Davies Adult Echo

The American Society of Echocardiography adopted the "leading edge" method of measurement because:
A. People were turning up the gain too much.
B. The nature of the interaction between ultrasound and anatomical interfaces makes this advisable.
C. The advent of gray-scale M mode made this possible.
D. It produces the most consistent and reproducible measurements.

D. In 1978 the American Society of Echocardiography recommended that all echo measurements be taken from the leading edge of each structure so that all laboratories would be using a consistent method.
-It produces the most consistent and reproducible measurements.

The term basilar area of the ventricle refers to the:
A. Ventricular myocardium at the apex
B. Mid segments of the ventricle
C. Ventricular myocardium at the atrioventricular valves.
D. None of the above.

C. The basilar area of the heart is at a level near the AV valves.
-Ventricular myocardium at the atrioventricular valves.

The infudibulum is related to the area of the right ventricle called the:
A. inflow tract
B. Outflow
C. Apical area
D. Subvalvular area

B. The infundibulum is a funnel shaped passage leading directly out the right ventricle.
-Outflow tract

The three primary branches of the aortic arch include all of the following EXCEPT the:
A. Innominate artery
B. Right subclavian artery
C. Left common carotid artery
D. Left subclavian artery

B. The right subclavian artery arises from the innominate (brachiocephalic trunk).
-The right subclavian

The term tunica intima refers to which of the following:
A. The inner lining of the arterial wall
B. The outer lining of the arterial wall
C. Transverse arterial muscle fbers
D. Longitudinal muscle fibers
E. The middle layer of the arterial wall.

A. The inner lining of the arterial wall

The term tunica adventitia refers to:
A. The inner lining of the arterial wall.
B. The outer lining of the arterial wall.
C. Transverse arterial muscle fibers.
D. The intimal wall.
E. The middle layer of the arterial wall.

B. The three sections of the arterial wall are the intima, media, and the adventitia
-The outer lining of the arterial wall.

Dextracardia indicates:
A. Enlargement of all cardiac chambers
B. An abnormal conduction system
C. Heart located in the right side of the chest
D. Dual chambers of the right ventricle

C. Often people with dextracardia have all organs reversed.
-Heart located in the right side of the chest

You are asked to pay particular attention to the semilunar valves. These valves are the:
A. Mitral and aortic valves
B. Mitral and tricuspid valves
C. Pulmonic and tricuspid valves
D. Aortic and pulmonic valves

D. Semilunar refers to the crescent or half-moon shape of the aortic and pulmonic valves.
-Aortic and pulmonic valves

The great vessels of the heart are the:
A. Inferior vena cava and superior vena cava
B. Inferior vena cava and subclavian artery
C.
D. Aorta and pulmonary artery

D. The aortic and the pulmonary arteries are described as the great vessels. The aorta delivers oxygenated blood to the body, and pulmonary artery delivers unoxygenated blood to the lungs.
-Aorta and pulmonary artery

Name and label each point on the anterior mitral valve leaflet

-D, E, F, A, C Note that the B notch is seen only when there is interruption in the closure of the mitral valve.

Name and label the three walls transected by the transducer at mid ventricular level:

A Anterior right ventricle wall,
B Interventricular septum,
C left ventricular posterior wall.

Name and label all structures and chambers transected by the M-mode ultrasound beam directed through the base of the heart:

A. Anterior right ventricular wall
B. Right ventricular outflow tract
C. Anterior aortic wall
D. Aortic valve
E. Posterior aortic wall
F. Left atrium
G. Posterior left atrial wall

In M-mode, the structure used to pinpoint end systole for measurement is:
A. The R wave of the ECG.
B. Maximum anterior motion of the left ventricular posterior wall.
C. Maximum posterior motion of the interventricular septum
D. The Q wave of the ECG

B. The R wave denotes the electrical stimulation that initiates systole. The Q wave is not always present and is not an indicator of the end systole. Although the septum is at it maximum posterior motion under normal conditions, it is susceptible to electrical aberrations and volume and pressure changes and therefore not consistent for measurements. Only the maximum anterior motion of the left ventricular posterior wall is consistent for end-systolic measurements.
-Maximum anterior motion of the left ventricular posterior wall

The motion of the septum should be evaluated by M-mode at the:
A. Basal level
B. Mitral level
C. Mid-ventricular level
D. Apical level

C. At the basal level the M-mode beam is directly through the aorta and left atrium. At the mitral level the septum may still show a pattern consistent with aortic motion. At the apical level the beam would be crossing at an abnormal angle. The mid ventricular level is most accurate for evaluating sepal motion.
-Midventricular level

The coronary sinus returns blood to the left atrium:
True or False

False: The coronary sinus is the terminal portion of the great cardiac vein, and it returns blood to the right atrium

The osmium of the coronary arteries may sometimes be visualized in a short-axis two dimensional echo view at the level of he aortic valve:
True or False

True: A narrow opening on the left coronary cusp of the AV valve at approximately 4 o 5 o'clock may define the osmium (opening) of the left coronary artery.

Since phases of the cardiac cycle are discussed in terms of systole and diastole of the ventricle, what phase would occurring during atrial filling?
A. Diastole
B. Systole
C. Isovolumic phase

B. The atria and ventricles are always in opposites phases.
-Systole

In the ECG cycle, late ventricular filling occurs after the:
A. P wave
B. Q wave
C. R wave
D. T wave

A. The P wave on an ECG is the electrical stimulus that created the mitral A wave, which coincides with the atrial kick and late diastolic filling.
-P wave

If a patient presents with an early diastolic murmur you would concentrated interest on the: Aortic valve
True of False

True
-Early diastolic murmurs are due to aortic or pulmonic insufficiency

If a patient presents with an early diastolic murmur you would concentrated interest on the: Mitral valve
True or False

False
-Early diastolic murmurs are due to aortic or pulmonic insufficiency

If a patient presents with an early diastolic murmur you would concentrated interest on the: Tricuspid
True or False

False
-Early diastolic murmurs are due to aortic or pulmonic insufficiency

If a patient presents with an early diastolic murmur you would concentrated interest on the: Pulmonic valve
True or False

True
-Early diastolic murmurs are due to aortic or pulmonic insufficiency

Which valve would you suspect to be abnormal if auscultation revealed an Austin-Flint murmur:
A. Aortic valve
B. Mitral valve
C. Tricuspid valve
D. Pulmonic valve

A. Austin-Flint murmur is associated with aortic insufficiency.
-Aortic valve

Most authors consider the major components of the first heart sound to be:
A. Closure of the semilunar valves
B. Closure of the atrioventricular valves
C. Opening of the semilunar valves
D. Opening of the atrioventricular valves

B. Mitral closure normally precedes tricuspid closure by 0.02 to .03 second, so that audible splitting (duplicate) of the first heart sound is a common and normal occurrence.
-Closure of the atrioventricular valves

The heart sound most often associated with mitral valve prolapse is:
A. Gallop rhythm
B. Ejection sounds
C. Opening snap
D. Systolic click

D. Systolic Click

Early diastolic murmurs are due to aortic or pulmonic insufficiency.
True or False

True

The heart sound associated with mitral and/ or tricuspid stenosis is:
A. Gallop rhythm
B. Ejection sounds
C. A friction rub
D. Opening snap

D. Opening snap

Myxoms are the most common type of cardiac tumor. They comprise half of all cases. Which of the following statements are true?
-These tumors can be located either inside or outside the heart.
True or False

False

Myxoms are the most common type of cardiac tumor. They comprise half of all cases. Which of the following statements are true?
-Approximately 40% of patients with left atrial myxomas have systemic emobli to the brain or extremities.
True or False

True

Myxoms are the most common type of cardiac tumor. They comprise half of all cases. Which of the following statements are true?
-Myxomas occur only in the left atrium
True or False

False

Myxoms are the most common type of cardiac tumor. They comprise half of all cases. Which of the following statements are true?
-Females are affected slightly more often than males.

True

Symtoms associated with pericarditis include.
-A severe, sharp pain located precordially that may radiate into the shoudlers and neck
True or False

True

Symtoms associated with pericarditis include.
-Ankle swelling
True or False

False

Symtoms associated with pericarditis include.
-Changing positions and taking deep breaths increases the pain
True or False

True

Symtoms associated with pericarditis include.
-The pain is dull and radiates into the jaw.
True or False

False

Symtoms noted with mitral valve prolapse syndrome include.
-Palpitations and sharp pain unrelated to exercise
True or False

True

Symtoms noted with mitral valve prolapse syndrome include.
-Lower back pain and headache
True or False

False

Symtoms noted with mitral valve prolapse syndrome include.
-Fatigue and dyspnea
True or False

True

Symtoms noted with mitral valve prolapse syndrome include.
-Palpitations and dizzy spells
True or False

True

A pseudonym for mitral valve prolapse syndrome is:
A. Ebstein's anaomly
B. Barlow's syndrome
C. Crohn's disease
D. Prinzmetal angina

B. Barlow's syndrome

The term trepopnea is the sensation of dyspnea or palpataion, or an uncomfortable feeling that may occur when patients with cardiac disease lie on their left side.
True or False

True

The term dyspnea refers to the condition of:
A. Difficulty in digesting food
B. Difficulty in breathing
C. Rapid Breathing
D. Deep breathing

B. Difficulty in breathing

If a patient awakens in the night with shortness of breath, 1 to 2 hours after falling asleep, what disease might be suspected.
A. Angina pectoris
B. Mitral valve prolapse
C. Constrictive pericarditis
D. Congestive heart failure

D. Congestive heart failure

Anemia or cyanosis may be a manifestation of serious underlying heart disease.
True or False

True

Palpation of arterial pulses is a method used to help determine the presence or absence of diagnostic physical signs for certain cardiac diseases. Which of the following statements is/ are correct?
-Heart failure, obstruction of flow by valvular stenosis, and constricitive pericarditis can cause a diminished stroke volume
True or False

True

Palpation of arterial pulses is a method used to help determine the presence or absence of diagnostic physical signs for certain cardiac diseases. Which of the following statements is/ are correct?
-Normal peripheral pulses arrive later than the carotid pulse.
True or False

True

Palpation of arterial pulses is a method used to help determine the presence or absence of diagnostic physical signs for certain cardiac diseases. Which of the following statements is/ are correct?
-Pulses alternans implies impaired ventricular funcion and is often present in massive pericardial effusion, particulary pericardial tamponade.

True

Palpation of arterial pulses is a method used to help determine the presence or absence of diagnostic physical signs for certain cardiac diseases. Which of the following statements is/ are correct?
-Aortic regurgitation and carotid atherosclerosis cause a large stroke volume, wide pulse pressure, and lowered peripheral resistance with resultant bounding hyperkientic pulses.

True

Dextrocardia can detected by chest xray, percussion, ECG examination, auscultation, and asking the patient.
True or False

True

Which of the following sign are indicative but not diagnostic of heart disease?
-Sharp chest pains
True or False

True

Which of the following sign are indicative but not diagnostic of heart disease?
-Cyanosis
True or False

True

Which of the following sign are indicative but not diagnostic of heart disease?
-Clubbing
True or False

True

Which of the following sign are indicative but not diagnostic of heart disease?
-Obesity
True or False

True

Which one of the following is most likely to cause a decrease in cardiac output?
A. A decrease in peripheral resistance
B. Hyperemia
C. Decrease in left ventricular stroke volume
D. Increase in heart rate
E. Hypertension

C. Decrease in left ventricular stroke volume

If all other factors remain constant, you would expect a reduction in vessel diameter to:
A. Increase velocity
B. Decrease the likelihood of turbulence
C. Decrease viscosity
D. Decrease kinetic energy
E. Increase flow

A. Increase velocity

A decrease in left ventricular contractility secondary to acute myocardial infarction will:
A. Increase cardiac output (Q) by increasing resistance (R)
B. Decrease cardiac output (Q) by decreasing pressure (delta P)
C. Increase velocity of flow in the aorta
D. Decrease delta P with no effect on cardiac output (Q)

B. Decrease cardiac output (Q) by decreasing pressure (delta P)

Which of the following is most likely to cause turbulent flow of blood in the aorta?
A. An increase in cardiac output from 5L/min to 20L/min
B. An increase in hematocrit
C. A decrease in cardiac output to one-half of normal
D. An increase in arterial pressure of 5 mm Hg
E. A hypertensive episode

A. An increase in cardiac output from 5 L/min to 20 L/min

Which of the following are characteristics of turbulent flow?
-It can be predicted by Reynold's number
True or False

True

Which of the following are characteristics of turbulent flow?
-It is responsible for murmurs; bruits and thrills
True or False

True

Which of the following are characteristics of turbulent flow?
-It increases pressure down stream
True or False

False

Which of the following are characteristics of turbulent flow?
-It occurs where there are abrupt variations in vessel diameter
True or False

True

Which of the following are characteristics of turbulent flow?
-It is affected by velocity
True or False

True

During an experiment, a laboratoy animal suddenly develops 2:1 heart block, effectively reducing heart rate by one-half. Which ONE of the following responses would account for pressure being maintained at the same level as before the heart block.
A. Peripheral resistance decreased by one-half
B. Massive vasodilation of the arterial sphincters
C. Peripheral resistance doubled
D. Arteriovenous shunting
E. Peripheral resistance unchanged

C. Peripheral resistance doubled

A subject has a cardiac output of 5 L/min at a heart rate of 75 beats/min. If stroke volume remains constant, what will be the effect of an increase in heart rate to 150 beats per minute?
A. Cardiac output would increase to 22.5 L/min
B. Cardiac output would increase to 25 L/min
C. Cardiac output would increase to 10 L/min
D. Nothing; cardiac output is independent of heart rate
E. Cardiac output would triple

C. Cardiac output would increase to 10 L/min

Which ONE of the following statements is True regarding the term blood pressure?
A. It is reported in cm H20 unless otherwise specified
B. It represents the force exerted by the blood against any unit area of the vessel wall
C. It is constant throughout the cardiac cycle
D. it represents and can be used interchangeably with flow
E. It is the same as hydrostatic pressure

B. It represents the force exerted by the blood against any unit area of the vessel wall.

The minimal pressure in the arterial system during a cardiac cycle is termed:
A. Systolic pressure
B. Pulse pressure
C. Diastolic pressure
D. Mean pressure
E. Mean pulse pressure

C. Diastolic pressure

In measuring human blood pressure, the first sound was heard at 130mmHG, the second at 105, the third at 100, and the last at 95. What is the estimated mean blood pressure?
A. 118mmHg
B. 115mmHg
C. 122mmHg
D. 107mmHg
E. 104mmHg

D. 107mmHg

Which ONE of the following is a correct statement describing transmission of the arterial pressure wave?
A. It originates at the level of the arterioles
B. It slows with increasing age
C. It slows with increasing calcification of the vessels
D. It is caused in part by the inertia of blood in the aorta

D. It is caused in part by the inertia of blood in the aorta

In laminar flow, the velocity of the blood is:
A. Directly proportional to the cross-sectional area of the vessel.
B. Lowest when kinetic energy is highest
C. Lowest at the center of the vessel
D. Zero at the vessel wall

D. Zero at the vessel wall

The principal site of peripheral resistance in the vascular bed is determined to be in the arterioles because:
A. The blood pressure does not change across these vessels.
B. The blood flow is slowest in the arterioles
C. The pressure drop across these vessels is greatest
D. These vessels have thick muscular coats
E. The blood pressure is highest here.

C. The pressure drop across these vessels is greatest

As the arterial pressure wave moves towards the perphery, all of the following occurs except:
A. The pulse amplitude is increased by the presence of reflected waves.\
B. Speed of propagation diminishes
C. Pulsatile changes in arterioles and capillaries are "dampened" owing to vascular distensibilty and resistance
D. Speed of propagation increases

B. Speed of propagation

The incisura on the aortic pressure wave:
A. Indicates closure of the AV valves.
B. Occurs when the aortic valve opens
C. Is inscribed just after the aortic valve closes
D. Occurs during rapid ventricular filling
E. Result from aortic valve malfunction

C. Is inscribed just after aortic valve closes

Starling's law of the heart can be best expressed by which one of the following?
A. As heart rate increases, ventricular contractility also increases.
B. Increasing the arterial pressre decreases the stroke volume.
C. Within limits, an increase in venous return results in an increase in stroke volume.
D. The product of heart rate and stroke volume equals the cardiac output

C.Within limits, an increase in venous return results in an increase in stroke volume

Which ONE of the following best describes the role of the heart as a pump?
A. Regulating cardiac output
B. Forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow.
C. Suctioning blood from the venous circulation
D. Removing carbon dioxide from venous blood and suppling oxygen.

B.Forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow.

Which ultrasound system control automatically calibrates for measurements?
A. Overall gain
B. Rejects
C. Near gain
D. Depth

D. Depth

Increasing system gain can reduce technical artifacts.
True or False

False

The purpose of the time-gain compensation(TGC) circuit is:
-To suppress near-filed echos
True or False

True

The purpose of the time-gain compensation(TGC) circuit is:
-To enhance far-field echos
True False

True

The purpose of the time-gain compensation(TGC) circuit is:
-To selectively eliminate weak echos
True or False

False

The purpose of the time-gain compensation(TGC) circuit is:
-To compensate for loss of ultrasound energy (attenuate) as the beam enters the body
True or False

True

Which of the following are True/False regarding the side lobes seen in two-dimensional images.
-They are generated from the edges of individual transducer elements.
True or False

True

Which of the following are True/False regarding the side lobes seen in two-dimensional images.
-They are a greater problem with mechanical systems.
True or False

False

Which of the following are True/False regarding the side lobes seen in two-dimensional images.
-They are a greater problem with phased-array systems
True or False

True

Which of the following are True/False regarding the side lobes seen in two-dimensional images.
-They display fuzzy areas on the image
True or False

False

In a parasternal long-axis transducer position, imaging is being done from the wrong intercostal space when:
-The interventricular septum and the anterior aortic root wall meet at a right angle.
True or False

True

In a parasternal long-axis transducer position, imaging is being done from the wrong intercostal space when:
-The interventricular septum and the anterior aortic root wall are contiguous
True or False

False

In a parasternal long-axis transducer position, imaging is being done from the wrong intercostal space when:
-The interventricular septum and the anterior aortic root wall do not meet
True or False

True

In a parasternal long-axis transducer position, imaging is being done from the wrong intercostal space when:
-The interventricular septum and the posterior aortic root wall meet.
True or False

True

With which of the following conditions would a contrast agent not likely be used to enhance the echo diagnosis.
A. Atrial septal defect
B. idiopathic hypertrophic subaortic stenosis
C. Ventricular septal defect
D. Patent deuctus arteriosus

B. Idiopathic hypertrophic subaortic stenosis

Left-to-right shunts are more difficult than right-to-left shunts to detect with peripheral-vein contrast injections because:
-Contrast is totally filtered out at the pulmonary capillary level
True or False

False

Left-to-right shunts are more difficult than right-to-left shunts to detect with peripheral-vein contrast injections because:
-Negative contrast is not as easy to identify as positive contrast.
True or False

True

Left-to-right shunts are more difficult than right-to-left shunts to detect with peripheral-vein contrast injections because:
-Microbubbles will not travel left to right because of pressure differences.
True or False

False

Left-to-right shunts are more difficult than right-to-left shunts to detect with peripheral-vein contrast injections because:
-The microbubbles traveling from the right side into the left are rare and difficult to see.
True or False

True

In which condition could amyl nitrite be useful?
A. Mitral stenosis
B. Atrial septal defect
C. Aortic Stenosis
D. Idiopathic hypertrophic subaortic stenosis

D. Idiopathic hypertrophic subaortic stenosis

In the patient with hypertrophic obstructive cardiomyopathy(HOCM) with no systolic anterior motion(SAM) at rest, SAM may be demostrated by the use of:
-The valsalva maneuver
True or False

True

In the patient with hypertrophic obstructive cardiomyopathy(HOCM) with no systolic anterior motion(SAM) at rest, SAM may be demostrated by the use of:
-Amyl nitrite
True or False

True

In the patient with hypertrophic obstructive cardiomyopathy(HOCM) with no systolic anterior motion(SAM) at rest, SAM may be demostrated by the use of:
-Inspiration
True or False

False

In the patient with hypertrophic obstructive cardiomyopathy(HOCM) with no systolic anterior motion(SAM) at rest, SAM may be demostrated by the use of:
-Expiration
True or False

False

When using a large sample volume in performing a Doppler examination, the operator:
-Lengthens the examination time
True or False

False

When using a large sample volume in performing a Doppler examination, the operator:
-Minimizes the chances of missing jets
True or False

True