Echocardiography

5
Echocardiography






  1. Which of the following manipulations will increase the echocardiographic frame rate (see Box 5.1)?



    1. Increase depth
    2. Increase transmit frequency
    3. Decrease sector angle
    4. Increase transmit power



  2. The lateral resolution increases with:



    1. Decreasing transducer diameter
    2. Reducing power
    3. Beam focusing
    4. Reducing transmit frequency



  3. Axial resolution can be improved by which of the following manipulations?



    1. Reducing beam diameter
    2. Beam focusing
    3. Reducing gain
    4. Increasing transmit frequency



  4. Which of the following is associated with continuous-wave Doppler compared with pulsed-wave Doppler?



    1. Aliasing
    2. Range specificity
    3. Ability to record higher velocities
    4. All of the above



  5. An intraoperative transesophageal echocardiogram (TEE) revealed mitral regurgitation (MR) with the following measurements: regurgitant jet area 4 cm2, proximal isovelocity surface area (PISA) radius 0.8 cm at a Nyquist limit of 50 cm/s at a heart rate of 82 bpm and arterial blood pressure 80/40 mmHg (see Box 5.2). What does this represent?



    1. Mild MR
    2. Moderate MR
    3. Severe MR



  6. With one exception, for a given regurgitant volume all of the following result in a reduction in the jet size. Which is the exception?



    1. Fast heart rate
    2. Doubling the sector angle
    3. Increasing the imaging depth
    4. Increasing the blood pressure



  7. A patient has an LV outflow tract (LVOT) velocity of 1 m/s, time velocity integral (TVI) of 25 cm, LVOT diameter of 2 cm, aortic transvalvular velocity of 1.5 m/s, and heart rate 70 bpm. What is the cardiac output of this patient?



    1. 5.5 L/min
    2. 4.5 L/min
    3. 6.3 L/min
    4. Cannot be determined based on the data given



  8. A patient with aortic stenosis (AS) has an LVOT diameter of 2 cm, LVOT velocity (V1) of 2.5 m/s, and transaortic valve velocity (V2) of 5 m/s; two-dimensional examination showed moderate systolic anterior motion (SAM) of the mitral leaflet. How would you describe the valvular AS in this patient?



    1. Mild
    2. Moderate
    3. Severe
    4. Cannot be calculated based on data given



  9. In a patient with isolated aortic regurgitation (AR), the following measurements were obtained: transmitral flow 80 cm3/beat, flow across aortic valve 140 cm3/beat, TVI of AR signal 100 cm. How would you describe the AR in this patient?



    1. Mild
    2. Moderate
    3. Severe
    4. Cannot be determined



  10. The presence of severe AR in a patient with mitral stenosis (MS) is likely to do which of the following to the calculated mitral valve area by the pressure half-time method?



    1. Overestimate the valve area
    2. Underestimate the valve area
    3. Have no effect



  11. What is this patient in Figure 5.11 likely to have?



    1. Severe AS
    2. Severe MR
    3. Severe pulmonary hypertension
    4. Mild AS
    Photograph shows echocardiography frame with several markings like gain 50 comp, echo lab, 1.8MHZ, delay 1, et cetera.

    Figure 5.11




  12. For the patient in question above, the LVOT diameter was 2 cm and the LVOT velocity by pulse Doppler was 1 m/s. What is the aortic valve area by the continuity equation?



    1. 0.2 cm2
    2. 0.3 cm2
    3. 0.5 cm2
    4. 0.8 cm2



  13. Figure 5.13 is the continuous wave signal obtained from the pulmonary valve at the mid to proximal esophageal location. What is this patient likely to have?



    1. Wide-open pulmonary regurgitation (PR)
    2. Mild PR
    3. Severe valvular pulmonary stenosis (PS)
    4. Severe subvalvular PS
    Photograph shows echocardiagraphy frame of continuous wave signal from pulmonary valve at mid to proximal location.

    Figure 5.13




  14. The pulmonary vein flow shown in Figure 5.14 is indicative of what?



    1. Elevated LA pressure with normal end diastolic pressure (EDP)
    2. Elevated LA pressure with elevated EDP
    3. Abnormal LV relaxation with normal EDP
    4. Elevated LV EDP with normal LA pressure
    Photograph shows echocardiagraphy frame of patient’s pulmonary vein flow.

    Figure 5.14




  15. The mitral flow pattern shown in Figure 5.15 is suggestive of what?



    1. Normal LA pressure
    2. High LA pressure
    3. Atrial mechanical failure
    4. Abnormal LV relaxation with normal LA pressure
    Photograph shows echocardiagraphy frame of patient’s mitral flow pattern.

    Figure 5.15




  16. What condition does the patient in Figure 5.16 have?



    1. Mitral atresia
    2. Tricuspid atresia
    3. Transposition of great vessels with atrial baffle
    4. Epstein’s anomaly
    Photograph shows echocardiagraphy frame of patient having one of mitral atresia, tricuspid atresia, transposition of vessels, and Epstein’s anomaly.

    Figure 5.16




  17. Which of the following does the patient in Figure 5.17 have?



    1. Prominent Eustachian valve
    2. Ostium secundum ASD
    3. Ostium primum ASD
    4. Sinus venosus ASD
    Photograph shows echocardiagraphy frame of patient having one of prominent Eustachian valve, ostium secundum ASD, ostium premium ASD, and sinus.

    Figure 5.17




  18. What type of flow was recorded from the mid-esophageal position in Figure 5.18?



    1. Mitral flow
    2. Pulmonary vein flow
    3. Superior vena cava flow
    4. Flow across ASD
    Photograph shows echocardiagraphy frame of patient’s mid-esophageal position flow.

    Figure 5.18




  19. The patient in Question 5.17 with secundum ASD has ASD dimensions of the defect 3 cm × 2 cm, TVI of flow across the defect is 39 cm, and heart rate of 70/s. What is the approximate shunt flow across the ASD?



    1. 12.8 L/min
    2. 3 L/min
    3. 7 L/min
    4. Cannot be calculated



  20. What is the cause of the patient’s mitral valve problem shown in Figure 5.20?



    1. Rheumatic heart disease
    2. Degenerative valve disease
    3. Fen–phen valvulopathy
    4. Ischemic heart disease
    Photograph shows echocardiagraphy frame of patient having mitral valve problem.

    Figure 5.20




  21. Figure 5.21 shows a patient that may have all of the following except what?



    1. Atrial septal defect
    2. Wolf–Parkinson–White syndrome
    3. TR
    4. Bicuspid aortic valve
    Photograph shows echocardiagraphy frame of patient having atrial septal defect, wolf-Parkinson-white syndrome, TR, and bicuspid aortic valve.

    Figure 5.21




  22. The M-mode echocardiogram in Figure 5.22 is suggestive of what?



    1. Normal mitral valve motion
    2. MS
    3. Severe AR
    4. High LA pressure
    Photograph shows echocardiagraphy frame of patient’s M-mode echocardiogram.

    Figure 5.22




  23. What is the image shown in Figure 5.23 suggestive of?



    1. Mitral annuloplasty
    2. Catheter in the coronary artery
    3. Biventricular pacemaker or implantable cardioverter-defibrillator (ICD)
    4. An artifact
    Photograph shows echocardiagraphy frame of patient where green+E129 arrow pointing from left to right in middle.

    Figure 5.23




  24. What is the structure denoted by the arrow in Figure 5.24?



    1. LA appendage
    2. Left lower pulmonary vein
    3. Left upper pulmonary vein
    4. Right lower pulmonary vein
    Photograph shows echocardiagraphy frame of patient where green arrow points from bottom to top in middle.

    Figure 5.24




  25. The patient shown in Figure 5.25 has what condition?



    1. Valvular AS
    2. Subvalvular AS
    3. Endocarditis
    4. Hypertrophic obstructive cardiomyopathy (HOCM)
    Photograph shows echocardiagraphy frame of patient having one of valvular AS, subvalvular AS, endocarditis, and hypertrophic.

    Figure 5.25




  26. The cause of dyspnea in the patient in Figure 5.26 is likely to be due to what?



    1. Left heart failure
    2. Primary pulmonary hypertension
    3. Chronic obstructive pulmonary disorder
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having dyspnea along with its cause.

    Figure 5.26




  27. Figure 5.27 shows an end systolic frame in a patient with shortness of breath. What is the most likely diagnosis?



    1. Ebstein’s anomaly
    2. Hypertrophic cardiomyopathy
    3. ASD
    4. Dilated cardiomyopathy
    Photograph shows echocardiagraphy frame of patient having shortness of breath.

    Figure 5.27




  28. What is the most likely mechanism of MR in the patient in Figure 5.28?



    1. P2 tethering
    2. P2 prolapse
    3. Bileaflet mitral valve prolapse
    4. None of the above
    Photograph shows echocardiagraphy frame of patient where marking for CM/S is seen with range 49.

    Figure 5.28




  29. A 19-year-old patient was stabbed in the precordial area. Examination revealed a loud systolic murmur (Figure 5.29). What is the most likely cause of this murmur?



    1. Penetrating injury to the interventricular septum
    2. Mitral valve prolapse
    3. HOCM
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having loud systolic murmur.

    Figure 5.29




  30. What is the continuous-wave Doppler signal in Figure 5.30 suggestive of?



    1. AS and AR
    2. MS and MR
    3. VSD flow
    4. Aortic flow in a patient with coarctation
    Photograph shows echocardiagraphy frame of patient’s continuous-wave Doppler signal with several markings.

    Figure 5.30




  31. The continuous wave signal in Figure 5.31 was obtained from the mid-transesophageal location. What is it indicative of?



    1. AS and AR
    2. MS and MR
    3. VSD flow
    4. None of the above
    Photograph shows echocardiagraphy frame of patient’s continuous-wave Doppler signal from transesophageal location.

    Figure 5.31




  32. Figure 5.32 shows a TEE image from the mid-esophagus of a late diastolic frame of the aortic valve. What is this patient most likely to have?



    1. Severe AR
    2. Severe AS
    3. HOCM
    4. Ascending aortic dissection
    Photograph shows echocardiagraphy frame and TEE image from mid-esophagus with late diastolic frame.

    Figure 5.32




  33. What is the patient in Figure 5.33 most likely to have?



    1. Acute severe MR
    2. Chronic severe MR
    3. Severe MS and mild MR
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having one of acute severe MR, chronic severe MR, severe MS and mild MR.

    Figure 5.33




  34. The patient in Figure 5.34 had Staphylococcus aureus endocarditis of the aortic valve. What is the most likely cause?



    1. Central venous catheter-associated infection
    2. Dental work
    3. Immunosuppressed state
    4. Intravenous drug use
    Photograph shows echocardiagraphy frame of patient who had staphylococcus aureus endocarditis.

    Figure 5.34




  35. What is the image of the aortic valve in Figure 5.35 suggestive of?



    1. Aortic valve vegetation
    2. Node of Arantius
    3. Lambl’s excrescences
    4. Ascending aortic dissection causing prolapse of the noncoronary cusp
    Photograph shows echocardiagraphy frame of patient’s aortic valve.

    Figure 5.35




  36. What is the most likely cause of the signal shown in Figure 5.36?



    1. HOCM
    2. Critical valvular AS
    3. Acute MR
    4. None of the above
    Photograph shows echocardiagraphy frame with signal which cause one of HOCM, critical valvular AS, acute MR.

    Figure 5.36




  37. What is the image shown in Figure 5.37 suggestive of?



    1. Bioprosthetic tricuspid valve
    2. Carcinoid valvulopathy of tricuspid valve
    3. Tricuspid annuloplasty ring
    4. Large tricuspid vegetation
    Photograph shows echocardiagraphy frame of patient having one of bioprosthetic, carcinoid, tricuspid, and large tricuspid valve.

    Figure 5.37




  38. What is the 65-year-old patient with MR in Figure 5.38 likely to have?



    1. An opening snap
    2. Third heart sound
    3. Fourth heart sound
    4. Summation gallop
    Photograph shows echocardiagraphy frame of patient having MR with opening snap, third heart sound, fourth heart sound, and summation gallop.

    Figure 5.38




  39. What is the continuous-wave Doppler signal in Figure 5.39 consistent with?



    1. Critical AS
    2. Severe MR
    3. Maladie de Roger
    4. None of the above
    Photograph shows echocardiagraphy frame of patient’s continuous-wave Doppler signal.

    Figure 5.39




  40. The TR signal in Figure 5.40 was obtained from TEE. The clinically estimated right atrial (RA) pressure in this patient was 20 mmHg and there is no PS. What would the PA systolic pressure in this patient be?



    1. 30 mmHg
    2. 50 mmHg
    3. 80 mmHg
    4. Cannot be calculated
    Photograph shows echocardiagraphy frame of patient’s TR signal having TEE having pressure.

    Figure 5.40




  41. What condition is the patient in Figure 5.41 likely to have?



    1. Acute severe AR
    2. Mild AR
    3. MS
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having one of acute severe AR, MS, and mild AR.

    Figure 5.41




  42. The transmitral flow in Figure 5.42 is obtained from the esophageal transducer location from a patient with Staphylococcus aureus bacteremia and acute hemodynamic decompensation. The patient is in sinus rhythm. What is the most likely cause of his decompensation?



    1. Acute MR
    2. Acute AR
    3. Rupture of the ventricular septum
    4. None of the above
    Photograph shows echocardiagraphy frame of patient’s transmitral flow from esophageal transducer location of patient.

    Figure 5.42




  43. The pulse-wave Doppler flow signal in the descending thoracic aorta on a TEE shown in Figure 5.43 is indicative of what?



    1. Coarctation of the aorta
    2. Middle aortic syndrome
    3. Severe AR
    4. HOCM
    Photograph shows echocardiagraphy frame of patient’s pulse-wave Doppler flow having descending thoracic aorta.

    Figure 5.43




  44. What is the likely cause of heart failure in the 30-year-old man shown in Figure 5.44?



    1. Noncompaction of the left ventricle
    2. Hemochromatosis
    3. Cardiac amyloid
    4. Hypertrophic cardiomyopathy
    Photograph shows echocardiagraphy frame of patient having heart failure.

    Figure 5.44




  45. What is the structure indicated by the arrow in Figure 5.45?



    1. IVC–RA junction
    2. Superior vena cava
    3. Anomalously draining right upper pulmonary vein
    4. ASD
    Photograph shows echocardiagraphy frame of patient where green arrow points from bottom to top in left side.

    Figure 5.45




  46. What is the approximate MR flow rate of the patient in Figure 5.46 (PISA radius of 0.9 cm, aliasing velocity of 38 cm/s)?



    1. ∼200 cm3/s
    2. ∼200 cm3/min
    3. ∼100 cm3/min
    4. ∼100 cm3/s
    Photograph shows echocardiagraphy frame of patient having MR flow rate of approximately 200 cm3/s, 100 cm3/s, 200 cm3/min, and 100 cm3/s.

    Figure 5.46




  47. What is the likely diagnosis of the patient in Figure 5.47?



    1. An early diastolic murmur
    2. Late-peaking systolic ejection murmur with absent A2 component of S2
    3. Late-peaking systolic murmur increased by Valsalva’s maneuver and normal A2
    4. Mid-diastolic murmur
    Photograph shows echocardiagraphy frame of patient having one of diastolic murmur, systolic ejection, systolic murmur, and mid-diastolic murmur.

    Figure 5.47




  48. What is the most likely diagnosis of the patient in Figure 5.48?



    1. HOCM
    2. Severe AS
    3. Mitral valve prolapse
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having one of HOCM, severe AS, and mitral valve prolapse.

    Figure 5.48




  49. What is the most likely diagnosis of the patient in Figure 5.49?



    1. Apical HOCM
    2. Hypertensive heart disease
    3. Endomyocardial fibrosis
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having one of apical HOCM, hypertensive heart disease, endomyocardial fibrosis.

    Figure 5.49




  50. The appearance of the atrial septum in the patient in Figure 5.50 is due to what?



    1. ASD repair with a pericardial patch
    2. ASD closure device
    3. PFO closure device
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having atrial septum.

    Figure 5.50




  51. What does Figure 5.51 show?



    1. Normal native tricuspid valve
    2. Normal bioprosthetic valve
    3. Vegetation on a bioprosthetic valve
    4. Avulsion of the tricuspid valve
    Photograph shows echocardiagraphy frame of patient having one of normal tricuspid valve, bioprosthetic valve, vegetation on bioprosthetic, and avulsion.

    Figure 5.51




  52. A 31-year-old woman with no other medical history had two episodes of transient ischemic cerebral attacks, the first one after a long duration of air travel and the second one during straining in the rest-room. From the TEE image in Figure 5.52, what is the most likely cause of this patient’s attacks?



    1. Paradoxical embolism
    2. Vagally mediated atrial fibrillation
    3. LA thrombus
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having two episodes of transient ischemic cerebral attacks.

    Figure 5.52




  53. A 35-year-old patient with AIDS and bicuspid aortic valve has Staphylococcus bacteremia. What is the parasternal long-axis color flow image in Figure 5.53 suggestive of?



    1. Right coronary artery flow
    2. Pulmonary vegetation
    3. Fistulous communication between aorta and right ventricle
    4. None of the above
    Photograph shows echocardiagraphy frame of patient having AIDS and bicuspid aortic valve.

    Figure 5.53

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Apr 23, 2020 | Posted by in CARDIOLOGY | Comments Off on Echocardiography

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