Echo Midterm

Name 2 views you could use to detect Pulmonic regurgitation with color doppler 1. 2.

LAX/ SAX RVOT SAX Base SUB SAX

Grade 4+ MR, is indicative of a. severe MR b. Mild MR c. Moderate MR d. Trace of MR

a. severe MR

During an echo, if you detect a thickened aortic valve with a peak velocity of >2.6m/sec, the patient has ______. If you detect a thickened aortic valve without decreased excursion and a peak velocity <2.5m/sec, the patient has aortic _____. a. stenosis, sclerosis b. sclerosis, stenosis

a. stenosis, sclerosis

On M- mode Mitral valve prolapse creates a a. systolic dip b. diastolic dip

a. systolic dip

According to the continuity equation, the aortic valve area (AVA)= (.785) (LVOT diameter)2 (V1/V2) a. true b. false

a. true

Aortic regurgitation is possible with Aortic stenosis a. true b. false

a. true

Diastolic doming of the anterior mitral valve leaflet creates a "hockey stick" appearance with mitral stenosis a. true b. false

a. true

In cases of mid aortic insufficiency, the steeper the AI waveform slope the more severe a. true b. false

a. true

Mitral regurgitation is probable with mitral stenosis a. true b. false

a. true

Mitral stenosis can eventually cause pulmonary hypertension a. true b. false

a. true

Mitral stenosis creates a turbulent diastolic flow a. true b. false

a. true

Pulmonic insufficiency creates a low- pitched diastolic murmur that may increase with inspiration. When pulmonary hypertension is present, a high pitched blowing diastolic murmur may be heard (Graham- Steele murmur) a. true b. false

a. true

Tricuspid regurgitation is possible with tricuspid stenosis a. true b. false

a. true

Tricuspid stenosis can be congenital a. true b. false

a. true

Tricuspid stenosis murmur can vary with respiration a. true b. false

a. true

Up to 87% of patients have trace to mild Pulmonic regurgitation a. true b. false

a. true

When measuring the mitral valve deceleration slope, you would measure from the peak E waveform down to the E-F slope, back to baseline. a. true b. false

a. true

You measure aortic regurgitation using the pressure half time method a. true b. false

a. true

What is the valve area calculation for Tricuspid valve area? a. pressure half time/ 220 b. 190/ pressure half time c. peak gradient/190

b. 190/ pressure half time

Which of the following represents the formula for calculating the mitral valve area? a. pressure half time/ 220 b. 220/ pressure half time c. peak gradient/ 220 d. 4(V)2 where V= peak velocity

b. 220/ pressure half time

Severe tricuspid stenosis valve area is a. > 1.0cm2 b. < 1.0cm2 c. 7 to 9cm2

b. < 1.0cm2

Normal peak velocity for the mitral valve flow is a. >1.3 m/sec b. <1.3 m/sec c. 4m/sec d. 6m/sec

b. <1.3 m/sec

The AVA is calculated by using the following equation: a. AVA= (.785) (LVOTd) (V1) / (V2) b. AVA= (.786) (LVOT diameter squared) (V1) / (V2)

b. AVA= (.786) (LVOT diameter squared) (V1) / (V2) . Should be .785......

What equation is used to determine the pressure gradient between two chambers? a. peak velocity equation b. Bernoulli equation c. maximum velocity equation

b. Bernoulli equation

Downward displacement of the tricuspid valve leaflets into the right ventricle is known as a. carcinoid heart disease b. Ebstiens Anomaly c. cardiac hemochromatosis d. cardiac sarcoidosis

b. Ebstiens Anomaly

The flow convergence method can be used to estimate the MR volume. This method is also called a. PSAE b. PISA c. bernoulli d. mean PG

b. PISA

2D planimetry of the Aortic valve is performed in the a. SAX MV View b. SAX AORTA View c. RVIT

b. SAX AORTA View

Pulmonic insufficiency as seen on Doppler echo from the parasternal window. appears -- the baseline during -- a. above/ systole b. above/ diastole c. below/ systole d. below/ diastole

b. above/ diastole

Utilizing CW doppler, Tricuspid stenosis will have a ____ E-F slope a. increased b. decreased c. remains the same

b. decreased

In the SAX view of the mitral valve, tracing the opening of the mitral valve with mitral stenosis it will present a(an) a. increased MVA b. decreased MVA

b. decreased MVA

Mitral valve stenosis impedes _____ blood flow traveling from the _____ into the _____ a. systolic, left atrium, left ventricle b. diastolic, left atrium, left ventricle c. diastolic, right atrium, right ventricle d. systolic, left ventricle, aorta

b. diastolic, left atrium, left ventricle

When measuring the aortic root, everything on the aortic side of the annulus is measured during a. end systole b. end diastole

b. end diastole

A complication of mitral stenosis is increased cardiac output a. true b. false

b. false

A mean PG >3 mmHG is indicative of severe tricuspid stenosis a. true b. false

b. false

Aortic stenosis creates a turbulent diastolic color flow that travels from the aorta into the left ventricle a. true b. false

b. false

Calcific/ Rheumatic Aortic stenosis presents on an M- mode with decreased aortic cusp separation (ACS) = 2.6 -3.5 a. true b. false

b. false

Mitral regurgitation creates diastolic turbulent color flow a. true b. false

b. false

On a 2D echo, tricuspid stenosis has an increased tricuspid valve orifice a. true b. false

b. false

To acquire doppler of the Pulmonary vein you would use CW a. true b. false

b. false

Tricuspid stenosis impedes systolic blood flow due to narrowing or thickening of the Tricuspid valve. a. true b. false

b. false

Mitral regurgitation creates a _____ murmur a. holodiastolic blowing b. holosystolic blowing c. holosystolic click d. holosdiastolic click

b. holosystolic blowing

The characteristic M- mode findings for calcific aortic valve stenosis include all of the following EXCEPT: a. thickening of the aortic cusps b. increased aortic cusp separation c. decreased aortic cusp separation

b. increased aortic cusp separation

When measuring the aortic root, everything on the aortic side of the annulus is measured a. inner to inner b. leading edge to leading edge

b. leading edge to leading edge

Aortic stenosis is _____ of the aortic valve that impedes _____ blood flow a. narrowing, diastolic b. narrowing, systolic c. dilation, diastolic d. dilation, systolic

b. narrowing, systolic

The gold- standard two- dimensional echocardiographic view for diagnosing mitral valve prolapse is the: a. apical 4C b. parasternal long axis c. parasternal short axis of mitral valve d. apical 5C

b. parasternal long axis

To provoke MVP the tech can have the patient _____ a. breathe in b. perform the valsalva maneuver

b. perform the valsalva maneuver

P1 and P2 represents the ____ in the chambers ____ and ____ a. velocity, superior and inferior b. pressure, proximal and distal

b. pressure, proximal and distal

The E- wave peak velocity of the mitral valve ____ a. increases with age b. represents the early diastolic LA- LV pressure gradient

b. represents the early diastolic LA- LV pressure gradient

What type of aortic stenosis originates at the aortic valve cusps? a. degenerative b. rheumatic c. congenital d. prosthesis

b. rheumatic

If you detect an increased depth of the "a" wave > = 8 mm while acquiring the M- mode of the left pulmonic cusp, what is most likely the diagnosis? a. severe pulmonic regurgitation b. severe pulmonic stenosis c. severe pulmonary hypertension d. none of the above

b. severe pulmonic stenosis

What condition is most likely present if the peak pressure gradient across the pulmonic valve is >64 mmHg? a. normal pulmonic valve b. mild pulmonic stenosis c. moderate pulmonic stenosis d. severe pulmonic stenosis

d. severe pulmonic stenosis

Regurgitant flow through the aortic valve occur during a. diastole b. systole

diastole

When stenosis is present, the sonographer must obtain information pertaining to the valve which includes: a. peak velocity b. mean pressure gradient c. max pressure gradient d. valve area e. all of the above

e. all of the above

Pulmonic stenosis impedes diastolic blood flow from the RV into the main pulmonary artery. a. true b. false

false - PS impedes SYSTOLIC

The typical two-dimensional echocardiographic findings in rheumatic tricuspid stenosis include all the following EXCEPT: A. Diastolic doming of the anterior tricuspid valve leaflet B. Leaflet thickening C. Restricted motion of the tricuspid leaflets D. Systolic bowing of the posterior tricuspid valve leaflet

D. Systolic bowing of the posterior tricuspid valve leaflet

A peak pressure gradient of flow through a valve is obtained by using the equation: a. 4V squared b. squared 4 c. PHT/220 d. V4 squared

a. 4V squared

The murmur associated with severe aortic insufficiency is: a. Austin Flint murmur b. Carvallo's murmur c. Graham Steel murmur d. Still's murmur

a. Austin Flint murmur

Which doppler signal is used to calculate the tricuspid stenosis mean pressure gradient? a. CW b. PW c. all of the above

a. CW

Which spectral doppler is used to asses valvular regurgitation? a. CW b. PW

a. CW

When measuring blood flow through the mitral valve, we measure (circle all that apply) a. E/A velocity b. Deceleration slope c. D-E excursion d. EPSS

a. E/A velocity b. Deceleration slope

An MR jet that extends just beyond the mitral valve leaflets is a. Grade I b. Grade II c. Grade III d. Grade IV

a. Grade I

When is a raphe typically seen? a. bicuspid aortic valve b. cleft aortic valve c. degenerative aortic stenosis d. rheumatic aortic stenosis

a. bicuspid aortic valve

Tricuspid valve leaflets that are fixed, thick and rigid is seen with: a. carcinoid heart disease b. cardiac amyloidosis c. cardiac hemochromatosis d. cardiac sarcoidosis

a. carcinoid heart disease

The E-F slope of the M-mode of the anterior mitral valve leaflet in mitral stenosis is: a. decreased b. increased c. notched d. unaffected

a. decreased

The mitral valve is open during a. diastole b. systole

a. diastole

Mitral stenosis is associated with what type of murmur? a. diastolic rumble b. systolic rumble

a. diastolic rumble

The aortic annulus and LVOT is measured a. inner to inner b. leading edge to leading edge

a. inner to inner

The aortic annulus and LVOT is measured during a. mid systole b. end diastole

a. mid systole

MVP murmur presents as a a. mid systolic click b. blowing noise c. opening snap d. all of the above

a. mid systolic click

In most cases if the AMVL prolapses there is a _____ directed jet a. posterior b. anterior

a. posterior

How do you measure pulmonic insufficiency? a. pressure half time slope b. peak PV velocity

a. pressure half time slope

Diastolic flutter of the tricuspid valve may be detected in the presence of -- a. pulmonic insufficiency b. pulmonic stenosis c. tricuspid regurgitation d. tricuspid stenosis

a. pulmonic insufficiency

The etiology of aortic valve stenosis includes all of the following EXCEPT: a. pulmonic stenosis b. congential c. calcific d. rheumatic

a. pulmonic stenosis

Regurgitant flow through the mitral valve occurs during a. diastole b. systole

b. systole

The aortic valve is open during a. diastole b. systole

b. systole

A normal diastolic IVC measurement is a. 1.1 - 1.4 cm b. 1.2 - 3.2 cm c. 1.2 - 2.1 cm

c. 1.2 - 2.1 cm

Severe aortic stenosis peak velocity is a. >2.0 m/s b. >3.0 m/s c. >4.0 m/s d. >5.0 m/s

c. >4.0 m/s

Name two views where we could evaluate the tricuspid valve a. RVIT, RVOT b. PSLAX, SAX AO c. SAX AO, RVIT d. APICAL 4CH, APICAL 3CH

c. SAX AO, RVIT

Which of the following is the most common cause of pulmonic stenosis? a. rheumatic heart disease b. carcinoid heart disease c. congenital heart disease d. pulmonary artery aneurysm

c. congenital heart disease

_____ is the most common heart problem association with MVP a. mitral stenosis b. mitral valve pressure c. mitral regurgitation c. mitral valve obstruction

c. mitral regurgitation

Mitral stenosis is: a. back flow of blood into the aorta b. back flow of blood into the RA c. narrowing, thickening of the hearts mitral valve d. back flow of blood into the LA E. none of the above

c. narrowing, thickening of the hearts mitral valve

The best two- dimensional view for determining mitral valve area is: a. Apical 4C b. parasternal long axis c. parasternal short axis d. apical 2C

c. parasternal short axis

The peak A wave of the mitral valve _____ a. decreases with age b. represents the early diastolic LV- LA pressure gradient c. represents the late diastolic LA- LV pressure gradient

c. represents the late diastolic LA- LV pressure gradient

The most common cause of tricuspid valve stenosis is a. carcinoid heart disease b. infective endocarditis c. rheumatic fever d. right atrial myxoma

c. rheumatic fever

The image represents a football shaped opening known as a. semilunar bicuspid mitral valve b. atrioventricular bicuspid pulmonary valve c. semilunar bicuspid aortic valve d. none of the above

c. semilunar bicuspid aortic valve

The normal aortic cusp separation is: a. 0.6- 1.1cm b. < 2 cm squared c. < 1 cm squared d. 1.5- 2.6cm

d. 1.5- 2.6cm

The normal tricuspid valve area is: a. 1 to 3 cm2 b. 3 to 5 cm2 c. 4 to 6 cm2 d. 7 to 9 cm2

d. 7 to 9 cm2

With severe mitral stenosis, the MVA is _____ cm squared a. < 2.0 b. > 2.0 c. > 1.0 d. < 1.0

d. < 1.0

Causing of MVP include: a. Marfans syndrome b. hereditary factors c. mitral stenosis d. A & B e. all of the above

d. A & B

What view could you use to evaluate aortic stenosis? a. RVIT, RVOT b. RVOT, SAX AO c. SAX AO, RVIT d. APICAL 5CH, APICAL 3CH

d. APICAL 5CH, APICAL 3CH

When measuring flow through the MV, we measure normal flow, using _____, at the MV ______. a. CW, annulus b. PW annulus c. CW, leaflet tips d. PW, leaflet tips

d. PW, leaflet tips

A patient with aortic stenosis typically undergoes serial echoes in order to track changes of the -- a. peak, mean and max PG b. systolic and diastolic function c. chamber and wall size d. all of the above

d. all of the above

Complications with mitral regurgitation results in a. left atrial enlargement b. pulmonary hypertension c. possible left atrial thrombus d. all of the above

d. all of the above

Pulmonic stenosis is not that common in the adult. Which of the following 2D echo findings would indicate pulmonic stenosis? a. thickening of the pulmonic leaflets with systolic doming b. Right ventricular hypertrophy c. flattening of the interventricular septum d. all of the above

d. all of the above

Several windows should be utilized when acquiring the aortic valve doppler waveform, to include the a. apical window b. suprasternal window c. right parasternal window d. all of the above

d. all of the above

The following spectral doppler tracing represents what semilunar valve measurement? a. peak PG b. max PG c. mean PG d. all of the above

d. all of the above

When severe tricuspid regurgitation is suspected, enlargement may be noted in the: a. IVC b. RA c. hepatic veins d. all of the above

d. all of the above

A diastolic flutter of the anterior mitral valve leaflet can be caused from a. mitral regurgitation b. mitral stenosis c. aortic stenosis d. aortic regurgitation

d. aortic regurgitation

Mitral regurgitation is a. back flow of blood into the aorta b. back flow of blood into the LV c. narrowing of the hearts mitral valve d. back flow of blood into the LA

d. back flow of blood into the LA

On a 2D echo, AS may present; a. thickened cusps b. left ventricular hypertrophy c. dilated pulmonary artery d. both a & b

d. both a & b

When MR is present you should look at your 2D image and evaluate the: a. mitral valve apparatus b. left atrium c. aortic stenosis d. both a & b e. all of the above

d. both a & b

Tricuspid stenosis murmur is described as a a. diastolic blowing b. holosystolic blowing c. holosystolic click d. diastolic rumble

d. diastolic rumble

The patient has severe aortic insufficiency, what will be heard during the auscultation? a. high pitched, blowing, diastolic decrescendo murmur at the left sternal border b. low pitched, mid systolic, "rumble" at the apex c. high pitched, blowing, diastolic crescendo murmur at the apex d. low pitched, mid diastolic, "rumble" at the apex (Austin Flint Murmur)

d. low pitched, mid diastolic, "rumble" at the apex (Austin Flint Murmur)