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1

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

Rheumatic fever

2

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

Mitral, Aortic, Tricuspid, Pulmonic

3

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

Pulmonary hypertension

4

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

Left atrial thrombus

5

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

Left atrial myxoma

6

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

Gorlin

7

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

mitral stenosis

8

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

Diastolic doming

9

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

10

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

11

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

< 1.0cm2

12

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

13

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

14

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

15

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

90 to 400 msec

16

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

17

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

severe

18

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

19

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

20

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

21

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

22

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

dyspnea

23

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

left atrium

24

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

pulmonary edema

25

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

26

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

S3

27

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

Holosystolic murmur heart beats at the apex radiating to the axilla

28

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

29

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

30

108. The M-mode shown is demonstrating:

left ventricular volume overload pattern

31

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

mitral regurgitation

32

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

increased

33

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

34

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

Jet density

35

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

36

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

37

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

decreased

38

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

decreased

39

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

area

40

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

41

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

42

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

43

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

44

122. Diastolic mitral regurgitation is associated with:

Sever aortic regurgitation

45

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

46

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

47

125. The associated auscultatory findings for mitral prolapse include:

Mid-systolic click

48

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

redundant

49

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

prolapse

50

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

51

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

parasternal long axis

52

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

53

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

54

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

Left heart volume overload

55

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

Anterior

56

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.

57

135. Mitral valve chordal rupture usually results in:

mitral valve regurgitation

58

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

Mitral annular calcification

59

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

60

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

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

Bacterial

61

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

Congenital

62

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

63

141. The murmur of aortic stenosis is describes as:

Systolic ejection murmur heard best at the right upper sternal boarder

64

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

Pulsus parvus et tardus

65

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

<=.75cm2

66

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

Gorlin equasion

67

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

68

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

69

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

Concentric left ventricular hypertrophy

70

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

71

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

72

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

73

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

<= 8mm

74

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

75

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

parasternal long axis view

76

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

77

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

78

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

79

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

increased

80

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

81

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

82

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

83

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

84

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

Dilatation of the aortic root and aortic annulus

85

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

86

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

aortic

87

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

88

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

Diastolic decrescendo murmur heard best along the left sternal boarder

89

167. The murmur associated with sever aortic regurgitation is:

Austin-Flint

90

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

91

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

Fine diastolic flutter of the anterior mitral valve leaflet

92

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

severe aortic regurgitation

93

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

94

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

95

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%

96

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

97

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

98

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

opening

99

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

100

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

III or IV (restrictive)

101

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

increased

102

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

103

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

104

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.

105

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

106

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

107

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

prolapse

108

186. The most common etiology of tricuspid stenosis is:

Rheumatic fever

109

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

110

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

111

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

112

190. The most common cause of chronic tricuspid regurgitation is

pulmonary hypertension

113

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

114

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

pansystolic murmur heard best at the lower left sternal boarder

115

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

116

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

Paradoxical interventricular septal motion

117

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

118

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

119

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

Systolic pulmonary artery pressure

120

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

pulmonary hypertension

121

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

122

200. The most common etiology of tricuspid regurgitation is:

pulmonary hypertension

123

201. Significant chronic pulmonary regurgitation is associated with:

Right ventricular volume overload

124

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

125

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

Pulmonary artery end-diastolic pressure

126

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

Mean pulmonary artery pressure

127

205. The most common symptom of infective endocarditis is:

Fever

128

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

129

207. Infective endocarditis is a greater risk in patients with

Prosthetic heart valve

130

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

131

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

vegetation

132

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

atrial side of the valve leaflets

133

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

10mm

134

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

Echolucent

135

213. Valve ring abscess is usually cause by

infective endocarditis

136

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

Transesophogeal


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