Echo Final Deck 2

What degree of mitral regurgitation should be considered when systolic flow reversal is noted in the pulmonary veins?

Which of the following statements are TRUE regarding patients with coarctation of the aorta?
A. Lower extremity blood pressures are usually increased as compared to the arm blood pressure

B. Lower extremity blood pressures are usually decreased as compared to the arm blood pressure.
C. The arm blood pressure should be obtained from the patient's right arm.
D. The arm blood pressure should be obtained from the patient's left arm.
E. B, C

F. A, D

Which of the following is a finding of patients with mitral stenosis?

A. Flattening of the E-F slope in M-mode

B. "Hockey stick" appearance of the anterior mitral valve leaflet in 2D

C. "Candle-flame" appearance across the valve in color Doppler

D. All of the above are findings

Cardiac output/body surface area is the calculation for ______?

Where is the most common site for calcifications of the mitral valve annulus to form?

What affect can mitral regurgitation have on the E/A ratio obtained during a Doppler examination?

Which of the following statements is true regarding exercise echocardiography?
A. Exercise echocardiography may be performed after treadmill
B. Exercise echocardiography may be performed during supine bicycle exercise
C. Exercise echocardiography may be performed during upright bicycle exercise
D. Exercise echocardiography should not be performed using bicycle exercise
E. A, B, C
F. A and D

When performing exercise echocardiography, the imaging is most accurate when it is obtained within the first?
A. 5 minutes

B. 3 minutes

C. 4 minutes

D. 1 minute

Which two echocardiographic findings are associated with a right ventricular volume overload (RVVO) pattern?

A parabolic flow profile can be described as?

What is the normal resting cardiac output?

What artery perfused the interventricular septum and the apex of the heart?

Which two valvular diseases will present with a right ventricular volume overload (RVVO) pattern?

The sinus venous, cardiac loop, and the aortic and brachial arches are portions of the?

What nerve supplies the fibers for the SA node and control the heart rate?

The left and right bundle branches divide and sub-divide into the ______?

All of the following statements regarding cardiac myxomas are true except ______?
A. Patients may present with symptoms of chest pain
B. Patients may present with symptoms of weakness or fatigue
C. Patients may have an embolism(s)
D. The most common location for a myxoma is in the left ventricle

How many vessels drain into the right atrium?

The principle of the conservation of mass forms the basis for what equation?

What is the characteristic triad of findings that the clinical diagnosis of pericarditis is made from ______?

What are the 4 main categories of etiologies of pericarditis?

What is the most common primary valvular tumor of the heart?

When evaluating a patient with a large pericardial effusion and suspected cardiac tamponade, inferior vena cava plethora is an indication of?

A. Elevated left atrial pressure

B. Elevated left ventricular pressure

C. Elevated right atrial pressure

D. Normal pressures in the cardiac chambers

Which pathology is associated with the "dumb-bell" appearance of the interatrial septum?

What is Lutembacher's syndrome?

What conditions are responsible for the highest incidence of left atrial thrombus?

Which one of the following is NOT a primary, benign adult cardiac tumor?

A. Myxoma

B. Lipoma

C. Angiosarcoma

D. Hemangioma

What type of cancer has the highest rate of metastases to the pericardium?

What condition is most commonly associated with a sinus of Valsalva aneurysm?

Which of the following statements is NOT true regarding patients with a suspected restrictive cardiomyopathy?

A. Concentric LVH may be present

B. An outflow tract obstruction is typically present

C. Left ventricular diastolic function is abnormal

D. Right ventricular hypertrophy may be present

Inhaling amyl nitrate may cause a sub aortic stenosis to increase. TRUE or FALSE

In the absence of a right ventricular outflow tract obstruction, the right ventricular systolic pressure (RVSP) equals the?

Right coronary artery dominance happens in about 80% of cases and is when the RCA gives rise to which coronary artery?

Which ventricular septal defect would you visualize in the parasternal short axis view at the aortic valve area in the 12-3 o'clock position?

Sinus solitus refers to ______?

What are the typical changes seen on the electrocardiogram of a patient with an increase in ventricular muscle mass (hypertrophy)?

S4, or the fourth heart sound, can be described as?

When a cardiac murmur is detected, it is graded on a scale of 1-6. A 4/6 systolic murmur along the lower left sternal border accompanied by a palpable "thrill" would indicate a(n)?

Which ONE of the following statements is false regarding the Doppler waveform and flow velocity findings in a patient with mild diastolic dysfunction:
A. The isovolumic relaxation time is < or = 110 msec

B. The E velocity is low and the A velocity is high

C. The deceleration time is > or = 240 msec

D. The E/A ratio is < 1.0

Which of the following is NOT a view that can be used to obtain a continuous wave Doppler tracing from the ascending aorta?

A. Suprasternal

B. Right parasternal

C. Parasternal short axis

D. Apical five chamber

A congenital anomaly of the mitral valve in which there is two mitral valve leaflets but only one papillary muscle to attach to is called ______?

Which of the following is the least likely cause of calcification of the mitral valve annulus?

A. Metabolic disease

B. Aging

C. Hypertension

D. Pulmonic stenosis

CSA (cm2) x VTI (cm) =

Which of the following is NOT considered an origin of mitral valve prolapse?

A. Pulmonary disease

B. Ischemic heart disease

C. Valvular heart disease

D. Myocardial disease

In severe cases of aortic stenosis, the aortic root may:

A. Decrease in size

B. Dilate

C. Hypertrophy

D. Decrease in echogenicity

An ausculatory finding in tricuspid stenosis of an increase in intensity of the diastolic murmur with inspiration is referred to as:

A. DeRosier's sign

B. Carvallo's sign

C. Murphy's sign

D. Ebstein's sign

What is the least likely region for pulmonic stenosis to occur in a patient with Tetralogy of Fallot?

A. Infundibulum
B. Pulmonic valve
C. Pulmonic trunk
D. Subinfundibular

Which of the following is NOT a cause of mechanical valve failure?

A. Pannus ingrowth
B. Valve tears
C. Bad design
D. Loss of sutures around the sewing ring

Of the following, which is the primary feature on the echocardiogram of a left bundle branch block?
A. Upward movement of the inter ventricular septum at the onset of electrical depolarization

B. Downward movement of the interventricular septum at the end of the electrical depolarization

C. Downward movement of the interventricular septum at the onset of electrical depolarization

D. Flattening of the interventricular septum

When the aortic valve is measured from its initial opening to its closing, what calculation is being performed?

A. Wall stress
B. Ejection fraction
C. Left ventricular ejection time
D. Stroke volume

What are the indications for contrast to be added to an echocardiographic study?

Which one of the following statements is NOT true regarding harmonic tissue imaging?
A. Harmonic tissue imaging requires a high mechanical index

B. Harmonic imaging of bubbles requires a low mechanical index

C. Harmonic tissue imaging may make valves appear thinner than what they really are

D. Harmonic tissue imaging is an excellent method when performing stress echocardiography

Which one of the following statements is NOT true regarding the use of tissue Doppler in echocardiography?

A. It is used to quantitate wall motion
B. It is used to assess systolic function
C. It is used to assess diastolic function
D. It is used to determine valve orifice

The appearance of contrast in the left heart after a peripheral venous injection is diagnostic of a:

A. Right to left shunt

B. Left to right shunt

C. High grade stenosis of the aortic valve

D. High grade stenosis of the mitral valve

The appearance of contrast in the right heart following a direct left-sided pulmonary venous, or capillary wedge injection indicates:
A. Severe systemic hypertension
B. A left to right shunt
C. A right to left shunt
D. Severe pulmonary hypertension

What are the three major levels of shunting typically detected using peripheral venous injections?

The term "situs inverses" refers to ______?

After determining unresponsiveness in an adult victim, the first action a rescuer should take is:
A. Start CPR immediately

B. Find a partner and start CPR immediately

C. Activate Emergency medical services (call 911)

D. Perform a finger sweep of the patient's mouth

To check the pulse on an adult victim, the rescuer should palpate the?

A. Brachial artery

B. Radial artery

C. Carotid artery

D. Subclavian artery

The rate of compression during CPR on an adult should be:

A. 80 per minute

B. 100 per minute

C. 120 per minute

D. Rate doesn't matter

What type of atrial septal defect may be associated with abnormal drainage of the right pulmonary vein?

A. Ostium primum

B. Sinus venosus

C. Ostium secundum

D. Ostium sinus

What calculation is used to determine the pulmonary to systemic shunt ratio?

A. Dp/dt
B. CSA
C. Qp/Qs
D. SV/CO

Which leaflet of the tricuspid valve is usually least affected by Epstein's anomaly?

A. Septal
B. Posterior
C. All leaflets are affected the same
D. Anterior

What is the most common type of ventricular septal defect?

A membranous VSD, a large overriding aorta, and a right ventricular outflow tract obstruction are findings in what type of congenital abnormality?

A shunt from a patent ductus arteriosus will be noted from the ______ to the ______?

Which one of the following syndromes has a high association with endocardial cushion defects?

A. Down's syndrome

B. Marfan's syndrome

C. Eagle-Barrett syndrome

D. Fitz-Hugh Curtis syndrome

Which of the following tumors invade the heart via extension through the IVC?
A. Renal cell carcinoma
B. Rhabdomyoma
C. Wilm's Tumor
D. Teratoma
E. A and C
F. B and C

One of the most likely sources for a thrombus in the right side of the heart is ______?

What is the most common tumor found in children?

What type of tumor occurs on the AV node?

What valve is most commonly affected after a myocardial infarction?

The basal LV is divided into ______ segments of ______ degrees each.

What is the normal range for the diameter of the left ventricular posterior wall in diastole?

The mid LV cavity is divided into ______ segments of ______ degrees each.

The apical LV is divided into ______ segments of ______ degrees each.

What is the apical cap?

The wall of the heart is composed of three distinct tissue layers. Name and describe them.

Which LV walls are seen in the apical long-axis view?

The Valsalva maneuver ______ venous return to the right heart.

A. Decreases

B. Stops

C. Increases

D. Doubles

Improper setting (too high) of the mechanical index, will cause what artifact when using ultrasound contrast agents?

A. Swirling
B. Attenuation
C. No contrast effect
D. None of the above

Besides the mechanical index, what other system control can potentially cause microbubble destruction?

A. Dynamic range
B. Overall gain
C. TGC
D. Focus

What will occur as a result of using multiple focal zones?

A. Frame rate decreases

B. Reduces dynamic range

C. Increases frequency

D. Decreases compression

If the sonographer wants to improve temporal resolution, this can be accomplished by:
A. Using a shallower image depth

B. Decreasing the sector width

C. Increasing the frequency

D. Both A and B

E. Both B and C


Lowering the mechanical index is required when using transpulmonary contrast agents. This is accomplished by:

A. Decreasing frequency

B. Decreasing output power

C. Increasing dynamic range

D. Increasing compression

What is the function of the receiver gain?

To correct a swirling artifact from contrast, you can:


A. Increase the amount of contrast

B. Decrease the mechanical index

C. Reposition the focal point

D. All of the above


Attenuation is one of the most common artifacts when using ultrasound contrast. This is usually a result of:
A. Rapid administration

B. Low concentration

C. Low mechanical index setting

D. Improper focal zone placement

What are the risks of esophageal intubation associated with a TEE?

The role of the sonographer during TEE includes all of the following except:

A. Preparing the patient

B. Monitoring the patient

C. Assisting with ultrasound equipment

D. Inserting the probe

M-mode displays ______ on the horizontal axis.

A. Length
B. Area
C. Time
D. Depth

Increasing the depth of the image ______ the frame rate.

A. Increases

B. Decreases

C. Doubles

D. Does not affect

In order to increase the depth of penetration, one would:

A. Decrease sector width

B. Decreased transducer frequency

C. Increase Dynamic range

D. Increase transducer frequency

Post processing of the ultrasound single is performed ______ image storage.

A. Before

B. During

C. After

D. All of the above

In order to increase axial resolution, one would:

A. Increase transducer frequency

B. Increase depth

C. Decrease transducer frequency

D. Decrease sector width

What is the most common reason for a papillary muscle rupture?

A "spanish notch" is visualized with which pathology?

Which organs in the body are the most affected by systemic hypertension?

What are the types of ventricular hypertrophy?

What are the reasons that a sonographer might get a false positive for pericardial effusion?

In constrictive pericarditis, the most characteristic finding is:

What is the purpose of the pericardium?

A. Minimize friction

B. Provide protection

C. Keep heart contained in chest cavity

D. All of the above

How is pulmonary hypertension diagnosed by Doppler echocardiography?

What are the most common secondary findings on the 2D echocardiogram in a patient with pulmonary hypertension?

Pulmonary artery flow patterns recorded in patients with pulmonary hypertension demonstrate:
A. A late onset of flow
B. An early peak velocity
C. An abrupt reduction of flow in mid-systole (notching)
D. All of the above

In the absence of pulmonic stenosis, RV systolic pressure should be equivalent to:

A. PA systolic pressure

B. PA diastolic pressure

C. Systemic pressure

D. None of the above

What are the three most common types of cardiomyopathy?

What are the most common causes of dilated cardiomyopathies?

What is/are the most common 2D echo feature(s) of dilated cardiomyopathy?

A. Dilated LV cavity

B. Decreased global systolic function

C. Increased LV mass

D. All of the above

What are the most common M-mode echo-features of a dilated cardiomyopathy?

Restrictive cardiomyopathy is characterized by mitral inflow velocities that show:

A. Increased E velocity

B. Decreased A velocity

C. Shortened deceleration time

D. All of the above

The echocardiographic features listed below most likely represent which form of cardiomyopathy?

-LV hypertrophy
-Hypertrophy of other cardiac structures including intertribal septum
-"Granular sparkling" appearance of ventricular myocardium
-Normal or small-sized ventricles with dilated atria

What are the most common etiologies of hypertrophic cardiomyopathy?

What are the common 2D features of hypertrophic cardiomyopathy?

What are the common Doppler features of hypertrophic cardiomyopathy?

What are the provocative maneuvers used in patients with hypertrophic cardiomyopathy?

What is the most likely cause for a reduced dP/dt?

RV infarction occurs most commonly when there is an occlusion of which coronary artery?

Which view is best for assessing RV infarction?

A. Parasternal long-axis

B. Parasternal short-axis

C. Apical 4-chamber

D. Apical long-axis

The ability of the RV to pump equivalent cardiac output as the LV is due to:

Besides myocardial infarction, other causes of segmental LV dysfunction include:

The rate of LV pressure change during the isovolumic contraction period is called ______.

Approximately what percentage of primary cardiac tumors are benign?
A. 25%

B. 50%
C. 75%

D. 100%

Where are myxomas most commonly found?

Describe the echocardiographic features of papillary fibroelastomas.

What is the vena contracta?

How can you differentiate Lambl's excrescences from papillary fibroelastomas by echocardiography?

What is the most common echocardiographic finding in metastatic disease?

A. Pericardial effusion
B. Left ventricular hypertrophy
C. Right ventricular enlargement
D. Mitral insufficiency

List some normal anatomic variants that can be confused with cardiac tumors.

Paradoxical septal motion on the m-mode echocardiogram is most commonly seen with:

A. Right ventricular volume overload
B. Left ventricular volume overload
C. Right ventricular pressure overload
D. Left ventricular pressure overload

Right ventricular volume overload is commonly seen with:

A. Ventricular septal defects

B. Pulmonary stenosis

C. Mitral insufficiency

D. Atrial septal defects

What is afterload?

What are the four types of pulmonary stenosis?

What is the most common cause of pulmonic stenosis?

Secondary findings on the echocardiogram in a patient with pulmonic stenosis may include:

A. Left ventricular hypertrophy

B. Left atrial enlargement

C. Right ventricular hypertrophy

D. All of the above

What congenital anomaly produces an "hourglass" deformity of the ascending aorta?

A. Bicuspid aortic valve
B. Supravalvular aortic stenosis
C. Coarctation of the aorta
D. Tetralogy of Fallot

Name the types of atrial septal defects.

Which ASD is most commonly associated with endocardial cushion defect?

What is Qp/Qs?

What echocardiographic feature(s) is/are associated with ASD?

A. Right ventricular volume overload

B. Left ventricular volume overload

C. Left ventricular volume overload

D. All of the above

What is the Myocardial Performance Index?

How is contrast (agitated saline) used to detect an atrial septal defect?

Inlet VSD's are best seen in which view.

A. Apical 4-chamber

B. Apical 2-chamber

C. Apical 5-chamber

D. Apical long-axis

Muscular VSD's are best seen in which view:

A. Parasternal long-axis

B. Parasternal short axis

C. Apical 4-chamber

D. Apical 5-chamber

Describe the hemodynamics associated with a ventricular septal defect.

What are the two types of congenital subaortic stenosis?

Name the three layers of the artery wall.

Describe the difference between a true aneurysm and pseudoaneurysm.

Aortic aneurysms are classified by:

A. Shape

B. Location

C. Cause

D. All of the above

A fusiform aneurysm:

A. Involves only the adventitia

B. Involves the entire circumference

C. Is a form of dissecting aneurysm

D. Separates the intima and media

What are the common etiologies for aortic aneurysm?

Where is the most common site for an aortic aneurysm?

A. Ascending thoracic aorta

B. Descending thoracic aorta

C. Aortic arch

D. Abdominal aorta

What shape are most aortic aneurysms?

Where is the most common site for coarctation?

A. Ascending aorta

B. Aortic arch

C. Descending aorta

D. Abdominal aorta

What is the most common congenital anomaly associated with coarctation?

A. Bicuspid aortic valve

B. Ventricular septal defect

C. Atrial septal defect

D. Tricuspid atresia

What are the causes of sinus of Valsalva aneurysm?

What are the pitfalls in using the modified Bernoulli equation?

What is the continuity equation?

What is PISA?

"Switching" can occur at three levels. They are:

In laminar flow, the velocity of blood is:

A. Lowest in the center of the vessel

B. Lowest at the vessel wall

C. Highest at the vessel wall

D. Directly proportional to the vessel diameter

The Doppler angle yielding the highest Doppler shift is:

A. 0˚

B. 60˚

C. 90˚

D. 180˚

Continuous wave Doppler:

A. Provides information on depth
B. Cannot measure high velocities
C. Does not alias
D. All of the above

Gating determines the:

A. Sample volume length
B. Doppler frequency
C. Frame rates
D. Aliasing velocity

The highest blood flow velocities present can be best evaluated by:

A. Color Doppler

B. Pulsed wave Doppler

C. Continuous wave Doppler

D. High PRF Doppler

Theta is the angle between ______ and ______.

The Nyqvist limit ______ when the sample volume is placed at 12 cm than when at 4 cm (implying transducer frequency is unchanged).

A. Does not change

B. Is lower

C. Is higher

D. None of the above

List some of the common indications/objectives for stress echocardiography.

When performing treadmill stress echocardiography, post exercise imaging must be accomplished within:

A. 5 minutes

B. 3 minutes

C. 90 seconds

D. 30 seconds

How would you calculate the target heart rate for a pharmacologic stress echocardiogram?

Name the stress modalities used for stress echocardiography.

Which protocol is most commonly used for treadmill stress echocardiography?

What are some endpoints of a stress echocardiogram?

List some of the contraindications for stress testing.

If a wall of the left ventricle was scored with a "2", that would mean the wall was _______.

A normal response to exercise is:

A. An increase in left ventricular contractility

B. A decrease in systolic wall thickening

C. Myocardial ischemia

D. Dyskinetic wall motion

Where is the SA node located?

What do the following waves represent on the ECG?

P wave
QRS complex
T wave

Propagation of the electrical signal from the AV node to the ventricles is provided by the:

Describe Frank-Starling law.

What is stroke volume?

Cardiac output equals:
A. Stroke volume x heart rate

B. End-diastolic volume - end-systolic volume

C. Left ventricular end-diastolic volume - left atrial end-diastolic volume

D. None of the above

What is isovolumic contraction?

What is isovolumic relaxation?

What is ejection fraction and what is a normal value?

What is S1?

What is S2?

What are the two main uses of Doppler in echocardiography?

What is the advantage of pulsed wave Doppler over continuous wave Doppler?

How can PA diastolic pressure be measured when pulmonic insufficiency is present?

What is the Doppler effect?

Describe laminar flow.

Describe the turbulent flow.

What is the main disadvantage of pulsed wave Doppler?

What is the main advantage and disadvantage of continuous wave Doppler?

All Doppler flow systems encode the directions of flow into two primary colors. What are they?