79. The most common etiology of mitral stenosis in adults is:
Rheumatic fever
80. The cardiac valves listed in decreasing order as they are affected by rheumatic heart disease are:
Mitral, Aortic, Tricuspid, Pulmonic
81. Signs and symptoms of mitral stenosis secondary to rheumatic heart disease include:
Pulmonary hypertension
82. Patients with mitral stenosis, left atrial enlargement and atrial fibrillation are at increased risk for the development of:
Left atrial thrombus
83. Conditions that may lead to clinical symptoms that mimic those associated with rheumatic mitral stenosis include:
Left atrial myxoma
84. The equation used in the cardiac catherization laboratory to determine mitral valve area is the:
Gorlin
85. The M-mode being demonstrated below is an example of:
mitral stenosis
86. A strong indication for mitral stenosis on two-dimensional echocardiography is an anterior mitral valve leaflet that exhibits
Diastolic doming
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
Reverse doming of the anterior mitral leaflet
88. The most accurate method for determining the severity of mitral valve stenosis is:
Performing planimetry of the mitral valve orifice by two-dimensional echocardiography
89. Critical mitral valve stenosis is said to be present if the mitral valve area is reduced to:
< 1.0cm2
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
Dilated left ventricle
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
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
Increased mitral valve area
93. The abnormal mitral valve pressure half-time for patients with mitral valve stenosis is:
90 to 400 msec
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:
232msec
95. A Doppler mean pressure gradient across a stenotic mitral valve of 22mmhg is obtained. The severity of the mitral stenosis is:
severe
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
Mitral valve Doppler A wave peak
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:
moderate to severed mitral annular calcification
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
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
Ruptured papillary muscle
100. The most common presenting symptom of significant chronic mitral regurgitation is:
dyspnea
101. Congestive heart failure in a patient with significant chronic mitral regurgitation occurs because of increased pressure in the:
left atrium
102. Possible signs and symptoms associated with acute severe mitral regurgitation include
pulmonary edema
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
Mitral annular calcification
104. The most likely heart sound to be hear in patients with significant chronic pure mitral regurgitation is:
S3
105. The classic description of the murmur of chronic mitral regurgitation is:
Holosystolic murmur heart beats at the apex radiating to the axilla
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
Detailed visualization of the mitral valve apparatus
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
Fine diastolic fluttering of the mitral valve
108. The M-mode shown is demonstrating:
left ventricular volume overload pattern
109. Systolic bowing of the inter-atrial septum toward the right atrium throughout the cardiac cycle may be an indication of:
mitral regurgitation
110. In patients with significant pure mitral regurgitation, the E velocity of the mitral valve pulsed-wave Doppler tracing is
increased
111. The effect significant mitral regurgitation has on the pulsed-wave Doppler tracing of the pulmonary veins may be described as:
S wave reverses, D wave increases
112. An accepted method for determining the severity of the mitral regurgitation by continuous-wave Doppler is spectral:
Jet density
113. In patients with significant mitral regurgitation, the continuous-wave Doppler tracing of the regurgitant lesion may demonstrate a(n):
Asymmetrical shape of the mitral regurgitation flow velocity spectral display
114. The peak mitral regurgitation velocity as determined with continuous-wave Doppler reflects the:
Maximum pressure difference between the left atrium and the left ventricle
115. In patients with severe acute mitral regurgitation, the continuous-wave Doppler peak velocity of the regurgitant jet is:
decreased
116. In patients with significant mitral regurgitation, the isovolumic relaxation time may be:
decreased
117. A color flow Doppler method for semi-quantitating mitral regurgitation is regurgitant jet:
area
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
Peak velocity
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
Regurgitant jet area
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%
Mitral valve E wave velocity <1.0 m/sec
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
Severity of mitral regurgitation is not affected by afterload
122. Diastolic mitral regurgitation is associated with:
Sever aortic regurgitation
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
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
Vavular stenosis
125. The associated auscultatory findings for mitral prolapse include:
Mid-systolic click
126. A key word that is often used to describe characteristics of the valve leaflets in mitral valve prolapse is:
redundant
127. The term myxomatous degeneration is associated with mitral valve:
prolapse
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
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:
parasternal long axis
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
Bicuspid aortic valve
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
Pulmonary atresia
132. Which of the following is most commonly associated with mitral valve prolapse:
Left heart volume overload
133. There is posterior mitral valve prolapse present. With color flow Doppler on, which direction will the mitral regurgitation jet be baffled?
Anterior
134. Flail mitral valve can be differentiated from severe mitral valve prolapse on two-dimensional echocardiography because flail mitral valve leaflet demonstrates:
leaflet tip that points towards the left atrium.
135. Mitral valve chordal rupture usually results in:
mitral valve regurgitation
136. A common finding associated with a regurgitant murmur in the elderly is:
Mitral annular calcification
137. On M-mode and two-dimentional echocardiography dense echoes are noted posterior to normal mitral valve leaflets. The probable diagnosis is mitral valve:
Annular calcification
138. The etiology of aortic valve stenosis includes all of the following except:
A. Bacterial
B. Congenital
C. Degenerative
D. Rhuematic
Bacterial
139. The most likely etiology of aortic valve stenosis in a 47-year-old patient is:
Congenital
140. The cardinal symptom of valvular stenosis includes all of the following except:
A. Angina pectoris
B. Congestive heart failure
C. Anasarca
D. Syncope
Anasarca
141. The murmur of aortic stenosis is describes as:
Systolic ejection murmur heard best at the right upper sternal boarder
142. The pulse that is characteristic of significant valvular stenosis is:
Pulsus parvus et tardus
143. The aoritic valve area considered critical aortic valve stenosis is:
<=.75cm2
144. The formula used to determine aortic valve area in the cardiac catherization laboratory is the:
Gorlin equasion
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
Peak velocity
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:
Lower than 100mmHg
147. An effect of significant aortic valve stenosis on the left ventricle is:
Concentric left ventricular hypertrophy
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
Mitral valve 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
Diastolic flutter of the aortic 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
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:
<= 8mm
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
Right ventricular hypertrophy
153. The two-dimensional view which best to visualize systolic doming of the aortic leaflets is the:
parasternal long axis view
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
Aortic pressure half-time
155. Of the transvalvular pressure gradients that can be measured in the echocardiography laboratory, the most useful in examining aortic valve stenosis is probably:
mean systolic gradient
156. A Doppler mean pressure gradient of 18mmHg is calculated in a patient with valvular aortic stenosis. The severity of the aortic stenosis is;
Mild
157. The onset of flow to peak aortic velocity CW Doppler tracing in severe valvular aortic stenosis is
increased
158. The severity of aortic valve stenosis may be underestimated if only the maximum velocity measurement is used in the following condition:
Low cardiac output
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
D is false
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:
Stenosis and regurgitation
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:
sclerosis
162. The most common etiology of chronic aortic regurgitation is:
Dilatation of the aortic root and aortic annulus
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
Aortic valve sclerosis
164. The LEAST common valve regurgitation found in normal patients is:
aortic
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
Holosystolic murmur herad best at the cardiac apex
166. The characteristic feature of the murmur of chronic aortic regurgitation is a:
Diastolic decrescendo murmur heard best along the left sternal boarder
167. The murmur associated with sever aortic regurgitation is:
Austin-Flint
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
Detailed resolution of the aortic valve
169. The hallmark M-mode finding for aortic regurgitation is:
Fine diastolic flutter of the anterior mitral valve leaflet
170. Reverse diastolic doming of the anterior mitral valve leaflet is associated with:
severe aortic regurgitation
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
Left atrial enlargement
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
Paraxoxical 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:
End-systolic dimension >=55mm and fractional shortening of <= 25%
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
Acute sever mitral regurgitation
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?
Closure of the mitral valve
176. The M-mode finding that indicates severe aortic regurgitation is premature aortic valve:
opening
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
Premature opening of the mitral valve
178. The mitral valve PW Doppler flow pattern often associated with sever acute aortic regurgitation is grade:
III or IV (restrictive)
179. The pulmonary vein atrial reversal wave may be ________ in peak velocity and duration in a patient with severe acute aortic regurgitation
increased
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
A maximum velocity of 4 m/s
181. The CW Doppler signal of aortic regurgitation may be differentiated for the CW Doppler signal for mitral stenosis by the following guideline:
If the diastolic flow pattern commences before mitral valve opening than the signal is due to aortic regurgitation
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
Measuring the aortic regurgitant jet aliasing area in the parasternal long axis view.
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
Sever mitral regurgitation
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
Peak velocity of the aortic regurgitation
185. Posterior displacement of the aortic valve leaflets into the left ventricle outflow tract during ventricular diastole is called aortic valve:
prolapse
186. The most common etiology of tricuspid stenosis is:
Rheumatic fever
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
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
Decreased pressure half time
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
Pulmonary hypertension
190. The most common cause of chronic tricuspid regurgitation is
pulmonary hypertension
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
Pulsus paradoxus
192. The murmur of tricuspid regurgitation is best described as a:
pansystolic murmur heard best at the lower left sternal boarder
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
Pulmonary veins
194. M-mode and 2D findings for chronic tricuspid regurgitation include:
Paradoxical interventricular septal motion
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
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.
Systolic flow reversal in the pulmonary vein
197. And intracardiac pressure that may be determined form the CW Doppler tricuspid regurgitation signal is:
Systolic pulmonary artery pressure
198. A tricuspid regurgitation peak velocity of 3.0 m/s is obtained. This indicates:
pulmonary hypertension
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
Tricuspid valve prolapse
200. The most common etiology of tricuspid regurgitation is:
pulmonary hypertension
201. Significant chronic pulmonary regurgitation is associated with:
Right ventricular volume overload
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
Peak velocity of <1.0 m/s
203. Which of the following pressures can be predicted when measuring the pulmonary regurgitation end-diastolic velocity
Pulmonary artery end-diastolic pressure
204. Which of the following pressures can be calculated when measuring the peak velocity of the pulmonary regurgitation
Mean pulmonary artery pressure
205. The most common symptom of infective endocarditis is:
Fever
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
Annular calcification
207. Infective endocarditis is a greater risk in patients with
Prosthetic heart valve
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:
infective endocarditis
209. The classic manifestation of infective endocarditis is cardiac valve:
vegetation
210. The usual site of attachment for vegetations on the mitral valve and tricuspid valve are the:
atrial side of the valve leaflets
211. The vegetation diameter as determined by 2D echo that most often is associated with systemic emboli is:
10mm
212. The essential 2D finding of valve ring abscess secondary to infective endocarditis may be best described as:
Echolucent
213. Valve ring abscess is usually cause by
infective endocarditis
214. The test of choice for diagnosing the presence of vegetation and the complications of infective endocarditis is:
Transesophogeal