Adult Echo 2 finalA connective tissue disorder that often affects the elderly causes swelling and loss of mobility in the body's joints. Scimitar syndrome Rheumatoid arthritis Systemic lupus erythematosus Erhlers-Danlos syndrome

A connective tissue disorder that often affects the elderly causes swelling and loss of mobility in the body's joints.

 

Scimitar syndrome

 

Rheumatoid arthritis

 

Systemic lupus erythematosus

 

Erhlers-Danlos syndrome

Rheumatoid arthritis

Non primary cardiac tumors are how many more times as likely to occur than primary cardiac tumors?

 

5 times

 

10 times

 

20 times

 

50 times

20 times

Amyloidosis involves improperly folded _________ that infiltrate the myocardium.

 

DNA

 

Glucose

 

Proteins

 

Lipids

Proteins

Secondary metastatic tumors, frequently travel:

 

To the pericardium, myocardium and then to the endocardium

 

From the IVC to the right atrium and then to the right ventricle

 

From the pulmonary veins into the left atrium

 

All of the above

All of the above

A skin lesion that develops in late stage AIDS infections is called

 

Ulcerations

 

Pustules

 

Angiosarcoma

 

Kaposi's sarcoma

Kaposi's sarcoma

A dumb-bell shaped configuration of the inter-atrial septum often mistaken as cardiac mass is associated with:

 

Amyloidosis

 

Lipomatous hypertrophy

 

Sarcoidosis

 

Sarcoma

Lipomatous hypertrophy

A common cardiomyopathy that develops in patients with chronic HIV infections is:

 

Dilated cardiomyopathy

 

Hypertrophic cardiomyopathy

 

Restrictive cardiomyopathy

 

Constriction

Dilated cardiomyopathy

Kawasaki's disease is an inflammatory illness that affects children.  A cardiac manifestation of Kawasaki's disease is:

 

Dilated coronary arteries

 

Dilated ventricular chambers

 

Cardiac thrombus formation

 

Mitral regurgitation

Dilated coronary arteries

The most common primary malignant intracardiac tumor in adults is which of the following?

 

Myxoma

 

Papillary fibroelastoma

 

Angiosarcoma

 

Fibroma

Angiosarcoma

A cardiac manifestation of carcinoid is

 

Restricted TV leaflet motion

 

Restricted MV leaflet motion

 

PHTN

 

Aortic stenosis

Restricted TV leaflet motion

A well-encapsulated, small tumor composed of fat cells is named____________.

 

Fibroelastoma

 

Mesothelioma

 

Angiosarcoma

 

Lipoma

Lipoma

The following is true of rhabdomyomas:

 

Found in the ventricular walls

 

Most common cardiac tumor in children

 

Often obstruct the conduction pathways in the myocardium

 

All of the above

All of the above

The improper retention and storage of iron particles in the body is called:

 

Sarcoidosis

 

Carcinoid

 

Scleroderma

 

Hemachromatosis

Hemachromatosis

An arteritis that presents with intimal thickening of the aorta and it's major branches is called:

 

Takotsubo

 

Fibromuscular dysplasia

 

Buerger's disease

 

Takayasu's arteritis

Takayasu's arteritis

The TEE image of the left atrial appendage revealed:

A normal LAA

 

A LAA clot

 

A double lobed LAA

 

None of the above

A LAA clot

The mass in the IVC on the image above is most likely consistent with which of the following diagnoses?

Rhabdomyosarcoma

Myxoma

 

Infiltrative renal cell carcinoma

 

Angiosarcoma

 

Infiltrative renal cell carcinoma

A patient is referred to the echo lab because of symptoms of TIA's.  The patient had an echo previously which showed a small patent foramen ovale.  A TEE is performed and reveals the above diagnosis.

Normal inter-atrial septum

Catheter protruding through the intra-atrial septum

 

A large clot lodged in the patent foramen ovale

 

An ASD closure device

A large clot lodged in the patent foramen ovale

In cases of secondary metastatic tumors in the heart, a common echocardiographic finding is 

 

Pericardial effusion

 

Well-circumscribed mass with definitive borders

 

Thickening of the interatrial borders

 

Cystic space in the pericardium

Pericardial effusion

The image above demonstrates a benign primary cardiac tumor.  The most likely diagnosis is which of the following?

right atrial myxoma

 

left atrial myxoma

 

right atrial hemangioma

 

left atrial hemangioma

left atrial myxoma

This was taken on a patient who has been diagnosed with postpartum cardiomyopathy and who currently has an ejection fraction of 20%.  What is the most likely diagnosis?

left atrial myxoma

 

left mitral valve vegetation

 

left ventricular thrombus

 

right atrial myxoma

left ventricular thrombus

A 34 year old man with lymphoma presents with a 3 week history of decreased exercise tolerance.  Physical exam reveals a diaphoretic man with a BP of 90/60, HR of 120 and respiratory rate of 24/min.  Lungs are clear, heart sounds are distant.  Echo reveals a large, circumferential pericardial effusion with RV diastolic collapse.  The most appropriate next step in treating this patient is which of the following?

 

Evaluate for RA systolic collapse

 

Record Doppler filling velocities with a respirometer

 

Insert a Swan-Ganz catheter

 

Perform a pericardiocentesis

Perform a pericardiocentesis

Etiological possibilities for the development of constrictive pericarditis include which of the following?

 

cardiac surgery

 

viral

 

bacterial

 

all of the above

 

all of the above

When evaluating a patient for cardiac tamponade, the echo helps determine the size, location and hemodynamic effects of the pericardial effusion on the heart.  Cardiac tamponade is a diagnosis made by which of the following?

 

Cardiac catheterization

 

Electrocardiogram

 

Tamponade is a clinical diagnosis

 

Thoracotomy

 

Tamponade is a clinical diagnosis

Classic clinical signs and symptoms of constrictive pericarditis include which of the following?

 

pericardial knock

 

murmur

 

none of the above

 

Ewart's Sign

pericardial knock

the physiologic severity of a pericardial effusion largely depends on which of the following?

 

volume and rate of fluid accumulation

 

volume and presence or absence of loculations in the fluid

 

rate of accumulation and fluid composition

 

fluid composition

volume and rate of fluid accumulation

A small posterior echo-free space is detected during the systolic phase only by M-mode/2D echo.  This is considered a:

 

Cardiac tamponade

 

Normal finding

 

Moderate pericardial effusion

 

Large pericardial effusion

Normal finding

In order to be considered full blown tamponade physiology, which of the following must be present?

 

right ventricular systolic collapse and right atrial diastolic collapse

 

right ventricular diastolic collapse and right atrial systolic collapse

 

left atrial systolic collapse and right ventricular diastolic collapse

 

left ventricular collapse and right atrial collapse throughout systole and diastole

right ventricular diastolic collapse and right atrial systolic collapse

A 10 mmHg decrease in systemic blood pressure with inspiration associated with cardiac tamponade is referred to as which of the following?

 

Beck's triad

 

precordium

 

orthostatic hypotension

 

pulsus paradoxus

pulsus paradoxus

Which of the following is a component of Beck's Triad?

 

Bradycardia

 

Muffled heart sounds

 

Decreased venous pressure

 

Hypertension

Muffled heart sounds

What diagnosis can be made from this echo image?

Normal parasternal long axis

 

Pericardial effusion

 

Pericardial and pleural effusion

 

Pleural effusion

Pericardial and pleural effusion

A 45-year old female presents to her doctor with complaints of increasing dyspnea on exertion for three months.  Her physical exam reveals jugular venous distention, ascites and a pericardial knock.  What is the most likely diagnosis?

 

constricitve pericarditis

 

amyloid heart disease

 

ihss

 

endocarditis

constricitve pericarditis

Constrictive pericarditis is best defined as which of the following?

 

a condition in which a pericardial effusion results in tamponade physiology

 

a condition in which the patient develops an outflow tract obstruction

 

a condition in which the pericardium becomes thickened and fibrotic

 

none of the above

a condition in which the pericardium becomes thickened and fibrotic

The best way to differentiate constrictive pericarditis from restrictive cardiomyopathy is by determining if respiratory variation is present.

 

True

 

False

True

Which of the following does not present the possibility for development of constrictive pericarditis?

 

cardiac surgery

 

Viral infection

 

Bacterial infection

 

Aortic dissection

Aortic dissection

Pulsed-wave Doppler evidence of cardiac tamponade includes:

 

Systolic flow reversal in the pulmonary veins

 

Systolic flow reversal in the hepatic veins

 

Inspiratory increase in peak velocity across the mitral valve with an inspiratory decrease in the tricuspid valve

 

Inspiratory decrease in peak velocity across the mitral valve with an inspiratory increase in peak velocity across the tricuspid valve

Inspiratory decrease in peak velocity across the mitral valve with an inspiratory increase in peak velocity across the tricuspid valve

One of the physical findings seen in constrictive pericarditis is Kussmaul's sign.  Which of the following is the correct definition?

 

Severe shortness of breath

 

A paradoxical rise in venous pressure with distension of the jugular veins during inspiration

 

A loud murmur caused from a stiff pericarium

 

Dissassociation between intrathoracic pressure and intracardiac pressures

A paradoxical rise in venous pressure with distension of the jugular veins during inspiration

A 68 year old woman presents with a two month history of increasing dyspnea, chest pain and decreased exercise tolerance.  Her past medical history is remarkable for rheumatoid arthritis, HTN and a coronary bypass 10 years ago.  BP is 138/86, HR, 88 and respirations 14/min.  On inspiration, a friction rub is noted.  Echo reveals normal LV size and function, no significant pericardial effusion.  Doppler shows a restrictive physiology, but respiratory variation is noted with the use of a respirometer.  What is the most likely diagnosis in this patient?

Pericardial tamponade

Constrictive pericarditis

 

Restrictive cardiomyopathy

 

Dilated cardiomyopathy

 

Hypertensive heart disease

Constrictive pericarditis

A pericardial effusion that is composed of several separate compartments of fluid would be correctly described as which of the following?

 

loculated

 

complex

 

simple

 

purulent

loculated

Pericardial brightness by echocardiography is diagnostic for pericardial disease.

 

True

 

False

False

What would be a primary concern for the patient with pericarditis in the photo above?

developing a pleural effusion

myocardial infarction

 

developing tamponade

 

developing an outflow tract obstruction

developing tamponade

A 45 year old patient comes to the lab as a referral from his doctor.  He has had elevated blood pressure that has not responded to traditional medications.  When performing his echo, you attempt to CW the MV to evaluate for any MR.  You get the resulting waveform.  What do we see here?

Artifact with mitral regurgitation

Mid cavity obstruction

 

LVOT outflow waveform

 

LVOT obstruction

Mid cavity obstruction

According to the AHA, Stage 1 hypertension is defined as:

 

130/80

 

140/90

 

150/95

 

Over 100mmHg diastolic pressure

130/80

You bring your patient back to the exam room.  Upon taking his blood pressure, you note it is 155/92.  You become concerned and check his chart and see his blood pressure has been elevated for at least 5 years.  Even before scanning, we would expect to see:

 

Aortic valve sclerosis due to high blood pressure

 

Elevated aortic valve velocities

 

Increased LV wall thickness

 

Significant MR

Increased LV wall thickness

The first line therapy to treat hypertensive heart disease is to reduce the afterload the heart has to pump against.  This is initially achieved by:

 

 

Statins only

 

Beta blocker and diuretics

 

Vasoconstricting medications

 

Warfarin/heparin

Beta blocker and diuretics

LV mass is an important indicator of disease prognosis with hypertensive heart disease.  We can obtain this value 2 ways:

 

 

PLAX LV dimensions and automated LV quantification programs

 

automated LV quantification programs and tracing the LV in the apical window

 

Apical biplane Simpsons method of discs and PLAX LV dimensions

 

Apical biplane Simpsons method of discs and automated LV quantification programs

PLAX LV dimensions and automated LV quantification programs

HFpEF is a term used to describe

 

Diastolic dysfunction

 

Systolic dysfunction

 

Reduced EF

 

Hypertension

Diastolic dysfunction

Although 90-95% of systemic hypertension is idiopathic, there are many secondary reasons.  Which of the following ARE NOT a secondary cause of hypertension?

 

Sleep apnea

 

Renal artery stenosis

 

Aortic coarctation

 

Coronary artery disease

Coronary artery disease

What is the final stage of hypertensive heart disease

 

Diastolic dysfunction

 

LV Failure and dilation

 

Systolic dysfunction

 

Severe coronary artery disease

LV Failure and dilation

Severe pulmonary hypertension by echocardiography is considered

 

40-69mmHg

 

>120mmHg

 

>70mmHg

 

>75mmHg

>70mmHg

Although hypertensive heart disease has deleterious effect on the heart, hypertension can cause serious systemic pathologies.  Which of the following is an immediate, not a complication of hypertension?

 

Stroke

 

Dissection

 

Aortic dilatation

 

Reduced cardiac output

Reduced cardiac output

You go to the emergency department to scan a recent arrival.  Before leaving you note he had a positive DVT study earlier in the week.  Upon entering the room you observe he is significantly short of breath with O2 saturations in the mid 80's.  While scanning the apical 4 chamber, you note hyper-contractility of the RV apex (apical wink).  Based on these findings, you would expect this patient has experienced a/an

 

Acute on chronic pulmonary hypertension

 

Stroke

 

Pulmonary embolism

 

Asthma attack

Pulmonary embolism

Pulmonary hypertensive heart disease can be caused by left sided pathology, such as mitral stenosis or aortic insufficiency.

 

True

 

False

True

One way to treat pulmonary hypertensive heart disease is to give the patient:

 

Beta blockers

 

Warfarin

 

Vasodilators

 

Antiarrythmic medications

Vasodilators

You scan a patient and in the PSAX view we see this image in both systole and diastole.  We would expect this patient to be experiencing

Tricuspid stenosis

RVH

 

Volume overload

 

Pressure overload

Pressure overload

With pulmonary hypertensive heart disease, the vessels in the lungs harden and are unable to dilate.  Due to the stiffness of these vessels we see that the RVOT spectral Doppler exhibits changes.  This change is described as:

 

Longer acceleration time

 

Flow reversal

 

Mid systolic notching

 

Severe PR

Mid systolic notching

Although we can measure RVSP by echocardiography using TR, what measurement of pulmonic flow do we use to evaluate mean pulmonary artery pressure (MPAP)?

 

PR peak velocity

 

PR end diastolic velocity

 

PR VTI

 

PR acceleration time

PR peak velocity

The ASE defines normal RV basal (or annular) dimension as:

 

<25mm

 

15-25mm

 

30-40mm

 

25-41 mm

25-41 mm

All of the following are causes of pulmonary hyptertensive heart disease through parenchymal disorders EXCEPT:

 

 

Lupus

 

COPD

 

Obesity

 

Emphysema

Obesity

A patient that is short of breath comes to the echo lab for an echocardiogram.  The peak TR velocity is 4 m/s with an IVC that measures 2.8cm and does not collapse with a "sniff".  You would calculate the RVSP as:

 

116mmHg

 

100mmHg

 

79mmHg

 

89mmHg

79mmHg

A 41-year-old female presents with a history of an ASD Shunt. The right ventricle demonstrates characteristics of pressure and volume overload. There is a right-to-left shunt noted at the atrial level. Which of the following is the most likely cause of these findings

 

Ebstein anomaly

 

Eisenmenger physiology

 

Endocarditis

 

Rheumatic heart disease

Eisenmenger physiology

A 44-year-old male presents with dyspnea, no history of smoking or cardiac disease and significantly increased pulmonary artery pressures. The most likely explanation is 

 

Tricuspid regurgitation

 

Pulmonary regurgitation

 

Grade 1 Diastolic dysfunction

 

Primary pulmonary hypertension

Primary pulmonary hypertension

This aortic valve M-mode is consistent with which of the following?

Bicuspid aortic valve

 

Mid-systolic closure of the aortic valve

 

Premature opening of the aortic valve

 

Eccentric closure of the aortic valve

Mid-systolic closure of the aortic valve

The most serious complication that could arise from undiagnosed hypertrophic obstructive cardiomyopathy is which of the following?

 

hypertension

 

sudden death

 

syncope

 

dyspnea with exertion

sudden death

The progressive replacement of RV myocardium with fatty and fibrous tissue is called:

 

HCM

 

ARVD

 

IHSS

 

Sarcoidosis

ARVD

A common late complication associated with dilated cardiomyopathy is:

 

Infective endocarditis

 

Aortic  Regurgitation

 

Systemic emboli

 

Ventricular gallop

Systemic emboli

Hypertrophic cardiomyopathy is considered obstructive when the gradient reaches

 

>25mmHg with valsalva

 

>25mmHg

 

>30mmHg

 

>35mmHg

>30mmHg

Cardiomyopathies are divided into which of the following categories, based on physiologic characteristics?

 

restrictive, hypertrophic, dilated

 

constrictive, restrictive, hypertrophic

 

hypertrophic, dilated, symmetric

 

symmetric, restrictive, dilated

restrictive, hypertrophic, dilated

A mitral valve E-point to septal separation of 4.0 cm is an indication of:

 

Severe dilatation of the left ventricle

 

Mild left ventricular dilatatoin

 

Normal LV size

 

None of the above

Severe dilatation of the left ventricle

Amyloidosis will most likely result in the development of which of the following types of cardiomyopathy?

 

restrictive cardiomyopathy

 

dilated cardiomyopathy

 

hypertrophic cardiomyopathy

 

amyloidosis probably will not cause cardiomyopathy

restrictive cardiomyopathy

Eddie is a 85 year old male in for a follow-up echocardiogram.  His previous echo noted a dilated left atrium at 56ml/m²  and a right atrial volume of 108ml.  Diastolic dysfunction was grade III with noted left ventricular hypertrophy.  His current echo still shows dilated atria, but now both ventricles are dilated with thin walls.  His EF is now reported as 25%.

Eddie likely has ___________ that has progressed to end stage and now looks like _____________.

 

Restrictive/infiltrative cardiomyopathy

 

Restrictive/dilated cardiomyopathy

 

Dilated/restrictive cardiomyopathy

 

Hypertrophic/dilated cardiomyopathy

Restrictive/dilated cardiomyopathy

This Doppler inflow image of the mitral valve is consistent with:

Restrictive physiology

Dilated cardiomyopathy

 

Hypertrophic cardiomypathy

 

Pericarditis

Restrictive physiology

This image was obtained by using which type of Doppler?

Continuous wave

 

High PRF

 

Pedoff

 

None of the above

High PRF

This image is an example of:

Dilated Cardiomyopathy

Restrictive cardiomyopathy

 

Noncompaction cardiomyopathy

 

Hypertrophic cardiomyopathy

 

Noncompaction cardiomyopathy

Carcinoid is a disease that primarily affects which valve?

 

Tricuspid

 

Mitral

 

Aortic

 

Pulmonic

 

Tricuspid

The image above is a parasternal long axis view and MOST likely represets which of the following pathologies?

dilated cardiomyopathy

hypertrophic cardiomyopathy

 

hypertrophic obstructive cardiomyopathy

 

restrictive cardiomyopathy

dilated cardiomyopathy

The patient in the apical echocardiographic view above is a 20 year old male with a history of unexplained deaths due to cardiac arrest in his family.  He has no history of hypertension.  What is the most likely diagnosis?

constricitve pericarditis

restrictive cardiomyopathy

 

dilated cardiomyopathy

 

hypertrophic cardiomyopathy

hypertrophic cardiomyopathy

Echocardiographic signs of outflow tract obstruction in hypertrophic cardiomyopathy include all of the following except which?

 

assymetric septal hypertrophy

 

left ventricular dilation

 

systolic anterior motion of the mitral valve

 

high systolic velocity in the left ventricular outflow tract

left ventricular dilation

The M-Mode tracing above was done at the level of the mitral valve leaflets in the parasternal short axis on a patient that has documented hypertrophic cardiomyopathy.  What critical finding does this M-Mode illustrate?

 

aortic valve flutter

 

increased A wave inflow

 

systolic anterior mitral leaflet motion

 

systolic posterior mitral leaflet motion

systolic anterior mitral leaflet motion

Asymmetric septal hypertrophy (ASH) is associated with which of the following myopathies.

 

Dilated

 

Restrictive

 

Hypertrophic

 

None of the above

 

Hypertrophic

Stress Echo can provoke LVOTO

 

True

 

False

True

Which of the following is strongly associated with Syncope

 

left ventricle outflow obstruction

 

VSD

 

rheumatic fever

 

Did Josie cover this?

 

both A and D

both A and D

When performing an echocardiogram on a patient with an LVAD, we want to evaluate the frequency of AV opening.  This is best accomplished by:

 

Observe blood flow through the valve with color Doppler

 

Use Definity or another UCA (ultrasound contrast agent)

 

Pulsed Doppler of the LVOT in the apical view

 

Using a low sweep speed with M-mode imaging in the PLAX view

Using a low sweep speed with M-mode imaging in the PLAX view

You are scanning a patient and notice an odd portion of the image in the apical 4 chamber atria.  What could it be?

Grating lobe artifact

 

Transplant suture lines

 

Thrombus

 

This is an image of normal atria

Transplant suture lines

There are 2 main categories of heart transplants, orthotopic and heterotopic.   A heterotopic heart transplant refers to:

 

 

The native heart is removed and replaced with an total artificial heart

 

A genetically similar heart is taken from an animal and replaces native heart

 

Native heart is removed, donor heart placed back into chest cavity

 

Donor heart is "piggybacked" onto a native heart

Donor heart is "piggybacked" onto a native heart

A common hemodynamic condition seen with transplanted hearts is:

 

Pulmonic regurgitation

 

Aortic regurgitation

 

Tricuspid stenosis

 

Tricuspid regurgitation

Tricuspid regurgitation

Why is dobutamine stress echocardiography used when evaluating post-transplant patients?

 

Due to deinnervation, the heart has a delayed response to exercise

 

Posttransplant patients typically cannot exercise well

 

Due to deinnervation, the heart has no response to exercise

 

Due to pretransplant cardiac conditions, we do not want to exercise them posttransplant

Due to deinnervation, the heart has a delayed response to exercise

A common early postoperative complication after heart transplant is

 

Anastomotic stenosis/scarring

 

Anastomotic leak

 

Pericardial effusion

 

Diastolic dysfunction

Pericardial effusion

Although we serially evaluate a transplanted heart for any changes with echocardiography, patient will also have serial:

 

Anti rejection blood concentration tests

 

RV biopsies

 

Cardiac catheterizations to evaluate left sided heart pressures

 

Exercise stress echos

RV biopsies

A RAMP study is used to evaluate and optimize:

 

VAD power consumption

 

VAD function

 

VAD speed settings

 

The patients mean arterial pressure (MAP)

VAD speed settings

The inflow cannula of an LVAD is placed at the:

 

Atrial appendage

 

Ascending aorta

 

Lateral wall

 

Apex

Apex

A patient with a transplanted heart may not feel any pain during a severe heart attack.

 

True

 

False

True

VADs are only used to support the failing left ventricle

 

True

 

False

False

For a patient waiting for a heart transplant, their placement of a VAD would be considered:

 

Destination therapy

 

Bridge to transplant

 

Permanent

 

Medically necessary

Bridge to transplant

Although patients with VADs are anticoagulated, ___________ remains a serious complication.

 

Exercise

 

Electrical shorts

 

Thrombosis

 

Lack of electrical outlets

Thrombosis

During a heart transplant, what important nerve connection is severed?

 

Vagus

 

Sciatic

 

Median

 

Subcostal

Vagus

With a properly adjusted LVAD, we will not be able to use the LVOT VTI to calculate the cardiac output as the aortic valve only opens intermittently.  What is the most common way to evaluate cardiac output in these patients?

 

RVOT VTI and diameter

 

PV VTI and RVOT diameter

 

Mitral valve inflow VTI and LVOT diameter

 

TR peak velocity + RAP

RVOT VTI and diameter

A patient arrives to the cardiac ICU presenting with acute shock and are expected to recover with few days.   However, their cardiac output is reduced with an estimated EF of 25%.  We would typically see a/an ________used.

 

LVAD

 

RVAD

 

IABP

 

Impella

Impella

When performing a dobutamine stress echo on a patient with a heart transplant, if the target heart rate is not achieved, atropine can be used to augment the heart rate.

 

True

 

False

False

Aortic coarctation occurs most commonly near the ductus

 

True

 

False

True

There are how many different locations for VSD?

 

4

 

7

 

3

 

5

5