Wk 3 Terry Reynold *Right Heart, PHT & DD Flashcards
*321. Possible echocardiographic findings for pulmonary hypertension include all the following EXCEPT:
A. Right atrial enlargement
B.Right ventricular enlargement
C. Pulmonary vein enlargement
D. Tricuspid regurgitation
C. Pulmonary vein enlargement
A right ventricle volume overload pattern is associated with all the following echocardiographic findings EXCEPT:
A. Abnormal interventricular septal motion
B. Dilatation of the right ventricle
C. Pancaking of the interventricular septum during ventricular diastole
D. Pancaking of the interventricular septum during ventricular systole
D. Pancaking of the interventricular septum during ventricular systole
Pulmonary insufficiency as detected by cardiac Doppler in structurally normal hearts is:
A. A rare finding
B. A common finding
C. An abnormal finding
D. Depend on expiration
B
*436. The sufficient of a bidirectional persistent ductus arteriosus shunt is that it:
A. Is an expected (“normal”) finding
B. Implies elevated systemic pressure
C. Implies elevated pulmonary pressure
D. Negates the simplified Bernoulli equationW
C
- The two-dimensional echocardiographic finding in acute pulmonary embolism is:
A. Left ventricular dilatation
B. Left ventricular hypertrophy
C. Right ventricular dilatation
D. Right ventricular hypertrophy
C
403.A pulsed-wave Doppler tracing of the mitral valve inflow is obtained with the following information: E:A RATIO IS 2.3:1, deceleration time is 110 msec, isovolumic relaxation time is 52 msec, and pulmonary vein “a” wave reversal is 44 cm/sec. These findings are consistent with:
A. Normal left ventricular diastolic filling
B. Stage I diastolic filling pattern
C. Stage II diastolic filling pattern
D. Stage III diastolic filling pattern
D
- A pulsed-wave Doppler tracing of the mitral valve inflow is obtained with the following information: E:A ratio is 0.7:1, deceleration time is 320 msec, isovolumic relaxation time is 110 msec, and pulmonary vein “a” wave is 22 cm/sec. These findings are most consistent with:
A. Normal diastolic function
B. Stage I diastolic filling pattern
C. Stage II diastolic filling function
D. Stage III diastolic filling pattern
B
!!!
- When compared with angiographic volumes, echocardiographic ventricular volumes are:
A. A.Equal
B. Larger
C. Smaller
D. Variable, depending on the method used to determine echocardiographic volume
C: Smaller
!!! read question. It’s about M mode
- An increased mitral E-point to septal separation may indicate left ventricular:
A. Decrease in compliance
B. Decrease in ejection fraction
C. Hyperdynamic wall motion
D. Increase in end-diastolic pressure
B: Decrease in ejection fraction
!!!
- A B notch of the mitral valve on M-mode indicates increased left ventricular:
A. End-diastolic pressure
B. End-systolic pressure
C. Mean pressure
D. Peak-to-peak pressure
A: End-diastolic pressure
- The rate at which the left ventricular pressure rises in systole is referred to as:
A. dv/dt
B. dP/dt
C. dt/dP
D. dd/tP
B: dP/dt
- Possible echocardiographic findings for patients with right bundle branch block include:
A. Decreased interval between tricuspid valve closure and pulmonic valve opening.
B. Early, systolic beaking of the interventricular septum.
C. Increased interval between mitral and tricuspid valve closure.
D. Systolic paradoxical septal motion.
C: Increased interval between mitral and tricuspid valve closure.
!!!
- Electrical pacing of the right ventricle mimics the electrocardiographic and echocardiographic findings of:
A. Complete atrioventricular block.
B. Left bundle branch block.
C. Right bundle branch block.
D. Wolff-Parkinson-White syndrome.
B: Left bundle branch block.
- The primary pulsed-wave mitral valve Doppler diastolic abnormality in a patient with systemic hypertension is stage:
A. I
B. II
C. III
D. IV
A. I
*321. Possible echocardiographic findings for pulmonary hypertension include all the following EXCEPT:
A. Right atrial enlargement
B.Right ventricular enlargement
C. Pulmonary vein enlargement
D. Tricuspid regurgitation
C. Pulmonary vein enlargement
- All the following may be used to calculate pulmonary artery pressure b cardiac Doppler EXCEPT:
A. Mitral regurgitation
B. Pulmonary insufficiency
C. Right ventricular outflow tract acceleration
D. Tricuspid regurgitation
A. Mitral regurgitation
!!!
- The Doppler finding used to calculate mean pulmonary artery pressure is:
A. Mitral regurgitation
B. Pulmonary insufficiency
C. Right ventricular outflow tract acceleration time
D. Tricuspid regurgitation
C. Right ventricular outflow tract acceleration time
*A two-dimensional echocardiographic finding associated with pulmonary hypertension is:
A. Flattening of the interventricular septum in diastole
B. Flattening of the interventricular septum in systole
C. Dyskinetic interventricular septal motion
D. Hyperkinetic interventricular septal motion
B. Flattening of the interventricular septum in systole
!!!
The most of the interventricular septum in pulmonary hypertension is:
A. Akinetic
B. Hyperkinetic
C. Hypokinetic
D. Paradoxical
D. Paradoxical
!!!
**M-mode findings associated with pulmonary hypertension include:
A. Absent or shallow “a” dip of the pulmonic valve
B. Deep “a” dip of the pulmonic valve
C. Paradoxical “a” dip of the pulmonic valve
D. Reverse “a” dip of the pulmonic valve
A. Absent or shallow “a” dip of the pulmonic valve
*note: Image recorded in a patient with pulmonary hypertension. Note the loss of the pulmonic valve A wave (downward-pointing arrow) and midsystolic notching (upward-pointing arrow) of the valve.
!!!
The most reliable M-mode indicator for pulmonary hypertension is:
A. Deep “a” wave of the pulmonic valve
B. Mid-systolic notching of the pulmonic valve
C. Shallow “a” dip of the pulmonic valve
D. Systolic flutter of the pulmonic valve
B. Mid-systolic notching of the pulmonic valve
*note: Image recorded in a patient with pulmonary hypertension. Note the loss of the pulmonic valve A wave (downward-pointing arrow) and midsystolic notching (upward-pointing arrow) of the valve.
**A patient with chronic systemic hypertension presents to the echocardiography laboratory. The following pulsed-wave Doppler data is acquired from the tips of the mitral valve leaflets: E:A ratio 1.2:1, deceleration time 210 msec, isovolumic relaxation time 83 msec, and pulmonary vein reversal 46cm/sec. The Doppler data indicates diastolic filling stage:
A. I
B. II
C. III
D. IV
B. II
An echocardiographic finding in congenital absent pericardium is volume overload of the:
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
D. Right ventricle
***Pulsed-wave Doppler evidence of cardiac tamponade includes:
A. Systolic flow reversal in the pulmonary veins
B. Systolic flow reversal in the hepatic veins
C. Insipiratory increase in peak velocity across the mitral valve with an inspiratory decrease in peak velocity across the tricuspid valve
D. Inspiratory decrease in velocity across the mitral valve with an inspiratory increase in velocity across the tricuspid valve
D. Inspiratory decrease in velocity across the mitral valve with an inspiratory increase in velocity across the tricuspid valve
What is IVC plethora?
IVC plethora is lack of the normal inspiratory collapse of a dilated IVC on echocardiography. Normally the IVC diameter decreases about 50% during inspiration. IVC plethora is seen in right heart failure and constrictive pericarditis
**The single most reliable echocardiographic predictor of cardiac tamponade that can be identified by M-mode or two-dimensional imaging is diastolic collapse of the:
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
D. Right ventricle
*Both RA & RV chamber collapse during early diastole
The pulse associated with cardiac tamponade is:
A. Pulsus alternans
B. Pulsus bisferiens
C. Pulsus paradoxus
D. Pulsus parvus
C. Pulsus paradoxus
*A possible auscultatory finding in a patient with pericarditis is:
A. Fixed splitting of S2
B. Mid-systolic click
C. Friction rub
D. Pericardial knock
C. Friction rub
*Note:
- A pericardial knock is a high-pitched sound made by the heart due to early diastole, which is when a ventricle does not fully fill with blood between heartbeats. The sound generally indicates diastolic dysfunction
- A pericardial knock is most often caused when heart valves have lost elasticity, reducing their ability to close completely. Loss of elasticity is most commonly due to scarring (i.e., fibrosis) and sometimes calcifications brought about by constrictive pericarditis
*In acute pericarditis, a possible electrocardiographic finding in most if not all leads is:
A. Depressed ST segments
B. Elevated ST segments
C. Increased QRS voltage
D. Pathologic Q waves
B. Elevated ST segments
!!! flag Question
Low voltage of the QRS complex throughout the electrocardiogram is often found in:
A. Constrictive pericarditis
B. Mitral stenosis
C. Pericardial effusion
D. Pleural effusion
C. Pericardial effusion
!!!
The absence of inferior vena cava collapse upon inspiration indicates elevated pressure in the:
A. Aorta
B. Left atrium
C. Left ventricle
D. Right atrium
D. Right atrium
*A possible M-mode finding for constrictive pericarditis is premature opening of the:
A. Aortic valve
B. Mitral valve
C. Pulmonic valve
D. Tricuspid valve
C. Pulmonic valve
***An M-mode echocardiographic sign for constrictive pericarditis is:
A. B notch
B. Chaotic notch
C. Fibrillatory notch
D. Spanish notch
D. Spanish notch
*An M-mode echocardiographic sign of constrictive pericarditis is
A. B notch sign
B. Mid-late systolic dip sign
C. Smoke-signal sign
D. Square root sign
D. Square root sign
Doppler evidence of constrictive pericarditis includes:
A. Increased peak velocity across the mitral valve with inspiration
B. Increased peak velocity across the aortic valve with inspiration
C. Increased peak velocity across the mitral valve with expiration
D. Increased peak velocity across the tricuspid valve with expiration
C. Increased peak velocity across the mitral valve with expiration
Echocardiographic signs associated with constrictive pericarditis include all the following EXCEPT:
A. B notch
B. Inferior vena cava plethora
C. Railroad track sign
D. Septal bounce
A. B notch
*note: The B bump on mitral valve M-mode echogram is predictive of significant elevation of left ventricular end-diastolic pressure (LVEDP)
*The square root is commonly found in:
A. Aortic valve stenosis
B. Constrictive pericarditis
C. Pericardial effusion
D. Pulmonary hypertension
B. Constrictive pericarditis
Cardiac catheterization findings in constrictive pericarditis include:
A. Absent “a” wave
B. Dip-and-plateau waveform
C. Increased “v” wave
D. Increased peak-to-peak pressure gradient
B. Dip-and-plateau waveform = square root sign
*The classic auscultatory finding in constrictive pericarditis is:
A. Friction rub
B. Mid-systolic click
C. Opening snap
D. Pericardial Knock
D. Pericardial Knock
*The pericardial knock is a high-pitched, early diastolic sound that occurs when unyielding pericardium results in sudden arrest of ventricular filling. It can be an important clue to the diagnosis of constrictive pericarditis
*The most common etiology of constrictive pericarditis is:
A. Cardiac surgery
B. Idiopathic
C. Rheumatic fever
D. Tuberculosis
B. Idiopathic
Pulmonary artery banding may result in all the following EXCEPT:
A. Pseudoaneurysm formation
B. Right ventricular hypertrophy
C. Supravalvular pulmonary stenosis
D. Valvular pulmonic stenosis
D. Valvular pulmonic stenosis
The right ventricular outflow tract obstruction associated with poststenotic dilatation of the main pulmonary artery is:
A. Valular
B. Subvalvular
C. Supravalvular
D. Subinfundibular
A. Valular
The right ventricular outflow tract obstruction associated with poststenotic dilatation of the main pulmonary artery is:
A. Valular
B. Subvalvular
C. Supravalvular
D. Subinfundibular
A. Valular
Post-stenotic dilatation of the main pulmonary artery is a two-dimensional echocardiographic finding for:
A. Pulmonary insufficiency
B. Pulmonary turmor
C. Tricuspid regurgitation
D. Valvular pulmonic stenosis
D. Valvular pulmonic stenosis
Possible two-dimensional echocardiographic findings for valvular pulmonic stenosis include all the following EXCEPT:
A. Pulmonic valve prolapsed
B. Right ventricular hypertrophy
C. Systolic doming of the pulmonic valve leaflets
D. Valvular thickening
A. Pulmonic valve prolapsed
On M-mode echocardiography, the effect of infundibular pulmonic stenosis on the pulmonic valve is:
A. Absent “a” dip
B. Coarse systolic flutter
C. Deep “a” dip
D. Shallow “a” dip
B. Coarse systolic flutter
The characteristic M-mode pulmonic valve leaflet pattern in pulmonic valve stenosis is:
A. Absent “a” dip
B. Deep “a” dip
C. Reversed “a” dip
D. Shallow “a” dip
B. Deep “a” dip
The most common etiology of pulmonic valve stenosis is:
A. Carcinoid
B. Congenital
C. Infective endocarditis
D. Rheumatic
B. Congenital
The most common type of right ventricular outflow tract obstruction is:
A. Subinfundibular
B. Subvalvular
C. Supravalvular
D. Valvular
D. Valvular
Fine diastolic flutter of the tricuspid valve is a characteristic finding for:
A. Infundibular stenosis
B. Primary pulmonary hypertension
C. Pulmonary insufficiency
D. Pulmonary valve stenosis
C. Pulmonary insufficiency
The normal pulmonary artery end-diastolic pressure (PAEDP) is:
A. 0 to 5 mmHg
B. 4 to 12 mmHg
C. 9 to 18 mmHg
D. 18 to 25 mmHg
B. 4 to 12 mmHg
An end-diastolic velocity of 2 m/sec for pulmonary insufficiency was obtained with an estimated right atrial pressure of 7 mmHg. The pulmonary artery enddiastolic pressure (PAEDP) is:
A. 2 mmHg
B. 16 mmHg
C. 23 mmHg
D. 26 mmHg
C. 23 mmHg
When pulmonary artery systolic pressure exceeds 70 mmHg, dilation of the pulmonic annulus results in a regurgitation jet of high velocity which is responsible for the murmur called:
A. Austin Flint
B. Rivero-Carvallo
C. Graham Steell
D. Lillehei-Kaster
C. Graham Steell
Pulmonary insufficiency is associated with:
A. Left ventricular volume overload
B. Right atrial hypertrophy
C. Right ventricular hypertrophy
D. Right ventricular volume overload
D. Right ventricular volume overload
The most common cause of pathologic pulmonary insufficiency is:
A. Carciniod heart disease
B. Infective endocarditis
C. Pulmonary hypertension
D. Rheumatic heart disease
C. Pulmonary hypertension
Possible echocardiographic/Doppler findings in a patient with carcinoid heart disease include all the following EXCEPT:
A. Pulmonic valve insufficiency
B. Pulmonic valve stenosis
C. Tricuspid valve prolapse
D. Tricuspid valve regurgitation
C. Tricuspid valve prolapse
Tricuspid valve leaflets that are in a fixed semi-open position with diffuse thickening are found in:
A. Carcinoid heart disease
B. Cardiac amyloidosis
C. Cardiac hemochromatosis
D. Cardiac sarcoidosis
A. Carcinoid heart disease
An intracardiac pressure may be determined from the continuous-wave tricuspid regurgitation signal is:
A. Mean pulmonary artery pressure
B. Pulmonary artery end-diastolic pressure
C. Systolic pulmonary artery pressure
D. Total pulmonary vascular resistance
C. Systolic pulmonary artery pressure
Systolic reflux of saline contrast noted by two-dimensional echocardiography in the inferior vena cava denotes the presence of:
A. Cardiac tamponade
B. Constrictive pericarditis
C. Pulmonary insufficiency
D. Tricuspid regurgitation
D. Tricuspid regurgitation
Cardiac Doppler findings associated with significant chronic tricuspid regurgitation include all the following EXCEPT:
A. Concave late systolic configuration of the regurgitant signal
B. Increased E velocity of the tricuspid valve
C. Systolic flow reversal in the hepatic vein
D. Systolic flow reversal in the pulmonary vein
D. Systolic flow reversal in the pulmonary vein
Methods for determining the severity of tricuspid regurgitation with pulsedwave Doppler include all the following EXCEPT:
A. Increased E wave velocity for the tricuspid valve
B. Mapping technique
C. Maximum velocity of the tricuspid regurgitant jet
D. Systolic flow reversal in the hepatic vein
C. Maximum velocity of the tricuspid regurgitant jet
M-mode and two-dimensional echocardiograophic findings for chronic tricuspid regurgitation include:
A. Left ventricular volume overload
B. Paradoxical septal motion
C. Protected right ventricle
D. Right ventricular hypertrophy
B. Paradoxical septal motion
On M-mode echocardiographic finding of the tricuspid valve, systolic coarse chaotic oscillation of the tricuspid valve leaflets may indicate:
A. A normal echocardiographic finding
B. Atrial fibrillation/atrial flutter
C. Flail tricuspid valve leaflet
D. Pulmonic valve insufficiency
C. Flail tricuspid valve leaflet
The M-mode finding for ruptured chordae tendineae of the tricuspid valve is:
A. Coarse diastolic flutter of the anterior tricuspid valve leaflet
B. Fine diastolic flutter of the anterior tricuspid valve leaflet
C. Irregular low-frequency diastolic fluttering of the anterior tricuspid valve leaflet
D. Right atrial enlargement
C. Irregular low-frequency diastolic fluttering of the anterior tricuspid valve leaflet
In significant chronic tricuspid valve regurgitation, all the following are dilated EXCEPT:
A. Hepatic veins
B. Inferior vena cava
C. Pulmonary veins
D. Right atrium
C. Pulmonary veins
Causes of organic tricuspid regurgitation include all the following EXCEPT:
A. Rheumatic heart disease
B. Right ventricular infarct
C. Tricuspid valve prolapsed
D. Flail tricuspid valve
B. Right ventricular infarct
The murmur of tricuspid regurgitation is best described as a:
A. Holodiastolic murmur heard best at the lower left sternal border
B. Pansystolic murmur heard best at the lower left sterna border
C. Pansystolic murmur heard best at the cardiac apex with radiation to the axilla
D. Systolic ejection murmur heard best at the upper right sterna border
Signs and symptoms of significant tricuspid regurgitation include all the following EXCEPT:
A. Hepatomegaly
B. Jugular venous distention
C. Pulsus paradoxus
D. Right ventricular failure
C. Pulsus paradoxus
Causes of tricuspid regurgitation include all the following EXCEPT:
A. Carcinoid heart disease
B. Ebstein’s anomaly
C. Pulmonary hypertension
D. Sinus of Valsalva aneurysm
D. Sinus of Valsalva aneurysm
The typical two-dimensional echocardiographic findings in rheumatic tricuspid stenosis include all the following EXCEPT:
A. Diastolic doming of the anterior tricuspid valve leaflet B. Leaflet thickening
C. Restricted motion of the tricuspid leaflets
D. Systolic bowing of the posterior tricuspid valve leaflet
D. Systolic bowing of the posterior tricuspid valve leaflet
The most common etiology of tricuspid valve stenosis is:
A. Carcinoid heart disease
B. Infective endocarditis
C. Rheumatic fever
D. Right atrial myxomaThe M-mode findings for tricuspid valve stenosis include all the following EXCEPT:
C. Rheumatic fever
A right ventricle volume overload pattern is associated with all the following echocardiographic findings EXCEPT:
A. Abnormal interventricular septal motion
B. Dilatation of the right ventricle
C. Pancaking of the interventricular septum during ventricular diastole
D. Pancaking of the interventricular septum during ventricular systole
D. Pancaking of the interventricular septum during ventricular systole
A pressure overload of the right ventricle may produce all the following echocardiographic findings EXCEPT:
A. D-shaped left ventricle
B. Right ventricular dilatation
C. Right ventricular hypertrophy
D. Small, protected right ventricle
D. Small, protected right ventricle
The geometric shape of the right ventricle is:
A. Prolate ellipse
B. Pyramid
C. Rectangle
D. Circle
B. Pyramid
On M-mode, the abrupt downward motion of the pulmonary valve leaflet following atrial contraction is called the:
A. “a” dip
B. “b” dip
C. “c” dip
D. “d” dip
A. “a” dip
