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Echo Registry Review > Wk 4 Terry Reynolds *CHD > Flashcards

Wk 4 Terry Reynolds *CHD Flashcards

1
Q

The two-dimensional echocardiographic views used to determine whether truncus arteriosus is present are the parasternal long-axis view and the:

A. Apical five-chamber view
B. Parasternal right ventricular inflow tract view
C. Parasternal short-axis view of the aortic valve
D. Parasternal short-axis view of the left ventricle

A

C. Parasternal short-axis view of the aortic valve

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2
Q

The two-dimensional view that may be used to directly visualize a patent ductus arteriosus is the:

A. Parasternal long-axis view of the left ventricle
B. Parasternal short-axis view at the base
C. Apical five-chamber view
D. Subcostal four-chamber view

A

B. Parasternal short-axis view at the base

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3
Q

!!!

  1. The physical finding of cyanosis is common in:

A. Atrial septal defect
B. Eisenmenger’s syndrome
C. Patent ductus arteriosus
D. Ventricular septal defect

A

B

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4
Q
  1. Eisenmenger’s syndrome may be associated with all the following EXCEPT:

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

A

B

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5
Q
  1. Possible repairs for D-transposition of the great arteries include all the following EXCEPT:

A. Blalock-Taussig
B. Jatene
C. Mustard
D. Senning

A

A: Blalock-Taussig

  • Blalock-Taussig - The Blalock-Taussig shunt, a treatment for single ventricle defects, is the creation of pathways between the right subclavian and pulmonary arteries.
  • Jatene (aka: The arterial switch surgery) involves cutting off the aorta and pulmonary arteries just above the point where they leave the heart. Part of this surgery is reconnecting them to the proper ventricle. The valve stays attached to the ventricle, so what was once the pulmonary valve is now the aortic valve
  • Mustard procedure - allows total correction of transposition of the great vessels. The procedure employs a baffle to redirect caval blood flow to the left atrium which then pumps blood to the left ventricle which then pumps the deoxygenated blood to the lungs.

Note: Mustard procedure and Senning procedure are basically same. The only difference is that Senning uses the patient’s own tissue for surgery and Mustard procedure uses synthetic material to create baffle (*a device used to restrain the flow of a fluid, gas, or loose material or to prevent the spreading of sound or light in a particular direction.)

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6
Q

!!!

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

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

A

A: Aortopulmonary window

*Note: An aortopulmonary window is a heart defect in which there is a hole between the aorta and the pulmonary artery. Because of this hole, blood from the aorta rushes into the pulmonary artery, and too much blood flows through the lungs.

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7
Q
  1. The anomaly characterized by a single great vessel arising from the base of the hear t is called:

A. L-transposition of the great arteries
B. Pulmonary atresia
C. Tetralogy of Fallot
D. Truncus arteriosus

A

D

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8
Q
  1. Prime characteristics of tetraolgy of Fallot include all the following EXCEPT:

A. Atrial septal defect
B. Malalignment ventricular septal defect
C. Pulmonic stenosis
D. Right ventricular hypertrophy

A

A

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9
Q
  1. Important factors in evaluating post-surgical repair of tetralogy of Fallot include all the following EXCEPT:

A. Evaluate right and left ventricular function
B. Rule out residual pulmonic valve stenosis
C. Rule out residual shunting at the margins of the atrial septal defect repair
D. Rule out residual shunting at the margins of the ventricular septal defect repair

A

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

*TOF is associated with:

  • PS
  • RV hypertrophy
  • VSD *not ASD
  • aorta overrides VSD
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10
Q

!!!

  1. Defects that are associated with tetralogy of Fallot in about 25% of cases include:

A. Bicuspid aortic valve
B. Overriding pulmonary artery
C. Parachute tricuspid valve
D. Right aortic arch

A

D: Right aortic arch

*Note: A right aortic arch can be associated with other congenital heart defects like Tetralogy of Fallot’s and Truncus Arteriosus. RAA is also associated with chromosomal abnormalities such as DiGeorge syndrome

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11
Q
  1. The four defects that make up tetralogy of Fallot are pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and:

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

A

D

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12
Q

!!!

  1. The Doppler finding associated with persistent patent ductus arteriosus is:

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

A

A Diastolic flow reversal in the descending thoracic aorta

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13
Q
  1. The maximum velocity of a persistent patent ductus arteriosus is 4 m/sec and the systolic blood pressure is 90/60. The systolic pulmonary artery pressure is:

A. 4 mmHg

B. 26 mmHg

C. 26 mmHg plus right atrial pressure

D. 64 mmHg

A

B

*90 - 4(42) = 26

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14
Q

!!!

  1. The cardiac chambers that are enlarged in patent ductus arteriosus are:

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

A

A Left atrium and left ventricle

*In a patient with a small ductus arteriosus, chamber sizes are usually normal, although mild left atrial and/or left ventricular enlargement may be present. In a patient with a moderate or large patent ductus, the left atrium and left ventricle are enlarged.

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15
Q
  1. The typical murmur associated with patent ductus arteriosus is:

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

A

A

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16
Q
  1. Congenital heart diseases that are ductal-dependant include all the following EXCEPT:

A. Aortic atresia
B. Interrupted aortic arch
C. Pulmonary atresia
D. Sinus venosus atrial septal defect

A

D: Sinus venosus atrial septal defect

*Note: Ductal-dependent congenital heart defects

Left-sided - Ductal-dependent pulmonary circulation: presents with cyanosis that is not really improved with oxygen because blood can’t get from the left heart to the body

  • Coarctation of aorta/critical aortic stenosis/interrupted aortic arch
  • Hypoplastic left heart

Right-sided - Ductal-dependent systemic circulation: presents with shock/acidosis that is often initially confused for sepsis but doesn’t really improve (or gets worse) with fluid because blood can’t get from the right heart to the lungs

  • Tetralogy of Fallot
  • Tricuspid atresia
  • Pulmonary atresia/pulmonic stenosis
  • Severe Ebstein’s anomaly
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17
Q
  1. 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 equation

A

C: Implies elevated pulmonary pressure

arterial pressure is higher than pulmonary pressure thus more blood flowing into pulmonary vasculature and elevate its pressure

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18
Q
  1. Persistent patent ductus arteriosus during a pulsed-wave Dopper examination may be confused with all the following EXCEPT:

A. Pulmonic insufficiency

B. Tricuspid insufficiency

C. Aortopulmonary window

D. Anomalous origin of the left coronary artery from the pulmonary artery

A

B: TR

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19
Q
  1. Another name that identifies Uhl’s anomaly is:

A. Barlow’s syndrome
B. Ebstein’s anomaly
C. Parchment heart
D. Right ventricular aplasia

A

C

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20
Q
  1. Expected echocardiographic findings in patients with Ebstein’s anomaly include all the following EXCEPT:

A. Abnormal apical insertion of the tricuspid valve
B. Atrial septal defect
C. Left ventricular volume overload
D. Right ventricular volume overload

A

C

21
Q

431.The classic M-mode finding for Ebstein’s anomaly is:

A. Delayed closure of the tricuspid valve
B. Flail tricuspid valve leaflet
C. Tricuspid valve prolapse
D. Tricuspid valve stenosis

A

A: Delayed closure of the tricuspid valve

22
Q
  1. Common cardiac Doppler findings in Ebstein’s anomaly include all the following EXCEPT:

A. Atrial septal defect with right -to-left shunting.
B. Funtional right ventricular outflow tract obstruction.

C. Mitral regurgitation.
D. Tricuspid regurgitation

A

C: MR

23
Q

!!!

  1. Congenital heart diseases strongly associated with Ebstein’s anomaly include:

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

A

A Atrial septal defect.

*Other heart conditions associated with Ebstein anomaly

Common associated heart conditions include:

  • ASD/PFO
  • arrhythmias
  • Wolff-Parkinson-White (WPW) syndrome. People with WPW syndrome have an abnormal electrical pathway in the heart that can lead to fast heart rates and fainting spells.
24
Q
  1. Important factors when considering surgical repair in Ebstein’s anomaly include all the following EXCEPT:

A. Degree of anterior tricuspid valve prolapse.
B. Degree of “atrialization” of the right ventricle.
C. Dysplasia of the valve leaflets.
D. Extent of leaflet tethering.

A

A

25
Q

427: The best echocardiographic view for determining the presence of Ebstein’s anomaly is the:

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

A

A

26
Q
  1. A congenital malformation of the tricuspid valve in which one, two, or all three leaflets are displaced downward from the annulus is known as:

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

A

A

27
Q

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

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

A

A: Left atrium and left ventricle

*Note: Larger VSDs cause volume overload to the left side of the heart, resulting in ECG findings of left atrial and ventircular enlargement and hypertrophy

28
Q
  1. The type of ventricular septal defect most often associated with ventricular septal aneurysm is:

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

A

C. Perimembranous

*Type 2: (membranous) This VSD is, by far the most common type, accounting for 80% of all defects. It is located in the membranous septum inferior to the crista supraventricularis. It often involves the muscular septum when it is commonly known as perimembranous

29
Q
  1. The most common type of ventricular septal defect is:

A. Inlet (posterior).
B. Membranous.
C. Outlet (supracristal).
D. Trabecular

A

B

30
Q

422: Cardiac chambers that are enlarged in atrial septal defect include all the following EXCEPT:

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

A

A Left atrium

*left-right shunt - extra blood flow into right side of the heart and increase pulmonary pressure

31
Q
  1. The classic M-mode finding for atrial septal defect is:
    A. Left ventricular volume overload.
    B. Right ventricular volume overload.
    C. Left ventricular pressure overload.
    D. Right ventricular pressure overload
A

B Right ventricular volume overload

*left has higher pressure - more blood flow into right heart - cause RV volume overload

32
Q
  1. An oxygen saturation sample taken at the superior vena cava is 74% and in the right atrium is 88%. A possible explanation is:
    A. Atrial septal defect.
    B. Coarctation of the aorta.
    C. Patent ductus arteriosus .
    D. Ventricular septal defect.
A

A

33
Q
  1. The congenital heart defect most commonly associated with ostium primum atrial septal defect is:

A. Cleft mitral valve.
B. Parachute mitral valve.
C. Partial anomalous pulmonary venous return
D. total anomalous pulmonary venous return

A

A Cleft mitral valve

*note: Ostium primum atrial septal defects (ASDs) are most commonly associated with Down syndrome (trisomy 21). The incidence of trisomy 21 is 1 per 800 live births, with an increased prevalence observed in children born to older mothers.

34
Q
  1. The most common type of atrial septal defect is:
    A. Coronary sinus.
    B. Ostium primum
    C. Ostium secundum
    D. Sinus venosus.
A

C Ostium secundum

*Secundum. This is the most common type of ASD . It occurs in the middle of the wall between the upper heart chambers (atrial septum).

35
Q
  1. The pulsed-wave Doppler characteristics of an uncomplicated atrial septal defect are:

A. Low -velocity left-to-right flow.
B. High -velocity left-to- right flow.
C. Low-velocity right-to-left flow.
D. High-velocity right-to-left flow

A

A Low -velocity left-to-right flow.

36
Q
  1. The congenital heart defect most often associated with Down’s syndrome (trisomy 21) is:

A. Coarctation of the aorta
B. Endocardial cushion defect
C. Peripheral pulmonary stenosis
D. Tetralogy of Fallot

A

B Endocardial cushion defect

*AVSD (atrioventricular septal defect aka: endocardial cushion defect) is the most common congenital heart condition in children with Down syndrome.

37
Q
  1. A complete atrioventricular canal defect is ostium primum atrial septal defect with:

A. Coarctation
B. Cleft mitral valve, coarctation of the aorta
C. Canal-type ventricular septal defect, patent ductus arteriosus
D. Canal-type ventricular septal defect, common atriovetricular valve

A

D: Canal-type ventricular septal defect, common atriovetricular valve

38
Q
  1. An unexpected postoperative finding with atrial septal defect repair is:
    A. Atrial septal aneurysm
    B. Mitral valve prolapsed
    C. Paradoxical interventricular septal motion
    D. Right ventricular volume overload pattern
A

C: Paradoxical interventricular septal motion

*Note: Paradoxical septal motion (PSM) is the systolic movement of the interventricular septum toward the right ventricle despite normal thickening. The PSM is a frequent echocardiographic finding after cardiac surgery

39
Q
  1. The view of choice when examining a patient with secundum atrial septal defect is:

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

A

D: Subcostal four chamber

40
Q
  1. Right coronary aortic valve leaflet prolapsed will most likely be seen in a patient with:

A. Coarctation of the aorta
B. Membranous ventricular septal defect
C. Ostium primum atrial septal defect
D. Patent ductus arteriosus

A

B: Membranous ventricular septal defect

41
Q
  1. Dilated coronary sinus has been associated with all the following EXCEPT:

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

A

B

42
Q
  1. Findings associated with congenital aneurysm of the left atrium include:

A. Electrical alternans
B. Cardiac arrhythmia
C. Bundle branch block
D. Pathological Q wave

A

B: Cardiac arrhythmia

*Note: Health conditions most commonly associated with the enlargement of the left atrium include high blood pressure, atrial fibrillation, mitral valve dysfunction, and left ventricle problems.

43
Q

When evaluating atrial septal defect flow with color doppler, the sonographer should…

A

reduce the color velocity scale

44
Q

A potential complication of PFO is

A

paradoxical embolus

45
Q

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

A

ASA (atrial septal aneurysm)

46
Q

In a patient with VSD the blood pressure is 120/80 mmHg and the peak systolic velocity of the VSD is 5m/s. The RVSP and SPAP is:

A

20 mmHg

*Note: 120 - 4(5 m/s)2

47
Q

Congenital heart defect strongly associated with Ebstein’s anomaly include

A

ASD

48
Q

Uhl’s anomaly is

A

RV dysplasia

*Uhl’s anomaly (a.k.a. “Parchment Heart”) is a rare congenital heart condition where the myocytes are absent in the right ventricle which results in right ventricular failure and arrhythmia during infancy. The right ventricular wall is very thin and hypocontractile.

Echo Registry Review (25 decks)

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