Measurement Techniques & Maneuvers

C. Normal for an adult

This image demonstrates an aortic annulus diameter of 2.4, which is:

A. Small for an adult

B. Stenotic for an adult

C. Normal for an adult

D. Enlarged for an adult

E. Indicative of aortic dissection

B. The end-diastolic dimension of the ventricle

The line labeled 1 represents:

A. The end-systolic dimension of the left ventricle

B. The end-diastolic dimension of the ventricle

C. The end-systolic dimension of the left atrium

D. The end-diastolic dimension of the left atrium

E. The end-diastolic dimension of the aortic root

E. Constrictive physiology

The doppler signal from the hepatic vein demonstrates:

A. Normal hepatic vein flow

B. Budd-chiari syndrome

C. Mitral regurgitation

D. Restriction physiology

E. Constrictive physiology

Frank-Starling law

Which principle states that the greater the length of the muscle fibers in the ventricular wall, the greater the force of ventricular contraction?

D. Severely enlarged

A 65 year old female presents with shortness of breath. Echocardiography demonstrates thickening of the mitral valve and poor excursion of the mitral leaflets. The left atrial volume divided by body surface area (mL/m^2) is estimated to be 50 mL. On the basis of this estimated volume index you would characterize the left atrium as:

A. Normal

B. Mildly enlarged

C. Moderately enlarged

D. Severely enlarged

E. Smaller than normal

C. Left atrium

In this schematic, what is the number 4?

A. Aorta

B. Right pulmonary artery

C. Left atrium

D. Pulmonary vein

E. Superior vena cava

all of these

In a patient with aortic stenosis, which view should you use to examine the aortic valve with continuous-wave (CW) Doppler?

C. Mid aortic stenosis

A 78 year old male with presents with angina, congestive heart failure and syncope. A late-peaking harsh systolic ejection murmur is heard. The Doppler velocity across the aortic valve is estimated to be 2.6 m/sec. The continuity equation estimates the aortic valve area to be 1.62 cm^2. This finding is consistent with:

A. A normal aortic valve

B. A trivial amount of aortic stenosis

C. Mid aortic stenosis

D. Moderate aortic stenosis

E. Severe aortic stenosis

Continuity equation

In a patient who has very little aortic insufficiency, no mitral regurgitation, and difficult-to-visualize leaflet tips, the best method of calculating the aortic valve area is:

B. The presence of tricuspid regurgitation

This spectral Doppler signal is taken from a hepatic vein. The tracing suggests:

A. A normal hepatic vein

B. The presence of tricuspid regurgitation

C. The presence of mitral regurgitation

D. Pulmonary hypertension

E. Systemic hypertension

D. The color Doppler frame corresponding to peak mitral regurgitation velocity

When calculating proximal isovelocity surface area, (PISA) for mitral regurgitation, you must measure the radius from which of the following?

A. The color Doppler frame corresponding to peak aortic velocity

B. The color Doppler frame corresponding to peak mitral stenotic velocity

C. The color Doppler frame corresponding to peak aortic regurgitation velocity

D. The color Doppler frame corresponding to peak mitral regurgitation velocity

E. The color Doppler frame corresponding to peak pulmonic velocity

D. Pulmonary vein

In this schematic, what is number 5 pointing to?

A. Aorta

B. Left atrium

C. Right pulmonary artery

D. Pulmonary vein

E. Superior vena cava

E. Superior vena cava

In this schematic, what is number 1 pointing to?

A. Aorta

B. Left atrium

C. Right pulmonary artery

D. Pulmonary vein

E. Superior vena cava

C. Normal left ventricular diastolic function

A 65-year old male presents for resting echocardiography and is noted to have an isovolumic relaxation time (IVRT) of 82 msec. He mostly likely has:

A. Restrictive left ventricular diastolic function

B. Prolonged filling time

C. Normal left ventricular diastolic function

D. Systemic hypertension

E. Pulmonary hypertension

C. 52%-72%

Which of the following is considered a normal ejection fraction range of a male patient?

A. 20%-40%

B. 20-40 mm

C. 52%-72%

D. 52-72 mm

E. 65%-85%

A 61-year-old female presents with atrial fibrillation and pulmonary edema. The aortic valve is thickened and domed, and the mitral valve is thickened and has a hockey stick appearance. The aortic valve area is estimated to be 0.99 cm^2 and the mitral valve area is estimated to be 0.55 cm^2. The cause of these findings is most likely:

A. Ehlers-danlos syndrome

B. Marfan syndrome

C. Congenital aortic stenosis

D. IV drug abuse resulting in endocarditis

E. Rheumatic heart disease

B. 2

In the image below, which number demonstrates the correct placement of the caliper to measure the peak flow gradient in a case of tricuspid regurgitation?

A. 1

B. 2

C. 3

D. 4

E. 5

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

Turbulent blood flow in the ascending aorta is mostly likely to be caused by:

A. A hypertensive episode

B. An increase in hematocrit

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

D. An increase in martial pressure of 5mmHg

E. A decrease in cardiac output to one-half or normal

B. If you use the left ventricular outflow tract (LVOT) peak velocity in the continuity equation, then you should use the aortic valve peak velocity instead of the aortic valve velocity-time integral (VTI) measurement.

When are you calculating the continuity equation for aortic valve area in a patient who is in sinus rhythm, which of the following is TRUE?

A. The continuity equation may render an overestimation of valve area

B. If you use the left ventricular outflow tract (LVOT) peak velocity in the continuity equation, then you should use the aortic valve peak velocity instead of the aortic valve velocity-time integral (VTI) measurement.

C. The continuity equation will probably be inaccurate

D. The proximal isovelocity surface area (PISA) method should be used instead

E. The continuity equation should not be used in this scenario

C. 145 msec

An 81 year old female presents with dyspnea, atrial fibrillation, shortness of breath, and fatigue. Echocardiography is performed. The mitral valve deceleration time is 500 msec. No other cardiac abnormalities are present. What is the pressure half-time?

A. 75 msec

B. 100 msec

C. 145 msec

D. 220 msec

E. 500 msec

B. Dilated left atrium

This image demonstrates a:

A. Dilated aortic root

B. Dilated left atrium

C. Dilated right

D. Dilated left ventricle

E. Dilated pulmonary artery

D. B-bump

This image demonstrates:

A. Systolic anterior motion of the mitral valve

B. Premature aortic valve closure

C. Premature aortic valve closure

D. B-bump

E. Decreased EPSS

D. 180 degrees

When using proximal isovelocity surface area (PISA) to calculate the mitral valve area, you must divide the angle of the isovelocity hemisphere by which of the following?

A. 40 degrees

B. 60 degrees

C. 90 degrees

D. 180 degrees

E. 200 degrees

B. Peak mitral inflow E velocity

When using proximal isovelocity surface area (PISA) to calculate mitral valve area, you must measure the radius from the color Doppler frame corresponding to the"

A. Peak mitral inflow A velocity

B. Peak mitral inflow E velocity

C. Peak mitral inflow S velocity

D. Peak mitral inflow D velocity

E. Peak mitral inflow R velocity

B. Parasternal short-axis

From which of the following views may the aortic valve area be assessed using 2D planimetry?

A. Parasternal long-axis

B. Parasternal short-axis

C. Apical four chamber

D. Apical two chamber

E. Suprasternal notch

B. Constrictive physiology

This Doppler signal from the tricuspid inflow demonstrates:

A. Restrictive physiology

B. Constrictive physiology

C. Tricuspid stenosis

D. Tricuspid regurgitation

E. Normal tricuspid inflow

E. An E/A ratio of 3.1

A patient with known restrictive diastolic filling presents for follow-up echocardiography. You would expect to find:

A. An E/A ratio of 0.8

B. An E/A ratio of 1.0

C. An E/A ratio of 1.5

D. An E/A ratio of 1.9

E. An E/A ratio of 3.1

B. Tricuspid valve

This image was taken from a patient known to have constrictive pericarditis. This most likely represents a Doppler signal taken from the:

A. Mitral valve

B. Tricuspid valve

C. Pulmonic valve

D. Aortic valve

E. Pulmonary valve

C. Moderate mitral regurgitation

A 50 year old female with mitral valve prolapse presents for resting echocardiography. Her mitral regurgitation fraction is noted to be 38%. This finding represents

A. Trivial mitral regurgitation

B. Mild mitral regurgitation

C. Moderate mitral regurgitation

D. Severe mitral regurgitation

E. Moderate to severe mitral regurgitation

E. A and B

Having a patient stand from supine position would cause which of the following physiologic changes?

A. Decreased stroke volume

B. Decreases cardiac volume

C. Increased stroke volume

D. Increased cardiac output

E. A and B

B. The time interval between the points of 1.0 m/sec and 3.0 m/sec on the mitral regurgitation trace

In order to perform the dP/dt measurement of the left ventricle, which of the following must you know?

A. The ejection time period for the pulmonary valve

B. The time interval between the points of 1.0 m/sec and 3.0 m/sec on the mitral regurgitation trace

C. The time interval between the points of 2.0 m/sec

D. The ejection time period for the aortic valve

E. Left atrial pressure during isovolumic relaxation

C. This patient has normal left ventricular performance

A patient with mitral valve prolapse is found to have a dP/dt of 875 mmHg/sec. Which of the following would accurately categorize this patient's left ventricular systolic performance?

A. This patient has normal left ventricular performance

B. This patient has borderline abnormal left ventricular performance

C. This patient has normal left ventricular performance

D. This patient has normal left atrial performance

E. This patient has impaired left atrial performance

A. Slower

In comparison with normal flow-velocity acceleration time in the aortic valve, acceleration in the pulmonic valve is normally:

A. Slower

B. Faster

C. The same

D. Not consistent

E. Dependent upon the phase of diastole

B. Time in milliseconds that it takes for the left ventricle to generate 32 mmHg

Which of the following does the dP/dt measure?

A. Time in seconds that it takes for the right ventricle to generate 32 mmHg

B. Time in milliseconds that it takes for the left ventricle to generate 32 mmHg

C. Time in seconds that it takes for the left ventricle to generate 10 mmHg

D. Time in milliseconds that it takes for the right atrium to generate 10 mmHg

E. Time in seconds that it takes for the left atrium to generate 32 mmHg

E. Body surface area

To calculate aortic valve area, you may multiply the aortic valve index by:

A. Velocity-time integral (VTI) of the left ventricular outflow tract (LVOT)

B. Cardiac output

C. Stroke volume

D. Bernoulli's equation

E. Body surface area

A. Inferior vena cava reactivity only

Right atrial pressure can be estimated by calculating:

A. Inferior vena cava reactivity only

B. Inferior vena cava reactivity plus tricuspid regurgitation

C. Inferior vena cava reactivity divided by pulmonary artery pressure

D. Inferior vena cava reactivity multiplied by tricuspid regurgitation

E. Hepatic vein reactivity

D. Mean pulmonary artery pressure

A 34-year female presents with a history of shortness of breath. You measure the peak pulmonary regurgitation velocity at 2.0 m/sec. The right atrial pressure is estimated to be 3 mmHg. This measurement would indicate that:

A. Central venous pressure is 16 mmHg

B. Peak pulmonary artery pressure is 8 mmHg

C. Mean pulmonary artery pressure is 16 mmHg

D. Mean pulmonary artery pressure

E. Left atrial pressure is 16 mmHg

A. Valve click

What is the arrow pointing to?

A. Valve click

B. Electronic noise artifact

C. Maximum tricuspid regurgitation jet

D. Pulmonic hypertension jet

E. Pulmonary regurgitation jet

A. PISA assumes that the mitral annulus is circular

Which of the following is a major drawback to using proximal isovelocity surface area (PISA) in calculating mitral regurgitation?

A. PISA assumes that the mitral annulus is circular

B. PISA calculates only mitral regurgitation associated with stenosis

C. PISA can be used only to calculate severe regurgitation

D. PISA cannot be used to calculate mitral regurgitation

E. PISA is cumbersome

C. Dynamic outflow tract obstruction

A 24 year old female presents with chest pain on exertion. During echocardiography a left ventricular outflow tract (LVOT) velocity of 3.0 m/sec is obtained. The qualitative properties of the LVOT continuous-wave Doppler signal demonstrate a dagger shape. This suggests:

A. Nonobstructive hypertrophic cardiomyopathy

B. Fixed outflow tract obstruction

C. Dynamic outflow tract obstruction

D. Mitral stenosis

E. Coarctation

C. Upper pulmonary vein 1-2 cm deep

Pulmonary vein inflow is best assessed with pulsed wave Doppler at the:

A. Tips of the mitral valve leaflets

B. Tips of the pulmonic valve leaflets

C. Upper pulmonary vein 1-2 cm deep

D. Superior vena cava 2-4 cm deep

E. Pulmonary artery 1-2 cm after the valve tips

A. Inverse

Pulmonary acceleration time ahs the following relationship to pulmonary artery systolic pressure:

A. Inverse

B. Equal

C. Direct

D. Complete

E. Exactly the same

B. Decreased mitral valve inflow velocity with inspiration

Your patient was referred for evaluation of suspected constrictive pericarditis. The spectral Doppler image demonstrates:

A. Increased velocity of the mitral valve inflow with inspiration

B. Decreased mitral valve inflow velocity with inspiration

C. No change in velocities with respiration

D. A Doppler inflow pattern seen with restrictive cardiomyopathy

E. Lack of use of a respirometer

B. 7-11 mm

Normal thickness of the interventricular septum is:

A. <5 mm

B. 7-11 mm

C. 11-15 mm

D. 16-20 mm

E. 21-25 mm

D. 36 mmHg

A 38-year old female presents with exertional dyspnea. Echocardiography demonstrates a peak velocity across the pulmonic valve of 3.0 m/sec. Based on this information the patient has a pulmonary artery peak gradient of:

A. 3 mmHg

B. 9 mmHg

C. 27 mmHg

D. 36 mmHg

E. 64 mmHg

D. Moderate aortic stenosis

An 82 year old female presents with angina, congestive heart failure, and syncope. A palpable systolic thrill is noted. The Doppler velocity across the aortic valve is estimated to be 3.4 m/sec. The continuity equation estimates the aortic valve area to be 1.2 cm^2. This finding is consistent with:

A. A normal aortic valve

B. A trivial amount of aortic stenosis

C. Mid aortic stenosis

D. Moderate aortic stenosis

E. Severe aortic stenosis

C. Atrial contraction

The A point of this M-mode echocardiogram represents:

A. Early-diastolic filling

B. Diastasis

C. Atrial contraction

D. Ventricular contraction

E. Isovolumic relaxation time

B. 2.1-2.9 cm

The normal aortic valve annulus diameter is:

A. 1.1-1.7 cm

B. 2.1-2.9 cm

C. 2.5-4.5 cm

D. 3.0-3.5 cm

E. 4.0-6.0 cm

C. 3.0-4.0 cm^2

The normal area of the aortic valve in adults is:

A. 1.1-1.7 cm^2

B. 1.8-2.9 cm^2

C. 3.0-4.0 cm^2

D. 4.1-5.0 cm^2

E. 5.1-6.0 cm^2

A. Precise, on axis visualization of the leaflet tips

Calculation of the mitral valve area using 2D planimetry requires:

A. Precise, on axis visualization of the leaflet tips

B. Deceleration time

C. Pressure half-time

D. Shift of the color baseline

E. Pressure gradient

D. The Doppler beam is parallel to the flow through multiple valves

The apical window is considered one of the best approaches for performing Doppler studies of flow across the cardiac valves. Why?

A. The transducer is closest to the valves in this position

B. More abnormalities can be identified from this location

C. It is the best view to evaluate flow across both semilunar valves

D. The Doppler beam is parallel to the flow through multiple valves

E. It is the easiest location from which to obtain both image and Doppler information

C. Parasternal short-axis view

Pulsed Doppler recordings of pulmonary insufficiency are normally recorded in the:

A. Subcostal four-chamber view

B. Suprasternal long-axis view

C. Parasternal short-axis view

D. Apical two-chamber view

E. Apical five-chamber view

C. Hepatic vein

What is the source of this spectral Doppler signal?

A. Inferior vena cava

B. Superior vena cava

C. Hepatic vein

D. Right upper pulmonary vein

E. Right lower pulmonary vein

A. Less than 3 mm

Aortic plaque is considered mild when the intimal thickness is:

A. Less than 3 mm

B. Less than 4 mm

C. Less than 5 mm

D. Less than 6 mm

E. Less than 7 mm

B. Velocity-time integral

Which of the following is needed to assess the mean inflow gradient in a case of tricuspid stenosis

A. Peak velocity

B. Velocity-time integral

C. Pressure half-time

D. Deceleration time

E. Acceleration time

A. Systolic anterior motion of the mitral valve

This image demonstrates:

A. Systolic anterior motion of the mitral valve

B. Premature aortic valve closure

C. Aortic regurgitation

D. B-bump

E. Increased E point septal separation

D. At the cusp insertion

The diameter of the aortic annulus should be measured at which of the following locations?

A. From 5 mm below the cusp insertion

B. From 2 mm above the cusp insertion

C. From 2 mm below the cusp insertion

D. At the cusp insertion

E. From 5 mm above the cusp insertion

D. 60%-70%

This image demonstrates an estimated ejection fraction of:

A. 20%-30%

B. 30%-40%

C. 50%-60%

D. 60%-70%

E. 80%-90%

B. The patient has Grade I impaired left ventricular diastolic function

A 40 year old patient has an E/A ratio of 0.7, an average E/a' ratio of 9, and a TR peak velocity of 2.7 m/sec. Which of the following statements is correct?

A. Time patient has normal diastolic function

B. The patient has Grade I impaired left ventricular diastolic function

C. This patient has Grade II impaired left ventricular diastolic function

D. This patient has Grade III impaired left ventricular diastolic function

E. This patient has restrictive physiology

C. Systolic blood pressure

In a patient with a patent ductus arteriosus, what other factor must be known in order to calculate the right ventricular systolic pressure (PVSP)?

A. Right atrial pressure

B. Inferior vena cava reactivity

C. Systolic blood pressure

D. Left atrial pressure

E. Diastolic blood pressure

A. Indicate remodeling of the heart based on athletic status

Resing echocardiography of a 32-year old, well conditioned athlete demonstrates that the septal wall is 1.4 mm and the left ventricular posterior wall is 1.6 mm. These measurements:

A. Indicate remodeling of the heart based on athletic status

B. Indicate the presence of carcinoid heart disease

C. Indicate the presence of dilated cardiomyopathy

D. Indicate follow up with stress echocardiography

E. Indicate hypertrophic obstructive cardiomyopathy

C. Peak instantaneous gradient

The peak aortic gradient calculated by echocardiography correlates best with which of the following catheterization measurements?

A. Peak-to-peak gradient

B. Mean gradient

C. Peak instantaneous gradient

D. A and B

E. All of the above

A. Innominate artery

In this suprasternal notch view, the arrow is pointing to the:

A. Innominate artery

B. Right common carotid artery

C. Left common carotid artery

D. Left innominate artery

E. Left subclavian artery

A. Early-diastolic filling

The E point on this M-mode echocardiogram represents:

A. Early-diastolic filling

B. Diastasis

C. Atrial contraction

D. Ventricular contraction

E. Isovolumic relaxation time

B. Stroke volume divided by end-diastolic volume

The correct equation for calculating ejection fraction is:

A. Stroke volume multiplied by heart rate

B. Stroke volume divided by end-diastolic volume

C. Cardiac output divided by surface area

D. Left ventricular end-diastolic volume subtracted from left ventricular end-systolic volume

E. Systolic blood pressure subtracted from diastolic blood pressure

A. 220 divided by mitral pressure half time

The correct equation for calculating mitral valve area using the pressure half-time method is:

A. 220 divided by mitral pressure half time

B. Mitral pressure half time divided by 220

C. 759 divided by mitral pressure half time

D. 222 divided by 759

E. Deceleration time divided by 220

E. Constriction physiology

This image is a DOppler signal from the mitral inflow. This image demonstrates:

A. Normal mitral inflow

B. Mitral stenosis

C. Mitral regurgitation

D. Restriction physiology

E. Constriction physiology

D. Severe aortic stenosis

Resting echocardiography reveals a mean aortic gradient of 57 mmHg. This patient's condition would be most accurately categorized as:

A. Trivial aortic stenosis

B. Mid aortic stenosis

C. Moderate aortic stenosis

D. Severe aortic stenosis

E. No aortic stenosis

D. D wave

In this pulsed-wave Doppler sample from the hepatic vein, what is the arrow pointing to?

A. S wave

B. C wave

C. V wave

D. D wave

E. A wave

D. 3.0-3.5 cm

The normal mitral annulus diameter is:

A. 1.1-1.7 cm

B. 1.8-2.4 cm

C. 2.5-4.5 cm

D. 3.0-3.5 cm

E. 4.0-6.0 cm

B. 42-48 mm

What is the normal range for left ventricular end-diastolic diameter in a female patient with no cardiac abnormalities or pathology?

A. 28-32 mm

B. 42-48 mm

C. 76-86 mm

D. 70-80 mm

E. 85-98 mm

B. The patient should be asked to hold his or hear breath or to breathe quietly while you are acquiring the outfit velocity-time integral (VTI)

In a patient with a membranous ventricular septal defect and highly varied venous return, which of the following is TRUE?

A. The systemic and pulmonary stoke volumes will remain the same from heartbeat to heartbeat

B. The patient should be asked to hold his or hear breath or to breathe quietly while you are acquiring the outfit velocity-time integral (VTI)

C. The Qp/Qs will be fixed

D. The outflow tract diameters will vary greatly

E. The shunt gradient will not be calculated correctly

C. 15 mmHg

An inferior vena cava that is dilated (2.2cm) and collapses less than 50%, with tricuspid regurgitation measuring 2.2 m/sec and pulmonary artery diastolic pressure of 10 mmHg, may indicate an estimated right atrial pressure of:

A. 3 mmHg

B. 8 mmHg

C. 15 mmHg

D. 20 mmHg

E. None of the above because the calculation cannot be performed with the information given

B. The continuity equation

Chamber measurements may be acquired using all of the following methods EXCEPT:

A. 2D measurements

B. The continuity equation

C. M-mode measurements

D. Simpson's rule

E. A and C

D. Severe mitral regurgitation

A 50 year old female with mitral valve prolapse is found to have a mitral valve regurgitant fraction of 58%. This patient has:

A. No mitral regurgitation

B. Mild mitral regurgitation

C. Moderate mitral regurgitation

D. Severe mitral regurgitation

E. Trivial mitral regurgitation

D. Cessation of flow across the mitral valve

All patients performance of a Valsalva maneuver during resting echocardiography would have all of the following hemodynamic effects EXCEPT:

A. Decreased cardiac output

B. Decreased stroke volume

C. Increased murmur in a patient with idiopathic hypertrophic subaortic stenosis (IHSS)

D. Cessation of flow across the mitral valve

E. A and C

D. Tamponade physiology

A patient presents with a large pericardial effusion. The instrumentation is set to a slow sweep speed for the Doppler signal and the respirometer is activated. On inspiration it is noted that the mitral peak E-wave velocity is 48 cm/sec on one beat that is with expiration and 10 cm/sec on a subsequent beat with inspiration. These findings are suggestive of:

A. Normal findings with respiration

B. Left ventricular diastolic dysfunction

C. Restriction physiology

D. Tamponade physiology

E. There is not enough information provided to comment on the findings

C. Maximum tricuspid regurgitant jet

What is the arrow pointing to:

A. Valve click opening

B. Valve click closure

C. Maximum tricuspid regurgitant jet

D. Pulmonic hypertension jet

E. Pulmonary regurgitation jet

A. 1.52 cm^2

An 81 year old female presents with dyspnea, atrial fibrillation, shortness of breath, and fatigue. Echocardiographic is performed. The mitral valve deceleration time is 500 msec. No other cardiac abnormalities are present. Based on this information, what is this patient's mitral valve area?

A. 1.52 cm^2

B. 1.8 cm^2

C. 2.00 cm^2

D. 2.25 cm^2

E. 4.51 cm ^2

A. Greater than 1200 mmHg/sec

A normal dP/dp would be:

A. Greater than 1200 mmHg/sec

B. Greater than 2000 mmHg/sec

C. Greater than 2200 mmHg/sec

D. Less than 1200 mmHg/sec

E. Less than 1000 mmHg/sec

B. Holding his or her breath for 90 seconds

In a patient with bradycardia, all of all following would help to increase the patients heart rate EXCEPT:

A. Inhaling amyl nitrate

B. Holding his or her breath for 90 seconds

C. Performing a series of handgrips

D. Performing Valsalva maneuvers

E. A and C

A. E point of the mitral valve

The arrow in this image is pointing to the:

A. E point of the mitral valve

B. A point of the pulmonic valve

C. F point of the mitral valve

D. E point of the aortic valve

E. B point of the mitral valve

B. Hypertrophic obstructive cardiomyopathy

The image demonstrates a spectral Doppler tracing typical of:

A. Restrictive cardiomyopathy

B. Hypertrophic obstructive cardiomyopathy

C. Amyloid heart disease

D. Noncompaction

E. Dilated cardiomyopathy

E. Severe pulmonary stenosis

A 77 year old female presents with a peak systolic velocity across the pulmonary valve of 4.5 m/sec. Based on this information, the patient would have:

A. A normal pulmonary artery velocity

B. Trivial pulmonary stenosis

C. Mild pulmonary stenosis

D. Moderate pulmonary hypertension

E. Severe pulmonary stenosis

C. Right pulmonary artery

In this schematic, what is the number 3 pointing to?

A. Aorta

B. Left atrium

C. Right pulmonary artery

D. Pulmonary vein

E. Superior vena cava

A. 2D caliper measurements and planimetry

Methods to quantify the size of a vegetation include:

A. 2D caliper measurements and planimetry

B. Pressure half-time

C. Simpson's method of discs

D. Jet height/area ratio

E. Length -area ratio

C. Decreased stroke volume

Having a patient perform a squat would result in all of the following physiologic effects EXCEPT:

A. Increased stroke volume

B. Increased cardiac output

C. Decreased stroke volume

D. Increased aortic insufficiency

E. Decreased blood volume returning to the heart

C. 56.5 mmHg

Echocardiography of a 41 year old female demonstrates a right ventricular outflow tract acceleration time measuring 50 msec. The estimates mean pulmonary artery pressure is:

A. 30.5 mmHg

B. 45.5 mmHg

C. 56.5 mmHg

D. 60.5 mmHg

E. 105.5 mmHg

E. This patient has Grade III diastolic dysfunction

An eighty-year-old female presents for echocardiography. The left atrial pressure is elevated, the mitral E/A ratio is 3.0, the average E/e' is 15, and the peak TR velocity is 3.0 m/sec. What do these findings indicate?

A. The patient has normal diastolic function

B. This patient has Grade 0 diastolic dysfunction

C. This patient has Grade I diastolic dysfunction

D. This patient has Grade II diastolic dysfunction

E. This patient has Grade III diastolic dysfunction

A. Degree of holodiastolic flow reversal

When you are calculating aortic regurgitation severity, which of the following can you assess when you place the pulsed-wave Doppler probe sample volume in the descending aorta?

A. Degree of holodiastolic flow reversal

B. Velocity-time integral (VTI)

C. Degree of aliasing

D. Mean gradient

E. Tricuspid regurgitation

C. Left common carotid artery

In this suprasternal notch view, the arrow is pointing to the:

A. Innominate artery

B. Right common carotid artery

C. Left common carotid artery

D. Left innominate artery

E. Left subclavian artery

D. Aortic insufficiency

With aortic stenosis, what coexisting condition leads to overstimulation of Doppler peak gradients?

A. Mitral stenosis

B. Mitral regurgitation

C. Tricuspid regurgitation

D. Aortic insufficiency

E. Decreased ejection fraction

A. The end-systolic dimension of the left ventricle

The line labeled 2 represents:

A. The end-systolic dimension of the left ventricle

B. The end-diastolic dimension of the left ventricle

C. The end-systolic dimension of the left atrium

D. The end-diastolic dimension of the left atrium

E. The end-diastolic dimension of the aortic root

A. S wave

In this pulsed-wave Doppler sample from the hepatic vein, what is the arrow point to?

A. S wave

B. C wave

C. V wave

D. D wave

E. A wave

E. Mitral valve leaflets

In this image the arrow points to:

A. Atrial septal defect

B. Tricuspid valve leaflets

C. Aortic valve leaflets

D. Ventricular septal defect

E. Mitral valve leaflets

A. Off-axis scanning planes

The major drawback of using 2D planimetry to calculate aortic valve area is:

A. Off-axis scanning planes

B. Difficulty in using the trace method

C. Having the color Doppler scale set too low

D. Encountering the lungs

E. Obtaining a parasternal short-axis

C. Mild mitral stenosis

An 81 year old female presents with dyspnea, atrial fibrillation, shortness of breath, and fatigue. Echocardiography is performed. The mitral valve decoration time is 500 msec. No other cardiac abnormalities are present. This patient most likely has:

A. A normal mitral valve

B. Mitral regurgitation

C. Mild mitral stenosis

D. Moderate mitral stenosis

E. Severe mitral stenosis

B. A point of the mitral valve

The arrow in this image is pointing to the:

A. E point of the mitral valve

B. A point of the mitral valve

C. A point of the aortic valve

D. D point of the mitral valve

E. B point of the pulmonic valve

E. A and D

What does the Doppler formula 4 x (V2^2 - V1^2) help us evaluate?

A. Aortic stenosis

B. Mitral stenosis

C. Mitral regurgitation

D. Left ventricular outflow obstruction

E. A and D

B. Left ventricle in systole

Which of the following two-dimensional measurement is required to calculate left ventricular ejection fraction?

A. Aortic root in diastole

B. Left ventricle in systole

C. Right ventricle in systole

D. Left ventricular outflow tract

E. Right ventricle in diastolic