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Echo URR exam with complete solutions 2024_2025
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Echo URR exam with complete solutions 2024_2025
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Echo URR exam with complete solutions2024/2025
You identify a PFO on an echo and the cardiologist asks you to calculate the LAP.
How will you perform this calculation? - ANSWER- Measure the peak velocity
across the PFO, calculate the peak pressure gradient across the defect and add
the RAP.
The mitral deceleration time is 300msec. What is the valve area? A) 1.3cm^2 B)
2.8cm^2 C) 2.5cm^2 D) 1.5cm^2 - ANSWER- C) 2.5cm^2 MVA = 759 / deceleration
time
Which of the following is preferred to document motion of the disk in a St. Jude
valve? - ANSWER- M-mode. M-mode is used to doc the MOTION of ball/disk in a
mechanical valve. Doppler is used to assess the FLOW of the valve.
A patient presents for an echo to rule out WMA. The TTE 2D exam is suboptimal.
What should you do next? A) cancel the order and dismiss the patient B) consult
the physician for permission to perform contrast imaging C) cancel the order and
schedule the patient for a TEE D) contact the ordering physician to recommend
that an MRI exam is ordered instead - ANSWER- B) consult the physician for
permission to perform contrast imaging; Suboptimal imaging of the LV wall
motion on a 2D exam is an indication for contrast administration. A physician
order for the contrast must be given, prior to performing the contrast exam.
Which Doppler measurement of flow through a stenotic AV best correlated w/ the
same value obtained during heart catheterization? - ANSWER- mean pressure
gradient
Which of the following cardiac abnormalities requires the use of the continuity
equation for proper calculation of AVA? A) decreased LV function B) HOCM C)
supravalvular AS
,D) Transcatheter AVR - ANSWER- A) decreased LV function; The continuity
equation compensates for the changes in LV function when calculating AVA. CW
Doppler is used to assess flow across the AV. Because CW Doppler has no range
resolution, it cannot determine the location of the elevated velocity. HOCM and
supravalvular stenosis will cause an improper AVA calculation b/c the stenosis is
not at the valve. A transcatheter AV replacement relies on the pressure gradients
and the velocity ratio to assess stenosis.
The peak velocity of PI can be used to assess:
A) Peak systolic pulmonary artery pressure
B) mean pulmonary artery pressure
C) pulmonary artery end diastolic pressure
D) severity of pulmonary stenosis - ANSWER- B) mean pulmonary artery
pressure; MPAP =4 x (peak velocity of PI)^2 The peak velocity of PI is peak
diastolic velocity so it cannot be used to assess systolic pressure. The end
diastolic velocity of PI can be used to assess the end diastolic pressure in the PA.
If the LVOT Doppler tracing is obtained from a location that is too far from the AV:
A) the SV will be overestimated
B) the AVA will be overestimated by the continuity equation
C) the LVOT velocity will be overestimated
D) the AVA will be underestimated by continuity equation - ANSWER- D) the AVA
will be underestimated by continuity equation; If the Doppler cursor is placed too
far from the AV, the LVOT peak velocity will be reduced from what it would be at
the correct location. This will cause the calculation of a smaller or
underestimated AVA or overestimated level of stenosis. The peak aortic velocity
and pressure gradient will not match the level of stenosis indicated by AVA.
What Doppler measurement is necessary to calculate the end diastolic pressure
in the pulmonary artery?
A) peak pressure gradient of PI
B) peak pressure of TR
C) end diastolic velocity of PI
D) peak systolic velocity of PI - ANSWER- C) end diastolic velocity of PI; PA end
diastolic pressure = 4 (end diastolic pressure velocity of PI)^2 + RA pressure;
normal PAEDP + 4-12mmhg
If _________________ is present, the RVSP calculation from the TR gradient is
inaccurate as the measurement of the PAP.
A) CHF
B) PI
,C) PS
D) PHTN - ANSWER- C) PS; The PA pressure is used to assess the pressure in
the lungs. If the PV is stenotic, the flow velocity and resistance increase the
pressures within the RV, TR is then related to the increased pressure at the valve
instead of the lungs.
Which of the following correctly describes how AS is evaluated by
catheterization?
A) the catheter is placed at the AV to assess the peak pressure gradient
B) Doppler ultrasound is used to assess the flow velocity in the LVOT and at the
AV
C) the catheter is placed in the LV and then advanced through the AV to assess
the pressure difference
D) the intracoronary transducer is inserted into the aorta to assess the peak
pressure - ANSWER- C)
Which of the following correctly describes how to measure the acceleration time
of the PV waveform?
A) measure the time from onset of sys to the systolic peak
B) trace the waveform from start to finish
C) measure the slope of the line from the onset of systole to the systolic peak
D) measure the distance from the onset of sys to the systolic peak - ANSWER- A)
When is imaging performed during a stress echo using a supine exercise bike?
A) within 30 sec after the cessation of exercise
B) within 60 sec after the cessation of exercise
C) during peak exercise
D) when the HR increases by 50% from the rest - ANSWER- C) bc the supine
exercise bike is normally used for valvular assessment, imaging is performed at
peak exercise to obtain the peak velocity
A patient presents for a 6 month follow up echo for a reported AVA of 1.0cm^2.
On today's exam, the continuity equation demonstrates an AVA of 1.6cm^2.
Which of the following could explain the variation in measurements?
A) improved EF% from the last exam
B) overestimated aortic velocity on current exam
C) overestimated LVOT diameter on prior exam
D) overestimated LVOT diameter on current exam - ANSWER- D)
Which of the following can be used to differentiate subvalvular from valvular AS?
A) CW Doppler
, B) TDI of aortic annulus
C) M-mode of the LV
D) M-mode of the aortic cusps - ANSWER- D)
While performing the PLAX views of the heart, you notice dilation of the aortic
root. Which 2D echo view will help best evaluate the extent of this aortic
abnormality?
A) 5C
B) suprasternal long axis
C) subcostal short axis
D) A3 - ANSWER- B) if the aortic root is dilated, the ascending, arch and
descending aorta should be evaluated. This is the best accomplished by using
the suprasternal view. The 2C can also provide the additional views of the
descending thoracic aorta.
Which of the following correctly describes how to manipulated the transducer
from the PLAX to the RVOT - ANSWER- tilt superiorly w/ a slight clockwise
rotation
Which sonographic view best demonstrates the LV inflow across a bioprosthetic
MV?
A) subcostal
B) PLAX
C) PSAX
D) apical - ANSWER- D) the LV inflow across a mechanical MVR would best be
evaluated in 4C but regurg is best performed in subcostal view dt valve masking
from the apparatus in the apical view. A bioprosthetic valve is composed of less
dense material and produce less artifact to obstruct flow visualization in the
standard preferred apical view from MV assessment.
The difference in LV length measuremens obtained in the 4C and 2C should be:
A) less than 20%
B) less than 10%
C) less than 5mm
D) less than 1 cm - ANSWER- B) less than 10%
The dobutamine infusion for a stress echo is typically stopped when the HR
reaches 85% of the calculated maximum HR. Which of the following is a
secondary reason the infusion will be stopped?
A) systolic BP below 100mmHg
B) diastolic BP below 100 mmHg
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