal right chest with the apex pointing to the left?
A. Dextrocardia
B. Mesocardia
C. Dextroposition
D. Levocardia
E. Levorotation
C. Dextroposition
Dextroposition is an abnormal heart position, with the heart in the right chest and the apex pointing left.
All of the following are normal levoposition EXCEPT:
A. 20 degrees
B. 45 degrees
C. 25 degrees
D. 65 degrees
E. 35 degrees
A. 20 degrees
The normal heart angle relative to midline is 45 degrees (+/- 20 degrees). The line traversing the interventricular septum and a line coursing from spine to mid chest should intersect at an angle of 25-65 degrees. This correct angle is normal levoposition of the fetal heart.
The view that best demonstrates the atrioventricular junction, including the valve leaflets and annulus, is the:
A. Apical four-chamber view
B. Short-axis view
C. Subcostal four-chamber view
D. Five-chamber view
E. A and C
E. A and C (Apical four-chamber view and Subcostal four-chamber view)
Subcostal and apical four-chamber view.
When the apex of the heart is pointing to the fetal left chest and the axis is 45 degrees, this is:
A. Levocardia
B. Mesocardia
C. Dextrocardia
D. Levorotated
E. Dextroposition
A. Levocardia
Normal heart position in the fetal thorax is termed levocardia. The normal heart is situated in the left chest with the apex pointing to the left. The axis of the heart should be 45 degrees (+/- 20 degrees).
In the short-axis view of the great vessels, all of the following can be demonstrated EXCEPT:
A. Foramen Ovale
B. Pulmonic valve
C. Left Atrium
D. Left Ventricle
E. Tricuspid valve
D. Left ventricle
In the short-axis view of the great vessels the left ventricle is located inferiorly. Therefore, it is not visualized in this view.
What is the best view to evaluate the number of aortic cusps?
A. Apical four-chamber
B. Subcostal four-chamber view
C. Long-axis view of the aorta
D. Long-axis view of the pulmonary artery
E. Short-axis view of the great vessels
E. Short-axis view of the great vessels
In the short-axis view of the great vessels the aortic root may be visualized. At this level, the cusps of the aortic valve are seen in cross section. The aorta is seen as a “circle” in the center of the image with the pulmonary artery coursing around it.
When diagnosing a fetal heart defect, the four-chamber heart view will be abnormal in what percentage of all defects?
A. 10%
B. 20%
C. 40%
D. 60%
E. 80%
D. 60%
The best view for evaluating a conoventricular or perimembranous ventricular septal defect is:
A. Apical four-chamber view
B. Subcostal four-chamber view
C. Long-axis view of the aorta
D. Long-axis view of the pulmonary artery
E. Short-axis view of the ventricles
B. Subcostal four-chamber view
In the subcoastal four-chamber view, the ultrasound beam is perpendicular to the interventricular septum, therefore increasing the detection of conoventricular or perimembranous defects and decreasing dropout artifacts.
What structure cannot be seen on the routine four-chamber heart view?
A. Foramen ovale flap bulging from right atrium to left atrium
B. Moderator band present in the right ventricle
C. Septal attachments of the tricuspid valve to the interventricular septum
D. Aortic wall continuity with the interventricular septum
E. Pulmonary veins being accepted into the left atrium
D. Aortic wall continuity with the interventricular septum
The aorta is located superior to the atrioventricular valves, so continuity of the aortic wall with the septum cannot be seen in the four-chamber view. The best view for this would be the long-axis view of the aorta.
Which modality transmits the highest amount of energy into the fetus?
A. 2D imaging
B. Pulse wave Doppler
C. Color Doppler
D. Power Doppler
E. M-mode
B. Pulse wave Doppler
In the three-vessel view, which vessel is most superior?
A. Aorta
B. Superior vena cava
C. Pulmonary artery
D. Ductus arteriosus
E. Both A and C are at the same level
C. Pulmonary artery
In the three-vessel view, the vessels are anteriorly/posteriorly related, not superiorly/inferiorly. Thus if you drew a line from anterior to posterior, the arrangement would be pulmonic artery-aorta-superior vena cava. The largest vessel would be the pulmonary artery, the aorta would be next largest, and the superior vena cava would be the smallest.
List in order the vessels in the three-vessel view from largest diameter to the smallest diameter in the normal thorax:
A. PA>SVC>AO
B. AO>PA>SVC
C. SVC>AO>PA
D. AO>SVC>PA
E. PA>AO>SVC
E. PA>AO>SVC
In the normal heart, the pulmonary artery should be larger than the aorta because the right ventricle ejects the majority of the blood flow, thereby increasing the diameter of the pulmonary artery compared to the aorta. The aorta is larger than the superior vena cava for the same reason. The higher the blood volume, the larger the diameter.
To what vessel is the arrow pointing int the image?
A. Pulmonary artery
B. Ductus arteriosus
C. Aortic Arch
D. Inferior vena cava
E. Superior vena cava
C. Aortic arch
The aortic arch has the classic “candy cane” appearance. The aortic arch should be seen exiting the fetal heart in the center of the fetal chest, giving rise to the head and neck vessels.
Number 1 represents the:
A. Aorta
B. Superior vena cava
C. Main pulmonary artery
D. Ductus arteriosus
E. Inferior vena cava
B. Superior vena cava
Number 2 represents the:
A. Aorta
B. Superior vena cava
C. Main pulmonary artery
D. Ductus arteriosus
E. Inferior vena cava
A. Aorta
Number 3 represents the:
A. Aorta
B. Superior vena cava
C. Main pulmonary artery
D. Ductus arteriosus
E. Inferior vena cava
C. Main pulmonary artery
What cardiac heart view was used to acquire the above image?
A. Long-axis view of the aorta
B. Three vessel view
C. Short-axis view of the great arteries
D. Long-axis view of the pulmonary artery
E. Five vessel view
B. Three-vessel view
Number 1 represents:
A. Innominate artery
B. Left common carotid artery
C. Left subclavian artery
D. Right pulmonary artery
E. Superior vena cava
C. Left subclavian artery
Number 2 represents:
A. Innominate artery
B. Left common carotid artery
C. Left subclavian artery
D. Right pulmonary artery
E. Superior vena cava
B. Left common carotid artery
Number 3 represents:
A. Innominate artery
B. Left common carotid artery
C. Left subclavian artery
D. Right pulmonary artery
E. Superior vena cava
A. Innominate artery
Number 4 represents the:
A. Right atrium
B. Left atrium
C. Superior vena cava
D. Right pulmonary artery
E. Persistent left superior vena cava
D. Right pulmonary artery
Number 1 represents the:
A. Left atrium
B. Right atrium
C. Foramen ovale
D. Coronary sinus
E. Pulmonary veins
B. Right atrium
Number 2 represents the:
A. Left atrium
B. Right atrium
C. Foramen ovale
D. Coronary sinus
E. Pulmonary veins
C. Foramen ovale
Number 3 represents the:
A. Left atrium
B. Right atrium
C. Foramen ovale
D. Coronary sinus
E. Pulmonary veins
A. Left Atrium
Number 1 represents the:
A. Left ventricle
B. Right ventricle
C. Moderator band
D. Foramen ovale
E. Pulmonary veins
C. Moderator band
Number 2 represents the:
A. Right Ventricle
B. Left Ventricle
C. Tricuspid valve
D. Mitral valve
E. Moderator band
A. Right ventricle
Number 3 represents the:
A. Right ventricle
B. Left ventricle
C. Tricuspid valve
D. Mitral valve
E. Moderator band
C. Tricuspid valve
Number 4 represents the:
A. Left ventricle
B. Right ventricle
C. Left atrium
D. Right atrium
E. Coronary sinus
D. Right atrium
Number 5 represents the:
A. Right ventricle
B. Left ventricle
C. Tricupsid valve
D. Mitral valve
E. Moderator band
A. Left ventricle
Number 6 represents the:
A. Right ventricle
B. Left ventricle
C. Tricuspid valve
D. Mitral valve
E. Moderator band
D. Mitral valve
Number 7 represents the:
A. Left ventricle
B. Right ventricle
C. Left atrium
D. Right atrium
E. Coronary sinus
C. Left atrium
Number 8 represents the:
A. Right atrium
B. Left atrium
C. Coronary sinus
D. Foramen ovale
E. Pulmonary veins
E. Pulmonary veins
Number 9 represents the:
A. Right atrium
B. Left atrium
C. Coronary sinus
D. Foramen ovale
E. Pulmonary veins
D. Foramen ovale
The fetus in the image is in the vertex presentation with the fetal spine down. The heart has {S, D, S} relationship with the normally related great arteries. The cardiac structure being measured is the:
A. Mitral valve
B. Tricuspid valve
C. Left atrium
D. Right atrium
E. Coronary sinus
A. Mitral valve
Number 1 represents the:
A. Aorta
B. Pulmonary artery
C. Ductus arteriosus
D. Trachea
E. Superior vena cava
D. Trachea
Number 2 represents the:
A. Aorta
B. Pulmonary artery
C. Ductus arteriosus
D. Trachea
E. Superior vena cava
B. Pulmonary artery
Number 3 represents the:
A. Aorta
B. Pulmonary artery
C. Ductus arteriosus
D. Trachea
E. Superior vena cava
A. Aorta
Number 4 represents the:
A. Aorta
B. Pulmonary artery
C. Ductus arteriosus
D. Trachea
E. Superior vena cava
A. Ductus arteriosus
What structure is being measured?
A. Tricuspid valve
B. Pulmonic valve
C. Ascending aorta
D. Mitral valve
E. Aortic valve
E. Aortic valve
Number 1 represents the:
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventrcle
E. Pulmonary vein
Number 2 represents the:
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle
E. Moderator band
C. Left ventricle
Number 3 represents the:
A. Left atrium
B. Right atrium
C. Left ventricle
D. Right ventricle
E. Moderator band
D. Right ventricle
What sonographic view was used to obtain this image?
A. Long-axis view of the aorta
B. Long-axis view of the pulmonary artery
C. Apical four-chamber heart view
D. Subcostal four-chamber heart view
E. Short-axis view of the great vessels
S. Long-axis view of the aorta
In the image the fetus is in a vertex presentation. The heart position is:
A. Dextrocardia
B. Dextroposition
C. Mesocardia
D. Levocardia
E. Levorotation
D. Levocardia
Normal heart position in the fetal thorax is termed levocardia. The normal heart is situated in the left chest with the apex pointing to the left. The axis of the heart should be 45 degrees (+/- 20 degrees). In this image, the fetus is in a vertex presentation, the left side would be down, and the axis is normal. This image demonstrates levocardia.
In the image the cardiac circumference : thoracic circumference (CC:TC) was calculated. Cardiomegaly is diagnosed when the CC:TC is:
A. Less than 30%
B. Less than 50%
C. Greater than 50%
D. Greater than 65%
E. Greater than 75%
C, Greater than 50%
Normal heart circumference is less than 50% of the thoracic circumference. A heart circumference to thoracic circumference ratio of greater than 50% of the thorax is considered cardiomegaly.
What sonographic view was used to obtain the ultrasound image above?
A. Long-axis view of the aorta
B. Long-axis view of the pulmonary artery
C. Long-axis view of great vessels
D. Subcostal four-chamber heart view
E. Short-axis view of the great vessel
D. Subcostal four-chamber heart view
The “apical four-chamber view” is also a correct answer when the probe is positioned above the fetal apex.
The image demonstrates a normal ductal arch view. All of the following should be visualized EXCEPT:
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
E. Ductus arteriosus
D. Mitral valve
Number 1 represents the:
A. Left atrium
B. Right atrium
C. Right pulmonary artery
D. Patent ductus arteriosus
E. Main pulmonary artery
D. Patent ductus arteriosus
Number 2 represents:
A. Left atrium
B. Right atrium
C. Right pulmonary artery
D. Left pulmonary artery
E. Main pulmonary artery
C. Right pulmonary artery
Number 3 represents the:
A. Left atrium
B. Right atrium
C. Right pulmonary artery
D. Left pulmonary artery
E. Pulmonic valve
E. Pulmonic valve
Number 4 represents the:
A. Left atrium
B. Right atrium
C. Right pulmonary artery
D. Left pulmonary artery
E. Main pulmonary artery
E. Main pulmonary artery
In the image, a measurement was taken of a 28-week fetus in the vertex presentation. The calipers are measuring the _____. Theis measurement of 0.63cm would be considered ______.
A. Aortic valve; normal
B. Aortic valve; abnormal
C. Pulmonic valve; normal
D. Pulmonic valve; abnormal
E. Tricuspid valve; normal
C. Pulmonic valve; normal
In this image of the pulmonary artery the calipers are measuring the pulmonic valve. This measurement is the normal range for a 28 week fetus. The normal range is 5.0-7.0mm.
The fetus in the image above is in the vertex presentation, spine down, and had a normal fetal heart scan. The white arrows identify the:
A. Persistent left superior vena cava
B. Right superior vena cava
C. Pulmonary artery
D. Prominent inferior vena cava
E. Pulmonary veins
E. Pulmonary veins
The four-chamber heart view has been reported to have a sensitivity of what percentage in detecting a congenital heart defect?
A. 10-25%
B. 50-78%
C. 85-92%
D. 40-57%
E. 100%
D. 40-57%
When the trachea is displaced, the differential diagnosis should include a right-sided aortic arch. What sonographic view should be obtained to make this diagnosis?
A. Apical four-chamber view
B. Subcostal four-chamber view
C. Long-axis view of the aorta
D. Short-axis view of the great arteries
E. Three-vessel view
E. Three-vessel view
The trachea is seen as a hypoechic circle with an echogenic wall on the right side of the aorta and behind the superior vena cava in the three-vessel view. The position of the trachea is a landmark to distinguish the correct left-sided aortic arch from an abnormal righ-sided arch.
In the apical four-chamber heart view, the interventricular septum is ____ to the sound beam.
A. Perpendicular
B. Parallel
C. 90 degree angle
D. Both A and C
E. None of the above
B. Parallel
What heart view must be obtained to acquire an M-mode tracing that will allow for measurement of the interventricular septal wall thickness and ventricular size?
A. Short-axis view of the right ventricle
B. Subcostal four-chamber view
C. Three-vessel view
D. Short-axis view of the left ventricle
E. Both B and D are acceptable
E. Both B and D are acceptable
(Subcostal four-chamber view and Short-axis view of the left ventricle)
To measure the interventricular septum and the ventricular size, the M-mode must be placed perpendicular to the sound beam.
All of the following are considered standard fetal echocardiography views EXCEPT:
A. Apical four-chamber view
B. Short-axis view of the great arteries
C. Long-axis view of the aorta
D. Long-axis view of the pulmonary artery
E. All of the above are considered standard views
E. All of the above are considered standard views
(Apical four-chamber view, Short-axis view of the great arteries, Long-axis view of the aorta, and Long-axis view of the pulmonary artery)
In the subcostal four-chamber heart view of the normal heart, the heart structure closest to the fetal spine is the:
A. Right atrium
B. Left ventricle
C. Right atrium
D. Left atrium
E. Mitral valve
D. Left atrium
The left atrium is the most posterior heart chamber and therefore the chamber closest to the fetal spine.
When scanning through the normal fetal heart in the subcostal four-chamber heart view, what structure or strucures should be seen entering the left atrium?
A. Pulmonary veins
B. Superior vena cava
C. Inferior vena cava
D. Aortic arch
E. Coronary sinus
A. Pulmonary veins
In which of the following heart views can the anterior aortic wall be seen continuous with the interventricular septum in the normal fetal heart?
A. Short-axis view of the great arteries
B. Long-axis view of the aorta
C. Subcostal four-chamber view
D. Apical four-chamber view
E. Short-axis view of the ventricles
B. Long axis view of the aorta
In this view, the aorta is elongated, allowing visualization of the left ventricular outflow tract, mitral valve, and septum
In the long-axis view of the pulmonary artery, the normal pulmonary artery courses:
A. Cephalad, leftward, ,and posterior to the right ventricle
B. Caudad, leftward, and posterior to the right ventricle
C. Cephalad, rightward, and anterior to the right ventricle
D. Caudad, rightward, and anterior to the right ventricle
E. Cephalad, rightward, and posterior to the right ventricle
A. Cephalad, leftward, and posterior to the right ventricle
The short-axis view of the ventricles can be used to evaluate all of the following EXCEPT:
A. Fetal arrhythmias
B. Ventricular free wall thickness
C. Intraventricular septal defect evaluation
D. Ventricular chamber size
E. All of the above
A. Fetal arrhythmias
In the long-axis view of the left heart, which of these structures are visible?
A. Left atrium, mitral valve, left ventricle
B. Left atrium, mitral valve, and papillary muscle
C. Left atrium, mitral valve, papillary muscle, right ventricle, and left ventricle
D. Left atrium, mitral valve, papillary muscle, left ventricle, and pulmonic valve
E. Papillary muscle, right ventricle, and pulmonic valve
C. Left atrium, mitral valve, papillary muscle, right ventricle, and left ventricle
Left atrium, mitral valve, papillary muscle, right ventricle, and left ventricle are all structures that should be seen in the long-axis view of the left heart. The pulmonic valve cannot be visualized because it lies superior to the aortic valve.
What fetal heart view is ideal to evaluate for pulmonary valve insufficiency?
A. Apical long-axis view of the pulmonary artery
B. Apical four-chamber heart view
C. Subcostal four-chamber heart view
D. Short-axis view of the great vessels
E. A and D
E. A and D
(Apical long-axis view of the pulmonary artery and short-axis view of the great vessels)
All of the following views may be helpful in evaluating fetal arrhythmias EXCEPT:
A. Long-axis view of the aorta
B. Short-axis view of the great vessels
C. Short-axis view of the ventricles
D. Apical five-chamber view
E. Apical four-chamber heart view
C. Short-axis view of the ventricles
To observe fetal arrhythmias, the atrial and ventricular activiy must be examined simultaneously. The short-axis view of the ventricles does not image the atria.
Multiple echoes within the right atrium can represent the:
A. Foramen ovalis flap
B. Eustachian valve
C. Chiari network
D. Tricuspid valve leaflets
E. Both B and C
E. Both B and C
(Eustachian valve and Chiari network)
Multiple echoes within the right atrium can represent the Eustachian valve and/or the Chiari network. The Chiari network is a reticular network of fibers originating from the Eustachian connecting to different parts of the right atrium
Regarding the apical five-chamber heart view in the normal fetal heart, all of the following statements are true EXCEPT:
A. Aortic and mitral valve continuity posteriorly
B. Aorta and septal continuity anteriorly
C. Aorta arises from the center of the heart
D. Aorta arises between the two atrioventricular valves
E. All of the above are true statements
E. All of the above are true statements
(Aortic and mitral valve continuity posteriorly, Aorta and septal continuity anteriorly, Aorta arises from the center of the heart, Aorta arises between the two atrioventricular valves)
All of the following statements pertaining to the normal pulmonary artery are true EXCEPT:
A. The pulmonary artery bifurcates into right and left pulmonary artery branches
B. The pulmonary valve lies posterior and cranial to the aortic valve
C. The pulmonary artery crosses over the aorta anteriorly
D. The pulmonary artery is larger than the aorta
E. All of the above statements are true
B. The pulmonary valve lies posterior and cranial to the aortic valve
The pulmonary valve lies anterior and superior to the aortic valve.
