79. The most common etiology of mitral stenosis in adults is:

80. The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are:

81. Signs and symptoms of mitral stenosis secondary to rheumatic heart disease include:

82. Patients with mitral stenosis, left atrial enlargement and atrial fibrillation are at increased risk for the development of:

83. Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral stenosis include:

84. The equation used in the cardiac catherization laboratory to determine mitral valve area is the:

85. The M-mode being demonstrated below is an example of:

86. A strong indication for mitral stenosis on two-dimensional echocardiography is an anterior mitral valve leaflet that exhibits

87. Two-dimensional echocardiographic findings for rheumatic mitral stenosis include all of the following except:

A. Hockey-stick appearance of anterior mitral leaflet
B. Increased left atrial dimension
C. Reverse doming of the anterior mitral leaflet
D. Thickened mitral valve leaflets and subvalvular apparatus

88. The most accurate method for determining the severity of mitral valve stenosis is:

89. Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to:

90. Typical echocardiographic finding in a patient with isolated rheumatic mitral stenosis include all of the following except:

A. D-shaped left ventricle
B. Dilated left ventricle
C. Left atrial enlargement
D. Left atrial thrombus

91. Secondary echocardiographic/Doppler findings in patients with rheumatic mitral stenosis include all of the following except:

A. Abnormal interventricular septal wall motion
B. Increase right heart dimensions
C. Increased tricuspid regurgitant jet velocity
D. Left ventricular dilation

92. The classic cardiac Doppler features of mitral valve stenosis include all of the following except:

A. Increased E velocity
B. Increased mitral valve area
C. Increased pressure half-time
D. Turbulent flow

93. The abnormal mitral valve pressure half-time for patients with mitral valve stenosis is:

94. A deceleration time of 800 msec was obtained by continues wave Doppler in a patient with rheumatic mitral valve stenosis. The pressure half-time is:

95. A Doppler mean pressure gradient across a stenotic mitral valve of 22mmhg is obtained. The severity of the mitral stenosis is:

96. Mitral stenosis is considered to be severe by all of the following criteria except:

A. Mean pressure gradient >=10mmHg
B. Mitral valve area <= 1.0cm2
C. Mitral valve Doppler A wave peak velocity >1.3m/s
D. Pressure half-time >220 msec

97. Two-dimensional echocardiographic examination reveals thin mobile mitral valve leaflet tips and a Doppler E velocity of 1.0m/s with a pressure half-time of 180msec in an elderly patient. The most likely diagnosis is:

98. All of the following are possible etiologies of anatomic mitral regurgitation except:

A. Mitral annular calcification
B. Mitral valve prolapse
C. Ruptured chordae tendineae
D. Dilated cardiomyopathy

99. All of the following are causes of chronic mitral regurgitation except:

A. Rheumatic heart disease
B. Cleft mitral valve
C. Ruptured papillary muscle
D. Mitral annular calcification

100. The most common presenting symptom of significant chronic mitral regurgitation is:

101. Congestive heart failure in a patient with significant chronic mitral regurgitation occurs because of increased pressure in the:

102. Possible signs and symptoms associated with acute severe mitral regurgitation include

103. Chronic significant mitral regurgitation may result in all of the following except:

A. Left atrial enlargement
B. Left ventricular enlargement
C. Left ventricular volume overload pattern
D. Mitral annular calcification

104. The most likely heart sound to be hear in patients with significant chronic pure mitral regurgitation is:

105. The classic description of the murmur of chronic mitral regurgitation is:

106. Cardiac magnetic resonance imaging provides all of the following information in the evaluation of mitral regurgitation except:

A. Regurgitant volume
B. Left ventricular volumes
C. Detailed visualization of the mitral valve apparatus
D. Left ventricular mass

107. M-mode and two-dimensional finding associated with significant chronic mitral regurgitation include all of the following except:

A. Fine diastolic fluttering of the mitral valve
B. Left atrial enlargement
C. Left ventricular enlargement
D. Left ventricular volume overload pattern

108. The M-mode shown is demonstrating:

109. Systolic bowing of the inter-atrial septum toward the right atrium throughout the cardiac cycle may be an indication of:

110. In patients with significant pure mitral regurgitation, the E velocity of the mitral valve pulsed-wave Doppler tracing is

111. The effect significant mitral regurgitation has on the pulsed-wave Doppler tracing of the pulmonary veins may be described as:

112. An accepted method for determining the severity of the mitral regurgitation by continuous-wave Doppler is spectral:

113. In patients with significant mitral regurgitation, the continuous-wave Doppler tracing of the regurgitant lesion may demonstrate a(n):

114. The peak mitral regurgitation velocity as determined with continuous-wave Doppler reflects the:

115. In patients with severe acute mitral regurgitation, the continuous-wave Doppler peak velocity of the regurgitant jet is:

116. In patients with significant mitral regurgitation, the isovolumic relaxation time may be:

117. A color flow Doppler method for semi-quantitating mitral regurgitation is regurgitant jet:

118. All of the following are useful color-flow Doppler techniques in the evaluation of mitral regurgitation except:

A. Vena contracta width
B. PISA diameter
C. Peak velocity
D. Jet area

119. Quantitative approaches to determine the severity of mitral regurgitation include all of the following except:

A. Regurgitant volume
B. Regurgitant fraction
C. Regurgitant jet area
D. Effective regurgitant orifice

120. Cardiac Doppler evidence of severe mitral regurgitation includes all of the following except:

A. Dense, triangular CW tracing
B. Mitral valve E wave velocity <1.0 m/sec
C. Pulmonary vein systolic flow reversal
D. Regurgitant jet area/left atrial area ration >40%

121. All of the following are true statements concerning mitral regurgitation except:

A. Mitral regurgitation may be acute, chronic, or intermittent
B. Mitral regurgitation may result in an increase in preload
C. Severity of mitral regurgitation is not affected by afterload
D. Regurgitant jet area, vena contracta width and proximal isovelocity surface area are recommended when determining severity

122. Diastolic mitral regurgitation is associated with:

123. The most common symptoms of mitral valve prolapse include all of the following except:

A. Atypical chest pain
B. Palpatations
C. Syncope
D. Ascites

124. The complications of mitral valve prolapse include all of the following except:

A. Increased risk of infective endocarditis
B. Significant mitral regurgitation
C. Mitral valve repair and replacement
D. Valvular stenosis

125. The associated auscultatory findings for mitral prolapse include:

126. A key word that is often used to describe characteristics of the valve leaflets in mitral valve prolapse is:

127. The term myxomatous degeneration is associated with mitral valve:

128. Echocardiographic characteristics of mitral valve prolapse include all of the following except:

A. Increased mitral valve annulus diameter
B. Systolic bowing of the mitral valve leaflets towards the LA
C. Thickened, redundant, myxomatous leaflets
D. Diastolic doming of the mitral valve leaflets

129. The gold standard Two-dimensional echocardiographic view recommended to diagnose the presence of mitral valve prolapse is:

130. Secondary causes of mitral valve prolapse include all of the following except:

A. Atrial septal defect
B. Bicuspid aortic valve
C. Cardiac tamponade
D. Primary pulmonary hypertension

131. All of the following are associate with mitral valve prolapse except:

A. Mitral regurgitation
B. Tricuspid valve prolapse
C. Aortic valve prolapse
D. Pulmonary atresia

132. Which of the following is most commonly associated with mitral valve prolapse:

133. There is posterior mitral valve prolapse present. With color flow Doppler on, which direction will the mitral regurgitation jet be baffled?

134. Flail mitral valve can be differentiated from severe mitral valve prolapse on two-dimensional echocardiography because flail mitral valve leaflet demonstrates:

135. Mitral valve chordal rupture usually results in:

136. A common finding associated with a regurgitant murmur in the elderly is:

137. On M-mode and two-dimentional echocardiography dense echoes are noted posterior to normal mitral valve leaflets. The probable diagnosis is mitral valve:

138. The etiology of aortic valve stenosis includes all of the following except:

A. Bacterial
B. Congenital
C. Degenerative
D. Rhuematic

139. The most likely etiology of aortic valve stenosis in a 47-year-old patient is:

140. The cardinal symptom of valvular stenosis includes all of the following except:

A. Angina pectoris
B. Congestive heart failure
C. Anasarca
D. Syncope

141. The murmur of aortic stenosis is describes as:

142. The pulse that is characteristic of significant valvular stenosis is:

143. The aoritic valve area considered critical aortic valve stenosis is:

144. The formula used to determine aortic valve area in the cardiac catherization laboratory is the:

145. All of the following may be measured in the cardiac catherization laboratory when evaluating aortic stenosis except:

A. Peak velocity
B. Maximum peak instantaneous pressure gradient
C. Peak-to-peak pressure gradient
D. Mean pressure gradient

146. The Doppler maximum peak instantaneous pressure gradient in a patient with aortic stenosis is 100mmHg. The cardiac catherization peak-to-peak pressure gradient will most likely be:

147. An effect of significant aortic valve stenosis on the left ventricle is:

148. Pathologies that may result in a left ventricular pressure overload include all of the following except:

A. Discrete subaortic stenosis
B. Mitral valve stenosis
C. Systemic hypertension
D. Valvular aortic stenosis

149. The characteristic M-mode findings for aortic valvular stenosis include all of the following except:

A. A lack of systolic flutter of the aortic leaflets
B. Diastolic flutter of the aortic leaflets
C. Reduced leaflet separation in systole
D. Thickening of the aortic valve leaflets

150. Possible two-dimensional echocardiographic findings in significant aortic valve stenosis include all of the following except:

A. Aortic valve calcification
B. Left ventricular hypertrophy
C. Post-stenotic dilatation of the ascending aorta
D. Post-stenotic dilatation of the decending aorta

151. In the parasternal long axis view, sever aortic valve stenosis is define as an aortic valve leaflet separation that measures:

152. Secondary echocardiographic findings associated with sever valvular aortic stenosis include all of the following except:

A. Decreased left ventricular systolic function
B. Left ventricular hypertrophy
C. Post-stenotic dilatation of the ascending aorta
D. Right ventricular hypertrophy

153. The two-dimensional view which best to visualize systolic doming of the aortic leaflets is the:

154. Cardiac Doppler parameters used to assess the severity of valvular aortic stenosis include all of the following except:

A. Aortic pressure half-time
B. Aortic velocity ratio
C. Mean pressure gradient
D. Peak aortic valve velocity

155. Of the transvalvular pressure gradients that can be measured in the echocardiography laboratory, the most useful in examining aortic valve stenosis is probably:

156. A Doppler mean pressure gradient of 18mmHg is calculated in a patient with valvular aortic stenosis. The severity of the aortic stenosis is;

157. The onset of flow to peak aortic velocity CW Doppler tracing in severe valvular aortic stenosis is

158. The severity of aortic valve stenosis may be underestimated if only the maximum velocity measurement is used in the following condition:

159. The echocardiographer may differentiate between the similar systolic flow patters seen in coexisting severe aortic valve stenosis and mitral regurgitation by all of the following except:

A. Aortic ejection time is shorter than that of the mitral regurgitation time
B. Mitral regurgitation flow always lasts until mitral valve opening, whereas aortic valve stenosis flow does not
C. Mitral diastolic filling profile should be present during recording of the mitral regurgitation, whereas no diastolic flow is observed in aortic valve stenosis
D. Since both are systolic flow patterns, it is not possible to separate mitral regurgitation from aortic stenosis

160. The two-dimentional echocardiogram demonstrates a thickened aortic valve with reduced systolic excursion. On physical examination there was a crescendo-decrescendo murmur heard. The most likely diagnosis is:

161. When two-dimensional evaluation of a systolic ejection murmur reveals thickened aortic valve with normal systolic excursion and a peak velocity across the aortic valve of 1.5m/s. The diagnosis is likely aortic valve:

162. The most common etiology of chronic aortic regurgitation is:

163. All of the following represents possible etiologies for acute aortic regurgitation except:

A. Infective endocarditis
B. Aortic valve sclerosis
C. Aortic dissection
D. Trauma

164. The LEAST common valve regurgitation found in normal patients is:

165. All of the following all associated with significant chronic aortic regurgitation except:

A. Wide pulse pressure
B. Congestive heart failure
C. Holosystolic murmur heard best at the cardiac apex
D. Angina pectoris

166. The characteristic feature of the murmur of chronic aortic regurgitation is a:

167. The murmur associated with sever aortic regurgitation is:

168. Cardiac magnetic resonance imaging provides all of the following information in a patient with aortic regurgitation except:

A. Detailed resolution of the aortic valve
B. Regurgitant volume
C. Effective regurgitant orifice
D. Left ventricular volumes

169. The hallmark M-mode finding for aortic regurgitation is:

170. Reverse diastolic doming of the anterior mitral valve leaflet is associated with:

171. All of the following are two-dimentional echocardiography findings in a patient with significant chronic aortic regurgitation except:

A. Left atrial enlargement
B. Abnormal aortic valve or aortic root
C. Left ventricular enlargement
D. Hyperkinetic left ventricular wall motion

172. In significant chronic aortic regurgitation, M-mode and 2D evidence includes all of the following except:

A. Hyperkinesis of the interventricular septum
B. Hyperkinesis of the posterior wall of the left ventricle
C. Left ventricular dilation
D. Paradoxical interventricular septal motion

173. The M-Mode/2D parameters that have been proposed as an indicator for aortic valve replacement in severe chronic regurgitation are left ventricular:

174. Premature closure of the mitral valve is associated with all of the following except:

A. Acute severe mitral regurgitation
B. Acute severe aortic regurgitation
C. First-degree AV block
D. Loss of sinus rhythm

175. In a patient with severe acute aortic regurgitation the left ventricular end-diastolic pressure increases rapidly. This pathophysiology will affect which of the following?

176. The M-mode finding that indicates severe aortic regurgitation is premature aortic valve:

177. Echocardiographic evidence of severe acute aortic regurgitation includes all of the following except

A. Premature closure of the mitral valve
B. Premature opening of the aortic valve
C. Premature opening of the mitral valve
D. Reverse doming of the anterior mitral valve leaflet

178. The mitral valve PW Doppler flow pattern often associated with sever acute aortic regurgitation is grade:

179. The pulmonary vein atrial reversal wave may be ________ in peak velocity and duration in a patient with severe acute aortic regurgitation

180. Severe aortic regurgitation is diagnosed with CW Doppler by all of the following except:

A. A maximum velocity of 4 m/s
B. A pressure half-time of < 200msec
C. Increased jet density
D. Steep deceleration slope

181. The CW Doppler signal of aortic regurgitation may be differentiated for the CW Doppler signal for mitral stenosis by the following guideline:

182. The severity of aortic regurgitation may be best determined with color flow Doppler by all of the following methods except:

A. Measuring aortic regurgitation jet aliasing area in the parasternal long-axis view
B. Comparing the aortic regurgitation jet width with the left ventricular outflow tract width in the parasternal long axis
C. Measuring the vena contracta in the parasternal long axis view
D. Determinging the presence of holodiastolic flow reversal in the descending aorta / abdominal aorta

183. Holodiastolic flow reversal in the descending aorta and or the abdominal aorta may be present in each of the following except:

A. Sever aortic regurgitation
B. Severe mitral regurgitation
C. Patent ductus arteriosus
D. Aortopulmonary window

184. All of the following are considered useful quantitative measurements to determine the severity of aortic regurgitation except:

A. Peak velocity of aortic regurgitation
B. Regurgitant volume
C. Regurgitant fraction
D. Effective regurgitant orifice

185. Posterior displacement of the aortic valve leaflets into the left ventricle outflow tract during ventricular diastole is called aortic valve:

186. The most common etiology of tricuspid stenosis is:

187. The typical 2D findings in rheumatic tricuspid stenosis include all of the following except:

A. Leaflet thickening especially at the leaflet tips and chordae tendineae
B. Diastolic doming of the anterior tricuspid valve leaflet
C. Right atrial dilatation
D. Systolic bowing of the posterior tricuspid valve leaflet

188. All of the following are cardiac Doppler findings for tricuspid valve stenosis except:

A. Increased Tricuspid valve E wave velocity
B. Decreased pressure Half-time
C. Decreased tricuspid valve area
D. Increased mean pressure gradient

189. Causes of anatomic tricuspid regurgitation include all of the following except:

A. Carcinoid heart disease
B. Ebstein’s anomaly
C. Infective endocarditis
D. Pulmonary hypertension

190. The most common cause of chronic tricuspid regurgitation is

191. Signs of significant tricuspid regurgitation include all of the following except:

A. Hepatomegaly
B. Jugular venous distension
C. Pulsus paradoxus
D. Right ventricular heart failure

192. The murmur of tricuspid regurgitation is best described as a:

193. All of the following are dilated in significant chronic tricuspid regurgitation except:

A. Hepatic veins
B. Inferior vena cava
C. Pulmonary veins
D. Right atrium

194. M-mode and 2D findings for chronic tricuspid regurgitation include:

195. Methods for determining the severity of tricuspid regurgitation with PW Doppler include all of the following except:

A. Increased E wave velocity of the tricuspid valve
B. Holosystolic flow reversal of the hepatic vein
C. Laminar flow of the tricuspid regurgitant jet
D. Peak velocity of the tricuspid regurgitant jet

196. Cardiac Doppler findings associated with significant tricuspid regurgitation include all of the following except:

A. Concave late systolic configuration of the regurgitation signal
B. Increased E velocity of the tricuspid valve
C. Systolic flow reversal in the hepatic vein
D. Systolic flow reversal in the pulmonary vein.

197. And intracardiac pressure that may be determined form the CW Doppler tricuspid regurgitation signal is:

198. A tricuspid regurgitation peak velocity of 3.0 m/s is obtained. This indicates:

199. Possible echocardiographic and cardiac Doppler findings in a patient with carcinoid heart disease include all of the following except:

A. Tricuspid regurgitation
B. Tricuspid stenosis
C. Tricuspid valve prolapse
D. Pulmonary regurgitation

200. The most common etiology of tricuspid regurgitation is:

201. Significant chronic pulmonary regurgitation is associated with:

202. All of the following color follow Doppler findings indicate significant pulmonary regurgitation except:

A. Wide jet width at origin
B. Jet width/right ventricular outflow tract width >70%
C. Holodiastolic flow reversal in the pain pulmonary artery
D. Peak velocity of <1.0m/s

203. Which of the following pressures can be predicted when measuring the pulmonary regurgitation end-diastolic velocity

204. Which of the following pressures can be calculated when measuring the peak velocity of the pulmonary regurgitation

205. The most common symptom of infective endocarditis is:

206. The complications of infective endocarditis include all of the following except:

A. Congestive heart failure
B. Embolization
C. Valve ring abscess
D. Annular calcification

207. Infective endocarditis is a greater risk in patients with

208. A patient with a history of IV drug use presents to the echocardiography laboratory with complaints of fever, night sweats, and weight loss. The most likely explanation is:

209. The classic manifestation of infective endocarditis is cardiac valve:

210. The usual site of attachment for vegetations on the mitral valve and tricuspid valve are the:

211. The vegetation diameter as determined by 2D echo that most often is associated with systemic emboli is:

212. The essential 2D finding of valve ring abscess secondary to infective endocarditis may be best described as:

213. Valve ring abscess is usually cause by

214. The test of choice for diagnosing the presence of vegetation and the complications of infective endocarditis is: