Instrumentation, optimization and contrast- 6%
When evaluating aortic regurgitation with CW Doppler in the apical view: · A. Set wall filter to the minimum level · B. Move the baseline to the top of the Doppler display · C. Set velocity scale so that the signal overfills the screen · D. Sweep speed set to 100mm/s
set sweep speed to 100mm/s
. Which of the following is usually better evaluated with Doppler than with a contrast exam? · A. thrombus formation in the left ventricular apex · B. shunt flow through a VSD · C. shunt flow through an ASD · D. persistent left SVC
shunt flow through vsd
Which imaging artifact is caused by non-specular reflections from a rough surface and wave interference? · A. speckle · B. multi-path · C. ghosting · D. misregistration
speckle
Which acoustic property causes the echogenic appearance of the pericardium related to surrounding structures? · A. refraction · B. non-specular reflection · C. specular reflection · D. attenuation
specular reflection
Which type of image resolution is negatively affected by the placement of multiple focal zones at the area of interest? · A. contrast · B. temporal · C. elevational · D. lateral
temporal
Which type of resolution improves with decreased image sector size? · A. temporal · B. contrast · C. elevational · D. axial
temporal
You suspect a calcification is present within the left ventricle. You activate Harmonics and add a focal zone to the field of view. Which type of resolution will degrade with these changes? · A. lateral · B. axial · C. temporal · D. contrast
temporal
The thickness of the interventricular septum will be best visualized when: · A. harmonics is turned off · B. the US beam is perpendicular to the long axis of the septum · C. the US beam is parallel to the long axis of the septum · D. the dynamic range is increased
the beam is perpendicular to the long axis of the septum
. A 27yr old patient presents for a follow up echocardiogram due to a history of a secundum ASD that was diagnosed two years ago. You are viewing the atrial septum in the subcostal view and apply color Doppler. No flow is detected across the septum. Which of the following could explain the lack of flow displayed across the defect? · A. The color Doppler map is inverted. · B. The color Doppler PRF is set too high. · C. PW Doppler is required to assess flow across the atrial septum because color Doppler is not well displayed in the subcostal view of the septum · D. Secundum ASDs commonly close spontaneously and the defect most likely has healed
the color doppler prf is set too high
The Doppler shift is: · A. the difference between the velocity of sound and the velocity of the blood flow · B. the amount of movement of blood flow that occurs each second · C. the difference between the speed of sound and the speed of the blood flow · D. the difference between the transmitted frequency and the reflected frequency.
the difference between the transmitted frequency and the reflected frequency
On an apical 4 chamber view, if you move the color Doppler sample box from the mitral level to the pulmonary veins, _______________. · A. the PRF increases · B. the sample size should be increased for better pulmonary venous flow evaluation · C. the frame rate decreases · D. temporal resolution will improve
the frame rate decreases
The pericardium can cause lobe artifact due to __________________________ · A. the high transmission rate of the beam through the tissue. · B. the close proximity to the diaphragm. · C. non-specular reflection of the smooth fibrous tissues. · D. the highly reflective nature of the tissue.
the highly reflective nature of the tissue
What effect will a mechanical index(MI) of 1.0 have on a contrast echo exam? · A. An MI setting of 1.0 or greater is preferred for contrast exams. · B. The increased beam intensity will burst the contrast bubbles quickly. · C. Mechanical index has no effect on contrast exams. The thermal index must be properly set for an optimal contrast exam. · D. The decreased beam intensity will reduce the appearance of the bubbles on the image.
the increased beam intensity will burst the contrast bubbles quickly
Increased overall gain levels on an ultrasound exam can cause ________________________. · A. underestimation of valve area on planimetry · B. increased posterior shadowing · C. myocardium to appear thinned · D. underestimation of Doppler velocity
underestimation of valve area on planimetry
How do you correct beam width artifact on a Doppler tracing? · A. use a smaller sample size · B. decrease the sweep speed · C. decrease the PRF · D. increase the incident angle of the Doppler cursor
use a smaller sample size
For optimal Doppler flow evaluation of the cardiac valves, a cursor angle of ____________ degrees should be used. · A. 0 · B. 45 · C. 60 · D. 90
0 degrees= parallel
All velocity and time interval measurements should be performed at a sweep speed of ___________ or greater. · A. 25 mm/s · B. 100 mm/s · C. 200 mm/s · D. 50 mm/s
100 mm/s
Frequencies used in transthoracic imaging are usually in the range of _______________. Frequencies used in transesophageal imaging are usually in the range of _______________. · A. 3-6MHz, 5-7MHz · B. 1-3MHz, 6-8MHz · C. 3-6MHz, 6-8MHz · D. 2.5-4MHz, 5-7MHz
2.504mhz, 5-7 mhz
A patient presents for an echocardiogram that is 6'3 and 320lbs. Which transducer would be the best transducer to use to perform the echo? · A. 4MHz · B. 5MHz · C. 2MHz · D. 3MHz
2mhz lower frequency=more penetration
Color scale settings should be set with a maximum velocity between ___________________cm/s for the routine echo exam. · A. 30 and 40 · B. 50 and 70 · C. 90 and 100 · D. 80 to 100
50-70
A 20yr old patient presents for an echocardiogram that is 5'3 and 110lbs. The exam is ordered to rule out sinus of Valsalva aneurysm. Which transducer would be the best transducer to use to perform the echo? · A. 4MHz · B. 1.75MHz · C. 5MHz · D. 2.5MHz
5mhz
The standard sector width for transthoracic echocardiography is: · A. 90 degrees · B. 180 degrees · C. 30 degrees · D. 60 degrees
60 degrees
. A Reynold's number ______________ indicates ________________. · A. >200, stenosis · B. >1.3, ventricular hypertrophy · C. >3.5, renal stenosis · D. >2000, turbulence
>2000, turbulence
Which of the following is best evaluated with perfluorocarbon contrast? · A. LVOT gradients · B. ASD · C. tricuspid regurgitation · D. VSD
LVOT gradients
Which of the following cardiac exam techniques provides the best spatial resolution of the cardiac structures? · A. resting echo with contrast · B. cardiac catheterization · C. transesophageal echo · D. stress echo
TEE
What is the major advantage of using color Doppler in transesophageal echo (TEE) evaluation of a prosthetic valve over color Doppler evaluation of the same valve on a transthoracic echo (TTE) exam? · A. TEE can identify paravalvular leakage which is usually very limited on a TTE. · B. TEE can identify turbulence caused by valvular stenosis which cannot successfully be diagnosed on TTE. · C. TEE can use color Doppler to assess the PISA radius of MR which is usually limited by valve masking on TTE. · D. TEE can identify valvular dehiscence while TTE usually cannot diagnose this abnormality with color Doppler.
TEE can identify paravalvular leakage which is usually very limited on a TTE
Which system control will simultaneously enhance far field echoes and diminish near field echoes? · A. overall gain · B. time gain compensation · C. rejection · D. threshold
TGC
If you increase the power output on the machine: · A. beam intensity and beam penetration increases · B. beam intensity and the magnitude of the Doppler shift increase · C. beam intensity, resolution and beam penetration increase · D. beam penetration and the magnitude of the Doppler shift increase
a beam intensity and beam penetration increases
Which of the following statements is true regarding the color flow evaluation of aortic stenosis? · A. The Reynold's number will be 1000-1500 in the area just distal to the stenosis. · B. When using a velocity map, aortic stenosis will cause a mosaic color pattern proximal to the stenosis. · C. A variance color map will demonstrate a green color in the aortic root, just distal to the stenosis · D. The greatest amount of turbulence seen with aortic stenosis is at the valve.
a variance color map will demonstrate a green color in the aortic root, just distal to the stenosis
Which of the following is an advantage of PW Doppler over CW Doppler? · A. ability to evaluate deeper flow patterns · B. not limited by PRF · C. no aliasing · D. ability to determine velocities at exact locations
ability to determine velocities at exact locations
While scanning in the apical 2 chamber view, you are trying to assess flow in a possible aneurysm in the thoracic aorta. Which of the following adjustments will assist in improving color flow in the aorta? · A. increase the color sample size · B. change the velocity color map to a variance map · C. activate the zoom function over the aorta · D. increase the wall filter setting
activate the zoom function over the aorta
While scanning an obese patient, you apply color Doppler to the mitral valve in the apical four chamber view. When you adjust the placement of the box, there is a delay between your adjustment and the box responding to the movement. How can you correct this? · A. switch to a higher frequency probe · B. activate the zoom function over the mitral valve · C. increase the sample size · D. decrease the color gain
activate the zoom function over the mitral valve
Which of the following would increase the frame rate? · A. increasing sector width · B. activating preprocessing zoom · C. adding a focal zone · D. increasing imaging depth
activating preprocessing zoom
Activating High PRF Doppler during evaluation of the LVOT velocity will cause the US system to: · A. reduce the Nyquist limit · B. switch to continuous wave Doppler · C. add a second PW Doppler sample volume · D. record the Doppler information faster
add a second PW Doppler sample volume
Harmonic imaging will: · A. allow for deeper penetration with improved lateral resolution · B. reduce the appearance of microbubble contrast on a contrast echo · C. degrade lateral resolution and improve axial resolution D. improve temporal resolution
allow for deeper penetration with improved lateral resolution
Contrast evaluation of the left heart can be used to differentiate: · A. aortopulmonary window from an outlet VSD · B. stunned endocardium from scar tissue · C. an LV aneurysm from an LV pseudoaneurysm · D. hibernating endocardium from scar tissue
an lv aneurysm from an lv pseudoaneurysm
At what point in the saline contrast echo will the patient perform the provocative maneuvers? · A. as soon as the contrast enters the right atrium · B. as soon as the contrast enters the left atrium · C. as soon as the contrast completely fills the right atrium · D. as soon as the contrast completely fills the left atrium
as soon as the contrast enters the right atrium
All of the following are advantages of contrast evaluation of shunt flow in the heart, except: · A. increases the strength of the Doppler signal displayed on the tracing · B. assists in proper placement of repair devices during corrective therapy · C. assists in proper placement of Doppler sample · D. aids in obtaining accurate velocity information across the defect
assists in proper placement of repair devices during corrective therapy
What console control does not change the amount or type of information displayed, only the perception of the images by viewer? · A. B-color · B. imaging depth · C. velocity scale · D. sector width
b-color
What acoustic artifacts can be mistaken for a vegetation on the native aortic valve? · A. side lobe · B. volume averaging · C. beam width · D. clutter
beam width
Which of the following statements best describes parabolic laminar flow? · A. Blood flow moves from an area of high pressure to low pressure. · B. Blood flow moves in layers that all move at the same speed. · C. Blood flow moves in layers with the highest velocity layer in the center of the vessel. · D. Small changes in vessel radius will cause significant changes in the resistance to flow.
blood flow moves in layers with the highest velocity layer in the center of the vessel
___________________ increases with increasing the overall gain. · A. The amount of attenuation · B. Image contrast · C. The amount of reflection · D. Brightness of the image
brightness of the image
Which of the following is a disadvantage of intracoronary ultrasound? · A. only allows for 90 degree imaging · B. cannot provide blood flow velocity information · C. high penetration but low resolution · D. can only be performed during open heart surgery
cannot provide blood flow velocity information
Which of the following correctly describes agitated saline contrast? · A. consists of a sodium chloride solution with bubbles small enough to easily pass through the pulmonary bed · B. consists of a nitrogen gas bubbles large enough to avoid passage through the pulmonary bed · C. consists of a sodium chloride solution with bubbles large enough to avoid passage through the pulmonary bed · D. consists of oxygen gas bubbles large enough to avoid passage through the pulmonary bed
consists of a sodium chloride solution with bubbles large enough to avoid passage through the pulmonary bed
Increasing the color Doppler sample size will __________________ the image frame rate. · A. decrease · B. increase · C. have no effect on D. only increase if you also decrease
decrease
Which of the following is related to degraded axial resolution on the image? · A. increase sector size · B. increase the number of focal zones · C. decrease in probe frequency · D. decrease imaging depth
decrease in probe frequency
Which of the following adjustments would improve the appearance of contrast on the echo image? · A. Use multiple focal zones · B. Turn off harmonic imaging · C. Increase the thermal index · D. Decrease output power
decrease output power
Which of the following adjustments will improve temporal resolution on color Doppler? · A. increase the wall filter · B. steer the sample box · C. increase color gain · D. decrease sample size
decrease sample size
Which of the following adjustments should be made to the Doppler settings when evaluating left ventricular inflow in a patient with constrictive pericarditis? · A. Decrease the sweep speed · B. Increase the sweep speed · C. Increase the PRF to demonstrate the expected E peak velocities greater than 2.0m/s · D. Decrease the PRF to demonstrate the expected low velocity peaks of the mitral waveform
decrease sweep speed
Increasing the imaging depth will: · A. decrease the pulse repetition frequency · B. increase the beam intensity · C. improve temporal resolution · D. decrease the pulse repetition period
decrease the PRF
While scanning the heart from the apical window, the ventricular chambers are anechoic but artifactual echoes appear to fill the atria. Which of the following adjustments of the system controls would best address this issue? · A. increase output power to increase penetration · B. decrease far field gain · C. decrease near field gain levels · D. switch to a higher frequency transducer
decrease the far field gain
. Increasing the imaging depth will: · A. decrease frame rate · B. increase the pulse repetition frequency · C. decrease the beam intensity · D. improve temporal resolution
decrease the frame rate
. You are performing an apical view during a microbubble contrast echo on a patient with suspected wall motion abnormalities in the basal anterolateral left ventricular segment. You notice significant swirling of the contrast in the area of the apex. How can you adjust the controls to reduce this artifactual swirling? · A. move the focal zone to the apex · B. turn off harmonic imaging · C. decrease the mechanical index setting · D. inject contrast at a faster rate
decrease the mechanical index setting
Which of the following adjustments will improve the temporal resolution on the image? · A. turning off the zoom function · B. turning on harmonic imaging · C. decreasing imaging depth · D. adding another focal zone
decreasing imaging depth
Which mode of US detects frequency shifts? · A. M mode · B. A mode · C. Doppler · D. B mode
doppler
Which of the following controls adjusts the number of shades of gray displayed of the 2D image? · A. output power · B. dynamic range · C. wall filter · D. monitor brightness
dynamic range
Which operator control can be used to adjust the image contrast? · A. dynamic range · B. overall gain · C. focal zone · D. output power
dynamic range
____________________ used to form the sector shaped field of view for a phased array transducer. · A. An acoustic lens is · B. Electronic steering is · C. Electronic focusing is · D. The curved arrangement of the elements are
electronic steering
Aliasing will occur when the Doppler shift ________________________. · A. exceeds twice the PRF · B. exceeds 1/2 PRF · C. is less than 1/2 PRF · D. is greater than the transducer frequency
exceeds 1/2 prf
Which of the following is a necessary machine setting when performing a contrast evaluation of the left ventricle to rule out thrombus? · A. Mechanical Index set to 1.0 or greater · B. Harmonic imaging off · C. Focal zone placement at the area of interest D. Low PRF color Doppler setting
focal zone placement at the area of interest
A high frame rate (≥30 frames per second) is preferred for cardiac imaging: · A. for accurate display of cardiac motion · B. because faster frames rates eliminate all acoustic artifacts · C. because faster frame rates improve penetration D. in order to reduce exam time and ultrasound exposure to the heart
for accurate display of cardiac motion
Harmonic imaging uses _______________________ to improve the image resolution by processing higher frequency reflections. · A. wave interference · B. frequency compounding · C. autocorrelation · D. apodization
frequency compounding
You are performing a bubble study to evaluate a patient with a possible pulmonary arteriovenous malformation(AVM). The standard echo demonstrates no shunt flow across the septum. Which of the following correctly describes what a positive study would demonstrate? · A. if bubbles are noted in the left atrium within three minutes of the injection, a pulmonary AVM is present · B. if bubbles are noted in the right atrium within four to eight cardiac cycles after the injection, a pulmonary AVM is present · C. if bubbles are noted in the left atrium within four to eight cardiac cycles after the injection, a pulmonary AVM is present · D. if bubbles are noted in the left atrium within 60 seconds of the injection, a pulmonary AVM is present
if bubbles are noted in the left atrium within 4-8 cycles after injection, a pulmonary avm is present
. Why is the temperature of the TEE probe monitored? · A. If the PE element is heated over 40 degrees Celsius it would cause the plastic housing to melt · B. If the PE element is heated over 40 degrees Celsius it would cause the element to lose its ability to produce soundwaves · C. If the PE element is heated over 40 degrees Celsius it would cause damage to the tissues of the esophagus/stomach · D. If the PE element is heated over 40 degrees Celsius it would cause the element to decrease the frequency of the soundwaves produced
if over 40 degrees celsius it could damage the esophagus/stomach
Why can't transesophageal probes be thermally sterilized? · A. because they do not detach from the ultrasound machine · B. if the probe is heated above the Curie temperature, the piezoelectric properties will be lost · C. because the electrical wiring cannot get wet · D. because the plastic components would probably melt
if the probe is heated above the curie temperature, the piezoelectric properties will be lost
Which of the following system settings should be kept the same during resting and stress images for a stress echo? · A. focal zone placement · B. overall gain · C. compression · D. image depth
image depth
Increasing transducer frequency will have what effect on scatter of the ultrasound beam? · A. no change · B. decrease · C. unable to answer without knowing how the elements are arranged and fired · D. increase
increase
Increasing the transducer frequency will: · A. improve temporal resolution · B. improve axial resolution but degrade lateral resolution · C. increase the Doppler shift detected D. decrease beam intensity
increase the doppler shift detected
Which of the following will improve the lateral resolution on the image? · A. decrease the PRF · B. adjust dynamic range · C. increase the focal zone number D. decrease transducer frequency
increase the focal zone number
While performing a Doppler evaluation of the aortic valve, a significant amount of wall motion artifact is displayed on the Doppler tracing. How can you eliminate the appearance of the artifactual information on the Doppler tracing while maintaining accurate display of the aortic waveform? · A. decrease the velocity scale · B. decrease the wall filter settings · C. decrease the Doppler gain · D. increase the high pass filter settings
increase the high pass filter settings
Which of the following will aid in visualization of the endocardium? · A. increased transducer frequency · B. larger sector size · C. decreased PRF · D. agitated saline contrast
increase the transducer frequency
The ____________________ of the signal displayed on CW Doppler is directly related to the severity of the regurgitation. · A. peak velocity · B. peak pressure gradient · C. size of the spectral window · D. intensity
intensity
The Doppler shift _____________________________ the blood flow velocity. · A. is always higher than · B. is always lower than · C. is directly proportional to · D. is indirectly proportional to
is directly proportional to
You suspect a calcification is present within the left ventricle. You activate Harmonics and add a focal zone to the field of view. Which type of resolution improves the most? · A. axial · B. contrast · C. elevational · D. lateral
lateral
Which of the following technical factors can negatively affect the 2D planimetry evaluation of the mitral valve? · A. transducer with a short spatial pulse length and high frequency · B. transducer with a short spatial pulse length and long wavelength · C. MVR valve masking and lateral resolution · D. lateral resolution and gain settings
lateral resolution and gain settings
Which of the following ultrasound techniques has the highest temporal resolution? · A. 2D imaging · B. 3D imaging · C. M-mode · D. Color Doppler
m-mode
______________ refers to shadowing caused by mechanical prosthetic valvular apparatus that inhibits flow display on a color Doppler image. · A. Ghosting · B. Masking · C. Reverberation · D. Clutter
masking
The coupling gel used for ultrasound exams provides the same function as what transducer component? · A. PE element · B. matching layer · C. backing layer · D. damping layer
matching layer
The ultrasound machine ___________________ the Doppler shift and ________________ the Doppler velocity. · A. measures, estimates · B. calculates, measures · C. measures, calculates · D. produces, evaluates
measures,calculates
Adjustment of which of the following imaging controls would be best to assist in improving visualization of the descending aorta posterior to the left atrium on an obese patient? · A. increase probe frequency · B. move focal zone to the level of the aorta · C. increase output power · D. use saline contrast injection
move the focal zone to the level of the aorta
. _________________ adjusts the brightness of the entire image, while ________________ adjusts the brightness of specific portions of the image. · A. monitor contrast, time-gain compensation · B. overall gain, output power · C. overall gain, time-gain compensation · D. post-processing, pre-processing
overall gain, TGC
Overgaining on an ultrasound exam can cause ________________________. · A. overestimation of valve area on planimetry · B. blood to appear anechoic · C. overestimation of Doppler velocity · D. increased posterior shadowing
overestimation of doppler velocity
Which of the following is an imaging technique that is not dependent on the angle of incidence of the sound beam? · A. Power Doppler · B. Speckle tracking · C. Color Doppler · D. CW Doppler
power doppler
. While scanning an echo, you change the gray map to a new choice and continue to scan. This would be termed a change in _____________________. · A. harmonic imaging · B. post-processing · C. pre-processing · D. bandwidth
pre processing
What type of magnification provides the highest frame rate and best image resolution? · A. complete · B. preprocessing · C. partial · D. postprocessing
preprocessing
The ultrasound system relies on the __________________________ for accurate recording of motion clips on an echo. · A. system timer to be set at 3 seconds · B. system timer to be set at 5 seconds · C. R wave and T wave on the EKG · D. QRS wave on the EKG
r wave and t wave on the ekg
Which of the following is a non-specular reflector that will scatter the sound waves? · A. The endocardium · B. The pericardium · C. The myocardium · D. Red blood cells
red blood cells
Which of the following describes a purpose for applying acoustic gel to the face of the transducer? · A. To increase the amount of reflection that occurs within the first 2cm of tissue · B. To reduce the beam intensity just before the sound beam enters the patient · C. To reduce the difference in impedance between the matching layer and the skin · D. To increase the amount of refraction that occurs within the first 2cm of tissue
reduce the difference in impedance between the matching layer and the skin
Which of the following refers to a dedicated CW (pedoff) probe? · A. Can only be used at the suprasternal window · B. Preferred for documentation of the location of the highest velocity · C. Requires correlation with the EKG tracing to confirm where the waveform is coming from · D. Single piezoelectric element
requires correlation with the ekg tracing to confirm where the waveform is coming from
Transesophageal transducers are considered _____________ devices that should be disinfected using _________________. · A. critical, high level disinfectant · B. semi-critical, thermal sterilization · C. semi-critical, high level disinfectant · D. critical, thermal sterilization
semi-critical, high level disinfectant
