ahiscu2 Written Test

ANSWERS 04/26/10

2010-07-23T10:05:00.000-07:00

1. A and B
2. B
3. A
4. A
5. B
6. A
7. A
8. D
9. B
10. B
11. True
12. True
13. true
14. True
15. G
16. D
17. C
18. D
19. E
20. True
21. True

Cardiovascular Principles
1. D
2. B
3. C
4. E
5. B
6. A
7. D
8. B
9. C
10. b

Adult Echo
1. D
2. A
3. A
4. B
5. False
6. C
7. True
8. False
9. B
10. D
11. D
12. A
13. All should be marked

Vascular Ultrasound
1. severe

Written Test Due 04/26/2010

2010-04-20T09:04:00.000-07:00

Written Test Name: ____________

Ultrasound Physics (#’s 66 – 83) Doppler!!! VIP!!! You cannot pass SPI without knowing the following:!!)

1. The change in the frequency due to motion of the source and/or the observer is called the Doppler:
A. Principle
B. Effect

2. The difference between the transmit frequency and the received frequency is called the Doppler:
A. Effect
B. Shift

3. The red blood cell velocity increases. The magnitude of the Doppler shift will:
A. Increase
B. Decrease

4. The transmit frequency is increased from 2 MHz to 5MHz. The magnitude of the Doppler shift will:
A. Increase
B. Decrease

5. The Doppler incident angle increases (0 degrees towards 90 degrees). The magnitude of the Doppler shift will:
A. Increase
B. Decrease

6. The optimal Doppler incident angle to maximize the Doppler shift is:
A. 0
B. 1
C. 60
D. 90

7. Spectral analysis for conventional Doppler (PW, CW, high PRF) is performed by:
A. FFT
B. Autocorrelation

8. The z axis provides information concerning:
A. Time (duration)
B. Velocity
C. Spectral strength (gray scale)
D. All of the above

9. Spectral broadening which results in window fill-in suggests _________ flow.
A. Laminar
B. Turbulent

10. The PRF is 10 kHz. The Doppler shift is 4 kHz for a stenotic mitral valve. Will aliasing occur?
A. Yes
B. No

11. True or False: The advantage of PW Doppler is range resolution (range discrimination).
12. True or False: The disadvantage of PW Doppler is that it has a sampling rate.

13. True or False: The advantage of CW Doppler is that there is no sampling rate.

14. True or False: The disadvantage of CW Doppler is range ambiguity.

15. All of the following are ways in which to avoid aliasing EXCEPT:
A. Increase the velocity scale (increases the PRF)
B. Decrease the image depth (increases the PRF)
C. Decrease the transmit frequency (decreases the magnitude of the Doppler shift)\
D. Shift the baseline
E. Use CW Doppler
F. Use high PRF
G. All of the above are ways to avoid aliasing

16. What color will flow be in the apical five chamber view during ventricular systole?
A. Blue
B. Black
C. Red
D. Blue with yellow-red
E. Red with blue

17. The number of pulses sent to create one line of color is:
A. Doppler principle
B. Doppler shift
C. Packet size
D. Autocorrelation

18. _________Doppler measures the strength of the returning signals from blood.
A. PW
B. CW
C. Color
D. Power

19. All of the following are ways to reduce aliasing during a color flow exam EXCEPT:
A. Increase the color velocity scale
B. Decrease the image depth
C. Decrease the transmit frequency
D. Shift the color baseline to all one color
E. All of the above will reduce the risk of aliasing

20. True or False: To increase the amount of color on the display the sonographer may increase color gain.

21. True or False: To increase the amount of color on the display, the sonographer may decrease the velocity scale which reduces the PRF.

To pass the SPI (physics exam) (guaranteed!)
1. Review the list
2. Review the Must Know list in the physics book
3. Review the Top 100 questions in the physics book
4. Review the Physics 500
5. Review every question in the Physics book

Cardiovascular Principles (My choice!)

1. All of the following are related to the RV EXCEPT:
A. Moderator band
B. Trabeculae carneae (trabeculations)
C. Triangular shaped
D. Normal thickness is 1.0 cm
E. AV valve (TV) is the valve closest to the cardiac apex

2. The _____________ coronary artery supplies blood to the anterolateral and inferolateral walls of the LV.
A. LAD
B. Circumflex
C. PDA
D. RCA

3. The _____________ contribute to the formation of the AV (MV; TV) valves.
A. Ductus arteriosus
B. Septum secundum
C. Endocardial cushions
D. Aortic sac

4. All of the following are defects associated with tetralogy of Fallot EXCEPT:
A. RVH
B. Overriding aorta
C. Malalignment VSD
D. RVOT obstruction (e.g., PS)
E. Ostium primum ASD

5. The abnormal insertion of the TV towards the cardiac apex with RV dysplasia is called:
A. Uhl’s
B. Ebstein’s
C. ARVD
D. Normal

6. The strain phase of the Valsalva maneuver is most useful in:
A. HOCM
B. PFO

7. The formula for stroke volume for Doppler is:
A. EDV – ESV
B. EDV –ESV / EDV x 100
C. EDD – ESD / EDD x 100
D. CSA (.785 x D2) x VTI

8. An early systolic murmur suggests:
A. ASD
B. VSD
C. PDA
D. Ruptured sinus of Valsalva

9. Alternating normal beat with PVC is called:
A. Ventricular fibrillation
B. Ventricular tachycardia
C. Bigeminy
D. Trigeminy

10. The cardiac Doppler peak (maximum) instantaneous gradient in AS is 100 mm Hg. The catheterization peak to peak gradient will be:
A. Higher
B. Lower

Adult Echo Registry Review

1. The view of choice for aortic coarctation is the:
A. Parasternal long axis
B. Parasternal short axis of the base
C. Apical 5
D. Suprasternal long axis of the aorta

2. The period of time from AV (MV, TV) closure to semilunar (AoV; PV) opening is called:
A. Isovolumic contraction
B. Isovolumic relaxation

3. The period of time from semilunar valve closure to AV valve opening is called:
A. Isovolumic relaxation
B. Isovolumic contraction

4. What effect does vagal stimulation have on the heart?
A. Increases heart rate
B. Decreases heart rate

5. True or False: Saline contrast may be used to determine the severity of AR.

6. All of the following could have normal global systolic function EXCEPT:
A. MVP
B. MS
C. Dilated cardiomyopathy
D. HOCM

7. True or False: MV PHT is not valid for determining MVA immediately post-balloon commissurotomy. (must wait 24 to 48 hours) (Pocket Reference page 7)

8. True or False: The chordae tendineae in rheumatic MS are usually thin and elongated.

9. A dagger shaped LVOT CW Doppler flow pattern (as seen in HOCM) suggests a ________ obstruction.
A. Fixed
B. Dynamic

10. The TR peak velocity is 3.0 m/s. The RVSP and SPAP are: ________ mm Hg
A. 3
B. 9
C. 36
D. 46

11. The most common cardiac valve tumor is the:
A. Myxoma
B. Rhabdomyoma
C. Sarcoma
D. Papilloma (papillary fibroelastoma)

12. All of the following are TRUE concerning the intra-aortic balloon pump EXCEPT:
A. Usually placed in the ascending aorta
B. Inflates during ventricular diastole
C. Deflates during ventricular systole
D. Improves coronary artery perfusion
E. Reduced afterload

13. Check the following if a segment visualized in the parasternal short axis of the LV:
______ Anterior IVS
______ Anterior LV
______ Anterolateral
______ Inferolateral
______ Inferior LV
______ Inferior IVS

To pass the adult echo boards (guaranteed!!)
1. Review the Echo 500
2. Review the Must Know questions in the SCU echo workbook
3. Review the multiple choice questions in the SCU workbook
4. Review the videos on the blog (ahiscu1.blogspot.com)
5. Review the written tests at ahiscu2.blogspot.com

Vascular Ultrasound
ABI: 0.9

1. How severe is the peripheral arterial disease? ________ (Pocket reference page 431)

VASCULAR FINAL FROM GAIL SIZE

2010-04-19T10:02:00.000-07:00

VASCULAR TESTING FINAL EXAM

1. The deep femoral artery or profunda becomes the popliteal artery at the level of the adductor canal.

a. True
b. False

2. Inaccuracies in blood pressure measurements associated with incomplete occlusion of the artery may be the result of

a. Rigid arteries
b. Obesity or edema
c. Blood pressure cuff too small
d. All of the above

3. The normal flow pattern in the arterial system can best be described as

a. Laminar and pulsatile
b. Disturbed
c. Turbulent
d. Pulsatile and turbulent

4. The most common area that chronic atherosclerotic lesions develop are of the

a. Large vessels of the abdomen and groin
b. Bifurcation of the artery
c. Superficial femoral artery
d. Small distal tibial vessels of non-diabetics
e. Both b and c

5. Acute arterial occlusion causes immediate disruption of the blood flow to the lower extremity resulting in severe symptoms requiring emergent treatment. Causes of acute arterial occlusion include

a. Embolus from the heart
b. Embolus from an aneurysm
c. Thrombosis of a graft or stenotic artery
e. All of the above

6. Trophic changes of an extremity with chronic vascular disease are related to reduced nutrients and oxygen needed by the cells. These trophic changes include

a. Hair loss
b. Thick brittle toe or finger nails
c. Thin, smooth shiny skin
d. Muscle atrophy
e. All of the above

7. You would expect erroneous pressure if

a. The cuff bladder was not placed directly over the artery
b. The cuffs were placed at an angle rather than straight
c. The cuffs are too narrow
d. All of the above

8. The segmental pressure measurement reflects the cuff location, not the site of the Doppler probe

a. True
b. False

9. You can make a normal Doppler signal appear abnormal by incorrect probe angle

a. True
b. False

10. If the Doppler probe is angled away from the optimal angle of insonation toward the skinline, the analog waveform will
a. Increase
b. Decrease

11. The external carotid artery terminates as the?

a. Internal maxillary artery
b. Superficial temporal artery
c. Middle cerebral artery
d. Posterior cerebral artery

12. The internal carotid artery has no branches in the neck?

a. True
b. False

13. The circle of Willis can serve as a collateral pathway in the event of an obstruction.

a. True
b. False

14. The blood pressure in the systemic arteries is greatest during?

a. Atrial systole
b. Atrial diastole
c. Ventricular systole
d. Ventricular diastole

15. The normal flow pattern in the internal carotid artery is best described as?

a. high resistive
b. Low resistive
c. Mildly resistive
d. Moderately resistive

16. Spectral Doppler displayed diastolic flow is determined by?

a. Distal vascular resistance
b. Proximal blood pressure
c. Transducer pressure on the skin
d. All of the above

17. Spectral Broadening always indicates turbulence.

a. True
b. False

18. Which normally has the smallest end diastolic flow?

a. Common Carotid artery
b. Internal Carotid artery
c. External Carotid artery
d. Middle Carotid artery

19. All of the following can cause abnormalities of the carotid arteries, but which is the most common in the U.S.?

a. Extrinsic compression
b. Traumatic occlusion
c. Intimal hyperplasia
d. Atherosclerosis

20. The most common site of atherosclerosis in the carotid arteries is?

a. Subclavian artery
b. Oriigin of the internal carotid branch
c. Distal internal carotid branch
d. Common carotid

21. The most typical disease pattern of the bulb and internal carotid artery is plaque formation leading to thrombosis or embolization.

a. True
b. False

22. Cerebral symptoms may be caused from?

a. Carotid plaque formation which is 50% diameter reduction in the ICA.
b. Embolization of plaque due to increased shearing force of blood around the plaque.
c. Partial blockage that suddenly occludes.
d. All of the above.

23. Which statement is False as it relates to Transient Ischemic Attacks (TIA)?

a. Temporary neurologic deficits
b. Lasts less than 24 hours
c. Lasts more that 24 hours
d. Major indicator of impending stroke

24. Subclavian Steal Syndrome.

a. Can cause vertebro-basilar symptoms with arm use
b. Occurs most frequently on the left side
c. Causes a pressure gradient which steals blood from the brains posterior circulation
d. All of the above

25. A bruit is a turbulent sound heard with a stethoscope over an artery. Which is not true?

a. Usually has no significant importance and can be ignored.
b. A bruit may indicate carotid stenosis.
c. It may be transmitted upward from a cardiac murmur.
d. Caused from tortuous vessels.
e. May be absent even with severe stenosis

26. The carotid bulb Doppler flow signal exhibits forward and reverse flow.
a. True
b. False

27. The ICA/CCA ratio is calculated by dividing Peak Systoic Velocity (PSV) in the proximal ICA or at the site of stenosis by the PSV in nonstenotic portion of CCA.

a. True
b. False

28. The ICA/CCA ratio should normally be above 2.0.

a. True
b. False

29. While scanning a patient you notice that the ICA does not show any color. You can then?

a. Increase the color gain
b. Make your color box smaller
c. Use a lower frequency transducer
d. Any of the above

30. You can call a high grade stenosis or a total occlusion by color alone?

a. True
b. False

31. End diastolic velocity (EDV) is normally highest in which of the following arteries?

a. ICA
b. ECA
c. CCA
d. Vertebral

32. Carotid endarterectomy is a beneficial treatment for a patient with an occluded ICA.

a. True
b. False

33. An ICA stenosis on one side may be overestimated due to and ICA occlusion on the opposite side.

a. True
b. False

34. Blood normally flow from the deep to the superficial system through the perforating veins in the lower extremities.
a. true
b. false

35. The common femoral vein begins as which of the following veins joins the superficial femoral?
a. greater saphenous
b. popliteal
c. lesser saphenous
d. profunda

36. Which of the following contributes to venous return?
a. pressure gradient to the heart
b. respiration
c. calf muscle pump
d. all of the above

37. Increased venous pressure may be caused by
a. venous thrombosis
b. extrinsic compression
c. valvular incompetence
d. all of the above

38. A patient who presents with a sudden onset of pain and swelling of the calf and ankle may be suspected of having:
a. chronic venous insufficiency
b. carotid disease
c. deep vein thrombosis
d. arterial insufficiency

39. Bilateral ankle swelling may be due to:
a. congestive heart failure
b. bilateral DVT
c. lymphedema
d. all of the above

40. Which of these conditions predisposes a patient to acute deep vein thrombosis?
a. recent surgery
b. malignant cancer
c. prolonged bed rest
d. all of the above

41. Augmentation ____________venous flow.
a. increases
b. decreases

42 The venous signal heard with normal breathing is called:
a. spontaneity
b. phasicity
c. competence
d. pulsatility

43. Reflux is indicative of:
a. a calf vein thrombosis
b. extrinsic compression
c. a vein segment that is pulsatile
d. incompetent valves

44. Veins are usually paired vessels in the calf:
a. true
b. false

45. Normal diagnostic criteria for venous imaging include:
a. phasic Doppler signals
b. changes in vein diameter with valsalva maneuver
c. clear vessel lumen and ability to compress vein
d. all of the above

46. Vessel compressions with the transducer should be performed:
a. in the longitudinal view
b. in the transverse view
c. in either view
d. none of the above

47. To examine the popliteal vein the transducer is placed:
a. on the anterior aspect of the thigh
b. on the posterior aspect of the thigh
c. behind the knee
d. above the medial malleolus

48. No response to augmentation indicates:
a. an obstruction distal to the Doppler probe
b. an obstruction at the level of the Doppler probe
c. an obstruction proximal to the Doppler probe
d. all of the above

49. Nonthrombotic structures include:
a. lymph nodes
b. cysts and tumors
c. hematomas
e. all of the above

50. A decrease in diameter of the arteries will:
a. Decrease flow beyond the constriction
b. Raise the blood pressure beyond the constriction
c. Increase the peripheral resistance
d. Has no effect on the artery

51. The major reason I am happy this school included noninvasive vascular testing is

a. I wanted to pass the course
b. I could get a job easier
c. I am now more marketable
d. All of the above

ANSWERS 04/19/10

2010-04-19T09:28:00.000-07:00

Ultasound Physics

1. A

2. A

3. C

4. All should be checked

5. True

6. E

7. C

8. True

9. True

10. True

CP

1. C

2. A

3. D

4. C

5. C

6. A and D

7. C

8. C

9. B

10. C

Adult Echo

1. B

2. B

3. C

4. A

5. A

6. D

7. B

8. C

9. B

10. A

11. C

12. All should be marked

Vascular

RAR: 3.7

Severity: greater than 70%

Written Test Due 04/19/10

2010-04-13T08:51:00.000-07:00

Written Test Name: ________________________

Ultrasound Physics (Final exam/Registry Review)

1. All of the following are TRUE statements concerning M-mode EXCEPT:

A. Provides a wide field of view

B. Excellent temporal resolution

C. Provides information concerning the motion of structures over time

D. Requires the M-mode cursor to be perpendicular

2. The sonographer decreases the field of view. The frame rate will:

A. Increase

B. Decrease

C. No change

D. Cannot be predicted

3. The sonographer reduces the field of view. Which resolution is improved?

A. Axial

B. Lateral

C. Temproal

D. Contrast

E. Elevational

4. Check the following if a way to increase the frame rate and improve temporal resolution:

________ Reduce the field of view

________ Decrease image depth

________ Decrease scan line density (interpolation)

________ Decrease the number of focuses

________ Decrease packet size (color flow Doppler)

5. True or False: Increasing the number of pixels (e.g., zoom) improves spatial resolution.

6. Which allows more shades of gray to be displayed?

A. 2 bits

B. 4 bits

C. 6 bits

D. 8 bits

E. 10 bits

7. Determine the number of gray shades that will be displayed in a 3 bit system.

A. 2

B. 4

C. 8

D. 12

8. True or False: A 1-bit system will result in a bistable display.

9. True or False: PACS allows for the transfer of images from the machine to memory outside the machine.

10. True or False: The protocol for communicating images and associated information is called DICOM.

Cardiovascular Principles (My choice)

1. The name of the two papillary muscles are:

A. Anterior; posterior

B. Medial; lateral

C. Anterolateral; posteromedial

D. Superior; inferior

2. The anterior IVS, anterior LV and cardiac apex is supplied by the:

A. LAD

B. Circumflex

C. RCA

D. Cannot be predicted

3. The _______________ contribute to the formation of the mitral and tricuspid valves as well as the septum primum.

A. Septum secundum

B. Truncus arteriosus

C. Ductus arteriosus

D. Endocardial cushions

4. The truncus arteriosus contributes to the formation of the:

A. MV; TV

B. Interatrial septum

C. Aorta; pulmonary artery

D. LA and RA

5. The normal oxygen saturation for the coronary sinus is:

A. 100%

B. 98%

C. 60%

D. 0%

6. All of the following decrease venous return EXCEPT:

A. Inspiration

B. Strain phase of the Valsalva maneuver

C. Supine to standing

D. Standing to supine

7. The primary cause of right heart failure is:

A. TS

B. Severe PR

C. Left heart failure

D. TVP

8. A patient presents with FUO, new murmur and positive blood cultures. The sonographer should be careful to evaluate for:

A. Thrombus

B. Chagas disease

C. Infective endocarditis

D. HOCM

9. The laminar core of a turbulent jet is called the:

A. PISA

B. Vena contracta

C. Disturbed flow region

D. Relaminarization

10. The actual continuity equation is:

A. CSA (.785 x D2)

B. CSA (.785 x D2) x LVOT VTI / AoV VTI

C. CSA1 x VTI1 = CSA2 x VTI2D.

D. 4 x V22

Adult Echocardiography

1. Standing to squatting ____________ venous return.

A. Decreases

B. Increases

C. No change

D. Cannot be predicted

2. The aortic valve is thick with normal excursion and the peak velocity is 1.7 m/s. This is aortic valve:

A. Stenosis

B. Sclerosis

3. Which of the following diastolic flows would most likely have the highest peak velocity?

A. MS

B. TS

C. AR

D. PR

4. What effect does partial anomalous pulmonary venous return (PAPVR) have on the heart?

A. RAE; RVE

B. LAE; LVE

C. RAE; RVH

D. LAE; LVH

5. The death of myocardial tissue may be referred to as:

A. Myocardial necrosis

B. Ischemia

C. Stenosis

D. Sclerosis

6. A clear lucent area around the aortic valve is seen in a patient with suspected infective endocarditis. This suggest:

A. Normal

B. Refraction

C. Perforation

D. Abscess

7. The PR end diastolic velocity is 2 m/s. This suggests ____________ pulmonary artery pressures.

A. Normal

B. Abnormal (pulmonary hypertension)

8. A mean pressure gradient of 22 mm Hg in a patient with MS suggests __________ MS. (Pocket Reference page 9)

A. Mild

B. Moderate

C. Severe

9. The excessive motion of a prosthetic heart valve (PHV) (usually due to infective endocarditis) is called:

A. Pannus

B. Dehiscence

C. Degeneration

D. Thrombus

10. The excessive ingrowth of tissue in a PHV is called:

A. Pannus

B. Dehiscence

C. Degeneration

D. Heart-valve mismatch

11. All of the following are associated secondary findings for significant chronic MR EXCEPT:

A. LAE

B. LVE

C. ASH

D. Pulmonary hypertension

12. Check the following if required to measure for Qp/Qs:

________ RVOT diameter in early systole

________ RVOT VTI (PW Doppler)

________ LVOT diameter in early systole

________ LVOT VTI (PW Doppler)

Vascular Ultrasound

Renal Artery Ultrasound (Pocket Reference page 410)

Peak velocity: 223 cm/s

Peak velocity of the proximal abdominal aorta: 60 cm/s

Calculate the RAR: _____________

Severity of the proximal renal artery stenosis: ___________

Questions you have: ________________________

Answers 04/12/10

2010-04-12T09:01:00.000-07:00

Ultrasound Physics
1. A
2. B
3. B
4. A
5. C
6. A
7. A
8. A
9. C
10. A
11. C
12. A
13. B
14.
15. A
16. A
17. C
18. D
19. C
20. D
21. E

Cardio Principles

1. C
2. A
3. B
4. B
5. B
6. A
7. C
8.
9. A
10. A

Adult Echo
Registry Review

1. B
2. B
3. B
4. B
5. D
6. A, B, C
7. A
8. D
9. True
10. B

Vascular

moderate

Written test DUE 04/12/10

2010-04-06T08:17:00.000-07:00

Written Test Name: _________________

Ultrasound Physics (Final Exam Review/SPI Registry Review) (#’s 45 to 52)

1. The two components of the range equation are:
A. Propagation speed; pulse round trip time
B. Frequency; wavelength
C. Period; Pulse duration
D. Velocity; wavelength

2. The time it takes for an ultrasound pulse to travel 1 cm roundtrip in soft tissue is: ______us.
A. 1
B. 13
C. 26
D. 39

3. The pulse round trip time is 52 us. The reflector distance (assume soft tissue).
A. 1 cm
B. 4 cm
C. 8 cm
D. 16 cm

4. The number of pulses created per second is called:
A. PRF
B. PRP
C. PD
D. SPL
E. DF

5. The primary limitations to the number of pulses that can be created per second is:
A. Frequency
B. Period
C. Image depth
D. Wavelength

6. The PRF is 12 kHz. The Doppler shift is 7 kHz. Will aliasing occur?
A. Yes
B. No

7. The sonographer reduces the image depth. The PRF will _________.
A. Increase
B. Decrease
C. Remain the same
D. Cannot be predicted

8. The sonographer reduces the image depth. The frame rate will:
A. Increase
B. Decrease
C. Remain the same
D. Cannot be predicted

9. The time take it takes for one pulse to occur is called:
A. PRF
B. PRP
C. PD
D. SPL
E. DF

10. The shorter the pulse duration (PD), the better the _________ resolution.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational

11. The length of a single pulse is called:
A. PRF
B. PRP
C. SPL
D. PD
E. DF

12. The shorter the SPL, the better the __________ resolution.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational

13. The SPL is 4 mm. The axial resolution is:
A. 4 mm
B. 2 mm
C. 1 mm
D. 0.5 mm

14. ______________ is the percentage of time the machine actually spends producing an ultrasound pulse.
A. PRF
B. PRP
C. SPL
D. PD

15. The sonographer increases the PRF by reducing the image depth. The DF will:
A. Increase
B. Decrease
C. remain unchanged
D. Cannot be predicted

16. Which gain influences the echo amplitude echo throughout the display, increases bioeffect risk and alters the MI (mechanical index)?
A. Transmit gain
B. Gain
C. TGC
D. LGC

17. The ____________ compensates for attenuation.
A. Transmit gain
B. Gain
C. TGC
D. Compression

18. ______________ alters the dynamic range.
A. Transmit gain
B. Gain
C. TGC
D. Compression

19. The _____________ is the range of echo amplitudes displayed.
A. Frequency
B. Wavelength
C. Dynamic range
D. Attenuation

20. The units for dynamic range are:
A. mm
B. mm Hg
C. dB
D. W
E. W/cm2

21. ___________ eliminates low amplitude signals and noise.
A. Amplification
B. Compensation
C. Compression
D. Demodulation
E. Rejection

Cardiovascular Principles (My Choice!)

1. Aortic coarctation is most commonly located in the area of the:
A. Ascending aorta
B. Aortic (transverse) aorta
C. Aortic isthmus
D. Descending thoracic aorta

2. Which coronary artery supplies the anterior IVS, anterior wall of the LV and cardiac apex?
A. LAD
B. Circumflex
C. RCA
D. Cannot be predicted

3. The two layers of the pericardium are:
A. Endocardium; epicardium
B. Epicardium (visceral pericardium); Parietal (fibrous) pericardium)
C. Myocardium; endocardium
D. Endocardium; Parietal pericardium

4. Which portion of the septum closes the foramen ovale at birth?
A. Septum primum
B. Septum secundum

5. The ductus arteriosus becomes the:
A. Ligamentum teres
B. Ligamentum arteriosus
C. Foramen ovale
D. Crista terminalis

6. The pulmonary wedge pressure is a right heart catheterization used to predict the ________ pressure.
A. LA
B. PAP
C. RA
D. RV

7. Which pulse is associated with cardiac tamponade?
A. Pulsus alternans
B. Pulsus bisfierens
C. Pulsus paradoxus
D. Pulsus parvus et tardus

8. The period of time from mitral/tricuspid valve opening to aortic/pulmonary valve opening is called:
A. Isovolumic relaxation (IVRT)
B. Isovolumic contraction
C. Diastasis
D. None of the above

9. Atrial systole is represented on the EKG as the _______ wave.
A. P
B. QRS
C. T
D. U

10. Closure of the MV and TV results in S _____.
A. 1
B. 2
C. 3
D. 4

Adult Echocardiography

Registry Review

1. Which effect does aortic coarctation have on the heart?
A. LAE
B. LVH
C. RAE
D. RVH

2. _____________ is the resistance to the ejection of blood.
A. Preload
B. Afterload

3. Which of the following does NOT increase afterload?
A. Systemic hypertension
B. Chronic MR
C. AS
D. Aortic coarctation

4. What causes the systolic obstruction in HOCM?
A. MR
B. SAM
C. Membrane
D. Cannot be predicted

5. What color should you normally expect to see in the apical five chamber view during ventricular systole?
A. Red
B. Red with blue
C. Black
D. Blue with aliasing (yellow/red)

6. Predict the effect of a left to shunt ASD on the heart. (more than one correct answer)
A. RAE
B. RVE
C. MPA dilatation
D. LAE

7. Aortic endocarditis will result in ____________ AR.
A. Acute
B. Chronic

8. RV dysplasia is associated with all of the following EXCEPT:
A. Ebstein’s anomaly
B. Uhl’s anomaly
C. Arrythmogenic RV dysplasia (ARVD)
D. Carcinoid

9. True or False: The most common echo finding in a patient with CHF is reduced global systolic function.

10. What effect does poor global systolic function have on peak systolic velocity, peak pressure gradient and mean pressure gradient in patients with AS?
A. Overestimation of severity
B. Underestimation of severity

Vascular Ultrasound

ABI: 0.70. Predict the severity of the obstruction. (Pocket Reference page 431) ____________

Questions you have: _________________________________________

ANSWERS 04/05/10

2010-04-05T08:41:00.000-07:00

Ultrasound Physics
1. B
2. B
3. B
4. D
5. A
6. C
7. A, B
8. B
9. A
10. B
11. A, B, C
12. D
13. A, B, C
14. B
15. D

CARDIOVASCULAR PRINCIPELS
1. B
2. D, E
3. D
4. A
5. C
6. A
7. A
8. C
9. B
10. B

ADULT ECHO
REGISTRY REVIEW
1. A, B, D
2. C
3. A, B, C, E
4. B
5. D
6. D
7. D
8. C
9. B
10. B
11. 19
12. 48

VASCULAR ULTRASOUND

normal

Written Test due 04/05/10

2010-03-30T09:36:00.000-07:00

Written Test Name: ________________

Ultrasound Physics: SCU Final Exam Review/Registry Review (#’s 29 – 44)

1. The summation of sound point sources (creative interference, destructive interference) creating a uniform sound beam is called the _______ principle.
A. Doppler
B. Huygen
C. Bernoulli
D. Continuity

2. The sound energy located between the transducer and the focal point (focus) is called all of the following EXCEPT:
A. Near field
B. Fraunhofer
C. Fresnel
D. Near zone

3. The near field length can be increased by (more than one correct answer):
A. Increasing the transducer diameter (most effective)
B. Increasing frequency
C. Increasing damping
D. Increasing receive (dynamic) focusing)

4. The transducer diameter for an unfocused CW probe is 10 mm. The sound beam diameter at one near zone length is: _________ mm
A. 20 mm
B. 15 mm
C. 10 mm
D. 5 mm

5. The ability to resolve structures PARALLEL to sound travel is called: _________ resolution.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational (slice thickness)

6. Determine the axial resolution for a spatial pulse length of 6 mm.
A. 1
B. 2
C. 3
D. 4
E. 5
F. 6

7. Axial resolution may be improved by decreasing pulse duration and spatial pulse length (SPL/2 = axial resolution) which can be done by:(more than one correct answer)
A. Increasing frequency
B. Damping
C. Focusing
D. Curving the piezoelectric element

8. The axial resolution at a 10 cm depth is 4 mm. Predict the axial resolution at a 20 cm image depth.
A. 2 mm
B. 4 mm
C. 8 mm
D. 18 mm

9. The shorter the pulse duration the better the __________ resolution.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational (slice thickness)

10. ___________ resolution is the ability to resolve structures which lie PERPENDICULAR to sound travel.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational (slice thickness)

11. How may lateral resolution be improved? (more than one correct answer)
A. Increase transducer diameter
B. Focus
C. Increase frequency
D. Damp

12. The lateral resolution at a 10 cm image depth is 4 mm. Predict the lateral resolution at a 20 cm image depth.
A. Higher then 4 mm
B. Equal to 4 mm
C. Lower than 4 mm
D. Cannot be predicted

13. Elevational resolution may be improved by all of the following EXCEPT:
A. Matrix transducers
B. Increasing frequency
C. Focusing
D. Damping

14. Receive (dynamic) focusing improves __________ resolution.
A. Axial
B. lateral
C. Temporal
D. Contrast
E. Elevational (slice thickness)

15. Which type of transducer has the best lateral resolution and elevational resolution?
A. Mechanical
B. Phased array
C. Sequential linear array
D. Annular
Cardiovascular Principles (My choice!)

1. A holosystolic murmur is heard at the cardiac apex. This suggests:
A. AR
B. MR
C. TR
D. PR

2. A continuous murmur is heard. This suggests: (more than one correct answer)
A. MR
B. ASD
C. TOF
D. Sinus of Valsalva aneurysm (ruptured)
E. PDA

3. All of the following are normal structures found in the right atrium EXCEPT:
A. Eustachian valve
B. Crista terminalis
C. Chiari network
D. Moderator band
E. Pectinate muscle

4. Systemic hypertension may result in which of the following? (more than one correct answer)
A. LAE
B. LVH
C. RAE
D. RVE

5. A click-murmur is heard. This suggests:
A. MS
B. AS
C. MVP
D. PDA

6. ____________ is the EDV or EDP of a cardiac chamber.
A. Preload
B. Afterload

7. S _________ is closure of the MV and TV and marks the beginning of systole.
A. 1
B. 2
C. 3
D. 4

8. The formula for stroke volume for Doppler is:
A. EDV – ESV
B. LVIDd – LVIDs / LVIDd x 100
C. CSA (.785 x diameter) x VTI (cm)
D. EDV – ESV / EDV x 100

9. The laminar core of a turbulent jet is called the:
A. PISA (flow convergence)
B. Vena contracta
C. Turbulent region
D. Relaminarization

10. Which ASD is strongly associated with cleft MV?
A. Ostium secundum
B. Ostium primum
C. Sinus venosus

Adult Echocardiography

Registry Review

1. How can you differentiate AS from MR on a CW Doppler tracing (more than one correct answer)
A. MR is usually a higher velocity
B. MR is longer in duration
C. AS is diastolic; MR is systolic
D. MR is “box-like” in shape while AS is “bullet” shaped

2. An elderly woman presents with an acute myocardial infraction (AMI). It is her first MI. Three days later, a new systolic murmur is detected. What is the most likely cause of the new murmur?
A. AR
B. LV apical aneurysm
C. Ventricular septal rupture
D. Pericardial effusion

3. All of the following may increase the frame rate improving temporal resolution EXCEPT:
A. Decrease image depth
B. Decrease the field of view
C. Decrease the number of focuses
D. Decrease the transmit frequency
E. Decrease scan line density

4. A dagger shaped LVOT CW flow pattern suggests a ___________ obstruction.
A. Fixed
B. Dynamic

5. A holosystolic murmur is heard at the cardiac apex. This suggests:
A. TS
B. MS
C. AR
D. MR

6. An early systolic murmur is heard. This suggests:
A. MS
B. TS
C. PR
D. VSD

7. The click-murmur syndrome is:
A. MS
B. TS
C. Carcinoid
D. MVP

8. The best view to evaluate for ASD is:
A. Parasternal
B. Apical
C. Subcostal
D. Suprasternal

9. When does MR occur?
A. Diastole
B. Systole

10. When should an aortic valve replacement occur in a patient with chronic severe AR?
A. LVIDd greater than 55 mm
B. LVIDs greater than 55 mm
C. LA greater than 4.0 cm
D. RA greater than 4.0 cm

11. Determine the peak pressure gradient across a stenotic MV with a peak velocity of 2.2 m/s. _________mm Hg.

12. Determine the peak pressure gradient where the V1 velocity is 2.0 m/s and the V2 peak velocity is 4.0 m/s. __________ mm Hg (use the lengthened Bernoulli equation)

Hemodynamics

Give the normal peak velocities for the following: (Pocket Reference pages 328 – 331)
MV E velocity: ____________ m/s or _____________ cm/s
TV E velocity: _____________ m/s or ____________ cm/s
LVOT: ______________m/s or _____________ cm/s
Aortic valve: ___________ m/s or ___________ cm/s
RVOT/PV: ___________ m/s or ____________ cm/s

List the expected “normal” peak velocity for the following:
MR: _______________ m/s or ________________ cm/s
AR: ____________ m/s or _______________ cm/s
TR: ____________ m/s or ______________ cm/s
PR: ___________ m/s or _____________ cm/s
VSD: ___________m/s or ____________ cm/s
PDA: ____________ m/s or _____________ cm/s

Vascular Ultrasound

Determine the severity: ABI: 1.0

CFA: 100 cm/s
Deep profunda(proximal): 87 cm/s
SFA (proximal): 88 cm/s
SFA (mid): 93 cm/s
SFA (distal): 77 cm/s
Popliteal: 75 cm/s

Severity: ____________________

QUESTIONS YOU HAVE: ______________________________________________

Written Test Due 03/29/10

2010-03-23T09:10:00.000-07:00

Written Test Name: _____________________

Ultrasound Physics Registry Review (19 – 28)

1. When will reflection occur?
A. Propagation speeds of the two media are different
B. Density of the two media are unequal
C. Acoustic impedances of the two media are different
D. None of the above

2. The formula for acoustic impedance is:
A. f x wavelength
B. PS/f
C. Density x propagation speed
D. 4 x V22

3. Predict the percentage of reflection at a soft tissue – air interface.
A. 1%
B. 30%
C. 75%
D. 99%

4. Predict the percentage of sound transmission at a fat – muscle interface.
A. 1%
B. 30%
C. 75%
D. 99%

5. _____________ is the change in the direction of sound travel as it crosses a medium.
A. Reflection
B. Rarefaction
C. Refraction
D. Range ambiguity

6. Refraction will occur when the
A. Propagation speeds are equal
B. Impedances are unequal and there is oblique incidence
C. Propagation speeds are unequal and there is oblique incidence
D. Impedances are unequal and there is oblique incidence

7. Which of the following are causes of attenuation?
A. Absorption
B. Reflection
C. Scatter
D. All of the above

8. The primary cause of attenuation in soft tissue is:
A. Absorption
B. Reflection
C. Scatter
D. All of the above
9. The primary control used to compensate for attenuation is:
A. Transmit gain
B. Gain
C. TGC
D. Dynamic range (compression)

10. Electrical energy is applied to a piezoelectric element which then creates sound (vibrates). This is called the: __________________ effect
A. Piezoelectric effect
B. Reverse piezoelectric effect

11. All of the following are TRUE concerning the matching layer EXCEPT:
A. Located behind the piezoelectric element(s)
B. Reduces the impedance difference between the piezoelectric element and the soft tissue
C. Thickness is ¼ wavelength
D. Improves sound transmission and reception
E. Impedance value is the mean between the piezoelectric element and the soft tissue

12. All of the following are TRUE concerning the damping material EXCEPT:
A. Placed in front of the piezoelectric element
B. Reduces the ringing of the piezoelectric element
C. Reduces SPL; PD
D. Improves axial resolution
E. Increases bandwidth
F. Reduces quality factor (QF)

13. ____________ is the range of frequencies produced by a damped piezoelectric element.
A. Bandwidth (BW)
B. Quality factor
C. Frequency
D. Period

14. The formula for quality factor(Q) (QF) is:
A. 4 x V22
B. CSA x VTI
C. f/BW
D. Wavelength x the number of cycles in a pulse

15. Modern imaging transducers are:
A. Wide bandwidths; low Q’s
B. Narrow bandwidth; high Q’s

Cardiovascular Principles Hemodynamics

1. The primary determinant of flow through a tube is:
A. Length
B. Viscosity
C. Pressure gradient
D. Diameter (radius)

2. ____________ flow is normal flow.
A. Laminar
B. Disturbed
C. Turbulent
D. Inlet (plug)

3. ___________ flow is laminar flow found at the entrance of great vessels and valve annuli.
A. Laminar
B. Disturbed
C. Turbulent
D. Inlet (plug)

4. Which of the following are components of turbulent flow? (more than one correct answer)
A. Flow convergence (PISA)
B. Vena contracta
C. Turbulent region
D. Relaminarization

5. Determine the peak pressure gradient for a peak velocity of 3.3 m/s.
A. 3.3 mm Hg
B. 11 mm Hg
C. 44 mm Hg
D. 54 mm Hg

6. Determine the peak pressure gradient using the lengthened Bernoulli equation (Pocket Reference page 377) where the V2 peak velocity is 4.0 m/s and the V1 peak velocity is 2 m/s. ______________ mm Hg.

7. Predict the effect (hypertrophy or dilatation) for the following:
AS: _____________
PS: ______________
Coarctation: __________________
DSS: __________________HOCM: _______________MS: _________________TS: __________________Chronic MR: _________________
Chronic TR: _________________Chronic AR: _________________Chronic PR: _________________ASD: ____________________VSD: ______________________
PDA: _________________________Systemic hypertension: ______________Pulmonary hypertension: _______________Pulmonary embolism: __________________

Adult Echocardiography Registry Review

1. All of the following maneuvers decrease venous return and will enhance the obstruction in HCM EXCEPT:
A. Strain phase Valsalva
B. Amyl nitrate
C. Supine to standing
D. Standing to supine

2. The formula for fractional shortening is:
A. LVIDd – LVIDs / LVIDd x 100
B. LVEDV – LVESV
C. LVEDV – LVESV / LVEDV x 100
D. CSA x VTI

3. A patient presents with an EF of 42%. The global LV systolic function is:
A. Normal
B. Mildly reduced
C. Moderately reduced
D. Severely reduced

4. The PW Doppler of the MV demonstrates E/A reversal (E/A ratio of less than 1.0). This is diastolic grade:
A. Normal for age
B. I (impaired relaxation)
C. II (pseudonormal)
D. III (restrictive)

5. The PW Doppler of the MV demonstrates a E/A ratio of 1.3. The E/E’ is 13. The patient has a history of systemic hypertension. The LA volume measured 55 ml/m2. This is diastolic grade:
A. Normal for age
B. I (impaired relaxation)
C. II (pseudonormal)
D. III (restrictive)

6. The PW Doppler of the MV demonstrated a(n) E/A ratio of 2.4. The E/E’ ratio is 21. The patient’s EF is 38%. The diastolic grade is most likely:
A. normal for age
B. I (impaired relaxation)
C. II (pseudonormal)
D. III (restrictive)

7. A patient presents with significant chromic MR. The echocardiogram demonstrates a normal MV apparatus. There is LV measures 6.8 cm (male). This type of MR is:
A. Anatomic (organic)
B. Functional

8. All of the following patients may present with LV thrombus at the cardiac apex EXCEPT:
A. MI involving the cardiac apex
B. LV apical aneurysm
C. Hypereosinophilic syndrome (endocardial fibroelastosis) (Pocket Reference page 131)
D. Normal systolic function including the cardiac apex

9. All of the following are “normal” finding in post-cardiac transplantation EXCEPT:
A. Biatrial dilatation
B. Trace to mild valvular regurgitation
C. Mild valvular stenosis
D. EF of 60%

10. Which coronary LEAST likely supplies the basal inferolateral as seen in the parasternal long axis?
A. LAD
B. Circumflex
C. RCA
D. None of the above

11. The cardiac Doppler peak pressure gradient in a patient with AS is 56 mm Hg. The cardiac catheterization peak to peak gradient will be __________.
A. Lower
B. Higher
C. Equal to
D. Cannot be predicted

12. All of the following are components of tetralogy of Fallot EXCEPT:
A. Ostium primum ASD
B. RVH
C. Over-riding aorta
D. Malalignment VSD
E. RVOT obstruction
F. Cyanosis

13. Premature closure of the MV on M-mode (usually seen in patients with acute severe AR) suggests increased:
A. RAP
B. RVSP
C. SPAP
D. PAEDP
E. LVEDP

14. The best window to use when examining a patient with COPD is:
A. Parasternal
B. Apical
C. Subcostal
D. Suprasternal

15. Which of the following regurgitation are always holo:
A. MR
B. AR
C. TR
D. All of the above

Calculations
PISA
Pocket Reference page 344
Determine RV and ERO using the following:
MR PISA radius: 1.0 cm
Aliasing velocity: 40 cm/s
MR peak velocity: 500 cm/s

RV (ml): _______________

ERO (cm2): _______________

Severity: ________________ (Pocket Reference page 16)

Questions you have: ______________________________________________

ANSWERS 03/22/10

2010-03-22T09:07:00.000-07:00

SPI Exam Review
1. C
2. A
3. True
4. first 4 items should be check marked
5. C
6. B
7. D
8. D
9. D
10. C
11. B
12. C
13. D
14. D
15. 10 to the 3rd power
16. 3.3
17. 420
18. 7

Cardio Principles
1. B
2. C
3. B
4. C
5. B
6. True
7-9
MS, AS, MR

Adult Echo Registry Review

1. E
2. F
3. C
4. C
5. C
6. D
7. C
8. C
9. D
10. A
11. B
12. B
13. A
14. A
15. B

Vascular
Severity NL

Written Test Due 03/22/10

2010-03-09T08:55:00.000-08:00

Written Test Name: _______________________

Ultrasound Physics

SPI Exam Review /SCU Final Exam Review ( #1 though 18 in the SCU Physics Workbook)

1. Sound is a mechanical _____________ wave.
A. Transverse
B. Shear
C. Longitudinal
D. Specular

2. For a longitudinal wave, the particles move:
A. East to west then west to east
B. North to south then south to north

3. True or False: Sounds requires a medium in which to travel.

4. Check the following if correct:
________ Infrasound: Less than 20 Hz
________ Audible sound 20 Hz to 20 kHz (20000)
________ Ultrasound: Greater than 20000 Hz
________ Clinical imaging ultrasound 2 MHz to 15 MHz

5. All of the following are TRUE concerning frequency (f) EXCEPT:
A. Number of cycles which occur per second
B. Units are Hertz (Hz)
C. Increasing the f improves depth of penetration
D. Increasing f improves axial resolution because the wavelength decreases/SPL decreases/PD decreases
E. Increasing the f improves lateral resolution because beam width decreases
F. Increasing f increases attenuation

6. The formula for wavelength is:
A. f x wavelength
B. PS/f
C. 0.5 x f
D. 4 x V22

7. Determine the wavelength of a 1 MHz transducer in soft tissue:
A. 154 mm
B. 15.4 mm
C. 1.54 cm
D. 1.54 mm

8. Which of the following mediums will have the shortest wavelength?
A. Bone
B. Blood
C. Muscle
D. Fat

9. Propagation speed is determined by:
A. f
B. T
C. Wavelength
D. Stiffness and density of a medium

10. Which if the following is arranged in correct increasing propagation speed:
A. Air, bone, soft tissue
B. Soft tissue; bone, air
C. Air, soft tissue, bone
D. Bone, soft tissue, air

11. All of the following are TRUE concerning amplitude (A) EXCEPT:
A. Increase transmit gain increases amplitude
B. Units are W
C. A decreases as sound travels
D. The greater the returning amplitude of the signal, the brighter the B-mode dot

12. All of the following are TRUE concerning intensity (I) EXCEPT:
A. P/area
B. W/cm2
C. SPTP is lowest intensity level
D. I is a way to quantify bioeffects

13. Decibels (dB) are units for all of the following EXCEPT:
A. Amplitude
B. TGC
C. Gain
D. Power
E. Attenuation
F. Dynamic range

14. The intensity is increased by 6 dB. The original intensity is 4 dB. The new intensity is ______ W/cm2.
A. 2
B. 4
C. 6
D. 8

15. Express the difference between 1 million and 1 billion in scientific notation. _______

16. Convert 330 cm/s to m/s. _____________ m/s.

17. Convert 4.2 m/s to cm/s: _______________ cm/s

18. Convert 70 mm into cm: ___________ cm.

Cardiovascular Principles Review Cardiac Evaluation Methods (cont.)

1. Chilled saline is used in the catheterization laboratory to determine cardiac output (CO). This method is called:
A. Fick
B. Thermodilution
C. Indicator dye
D. Ventriculography

2. The ____________ equation is used in the catheterization to determine valve area.
A. Bernoulli
B. Doppler
C. Gorlin
D. Continuity

3. The mean pressure gradient in the cardiac catheterization laboratory is 34 mm Hg. The Doppler mean gradient will be:
A. Higher than 34 mm Hg
B. Equal to 34 mm Hg
C. Lower than 34 mm Hg
D. Cannot be predicted

4. The Doppler peak (maximum) pressure gradient in aortic stenosis is 64 mm Hg. The cardiac catheterization laboratory peak to peak gradient will be:
A. Higher than 64 mm Hg
B. Equal to 64 mm Hg
C. Lower than 64 mm Hg
D. Cannot be predicted

5. Mediastinal widening on chest x-ray suggests:
A. Normal
B. Aortic dissection
C. MVP
D. TR

6. True or False: The nuclear exam which predicts ejection fraction is the MUGA.

7.-10. Identify the cardiac catheterization pressure waveforms. (AS, MS, MR)

Adult Echocardiography

Registry Review

1. A dilated coronary sinus is noticed in the parasternal long axis view. The differential diagnosis would include all of the following EXCEPT:
A. Increased RA pressure
B. Significant TR
C. Anomalous pulmonary venous return
D. Persistent left superior vena cava
E. Systemic hypertension

2. All of the following are associated with Marfan’s syndrome EXCEPT:
A. Aortic root/ascending aorta aneurysm
B. MVP
C. AR
D. MR
E. Aortic dissection
F. AS

3. All of the following indicate significant tricuspid regurgitation EXCEPT: (Pocket Reference page 54):
A. RAE
B. RVE
C. RVVO pattern
D. RJA/RAA greater than 40%
E. PISA radius greater than 0.9 cm
F. Vena contracta greater than 0.7 cm
G. Systolic flow reversal of the hepatic veins
H. TR peak velocity greater than 3.0 m/s

4. All of the following indicate significant chronic mitral regurgitation EXCEPT: (Pocket Reference page 16)
A. LAE
B. LVE
C. LVVO pattern
D. RJA/LAA greater than 40%
E. Systolic flow reversal in the pulmonary veins
F. PISA radius greater than or equal to 0.9 cm
G. Vena contracta greater than or equal to 0.7 cm
H. Peak velocity greater than 5.0 m/s

5. All of the following are normal structures found in the right atrium/right atrial appendage EXCEPT:
A. Eustachian valve
B. Chiari network
C. Moderator band
D. Pectinate muscle
E. Crista terminalis

6. Determine the RVSP and SPAP for a TR peak velocity of 3.3 m/s.
A. 3.3 mm Hg
B. 11 mm Hg
C. 44 mm Hg
D. 54 mm Hg

7. Determine the RVSP and SPAP for a VSD where the peak velocity is 4.0 m/s. The blood pressure is 100/60 mm Hg.
A. 5 mm Hg
B. 25 mm Hg
C. 36 mm Hg
D. 46 mm Hg

8. Determine the left atrial pressure for a mitral regurgitation peak velocity of 5.0 m/s. The blood pressure is 110/66 mm/Hg.
A. 5 mm Hg
B. 10 mm Hg
C. 20 mm Hg
D. 110 mmHg
E. 120 mm Hg

9. Which structure is used to determine the presence of a pericardial effusion?
A. Mitral valve posterior leaflet
B. Coronary sinus
C. Mitral annulus
D. Descending thoracic aorta

10. Which pulmonary is most often used to evaluate diastolic function and the severity of mitral regurgitation in the apical four chamber view?
A. Right upper
B. Left upper
C. Left lower
D. Right lower

11. Which pulmonary vein is NOT visualized in the apical four chamber view?
A. Right upper
B. Right lower
C. Left lower
D. Left upper

12. The most common mechanical bileaflet valve is the:
A. Starr Edwards
B. St. Jude
C. Medtronic Hall
D. Bjork Shiley

13. The most common mechanical ball and cage valve is the:
A. Starr Edwards
B. St. Jude
C. Medtronic Hall
D. Bjork Shiley

14. The two components of LVVO are:
A. LV dilatation with hyperkinesis
B. RV dilatation with paradoxical septal motion

15. The two components of RVVO are:
A. LV dilatation with hyperkinesis
B. RV dilatation with paradoxical septal motion

Hemodynamics

Determine MR regurgitant volume (RV), regurgitant fraction (RF), effective regurgitant orifice (ERO) using the following measurements (Pocket Reference page 347, 348)

LVOTd: 2.0 cm
LVOT VTI: 15 cm
MV annulusd (diastole): 3.0 cm
MV VTI: 20 cm
MR VTI: 150 cm

RV: ___________ml Severity: ____________ (Pocket Reference page 16)

RF: ___________% Severity: _____________ (Pocket Reference page 16)

ERO: _________ cm2 Severity: _____________ (Pocket Reference page 16)

Vascular (Peripheral)

The ABI for the following patient was 1.0.

CFA: 100 cm/s
Profunda: 76 cm/s
SFA proximal: 88 cm/s
SFA mid: 78 cm/s
SFA distal: 67 cm/s
Popliteal: 65 cm/s

Severity: _________________%

NO Class 03/15/10

2010-03-08T08:24:00.001-08:00

No written test this week as there is no class on 03/15/10.

ANSWERS 03/08/10

2010-03-08T07:42:00.001-08:00

Ultrasound Physics
1. C
2. A,B,C
3. A
4. B
5. A
6. B
7. A,B,C
8. A
9. True
10. True
11. True
12. True
13. True
14. True
15. True
16. True

Cardio Principles
1. C
2. C
3. B
4. A
5. A
6. A
7. A
8. A,C
9. A
10. A

Adult Echo
1. F
2. True
3. C
4. C
5. B
6. none should be marked
7. D
8. True
9. A

Cardiac transplantation
10. True
11. True
12. True

Hemodynamics
1. 44, moderate
2. .9, severe
3. .47, severe
4. .78 severe
5. 47, 47cc

Vascular Ultrasound Peripheral Arterial
1. Severe

Written Test due 03/08/10

2010-03-02T08:00:00.000-08:00

Written Test Name: _______________

Ultrasound Physics Bioeffects and Safety

1. The best way to practice ALARA is reduce (more than one correct answer):
A. Receiver gain
B. Time gain compensation (TGC)
C. Transmit gain
D. Scan time

2. Which of the following may lead to bioeffects? (more than one correct answer)
A. Thermal
B. Cavitation
C. Direct mechanical
D. Wavelength

3. ____________ cavitation is the expansion and contraction of a gas bubble which may result in microstreaming.
A. Stable
B. Transient

4. ___________ cavitation is the implosion of a gas bubble.
A. Stable
B. Transient

5. The ___________ index indicates the risk of cavitation and is always posted on the display screen because it is the preferred measure of bioeffects.
A. Mechanical (MI)
B. Thermal (TI)

6. The _________ index predicts the rise in temperature.
A. Mechanical (MI)
B. Thermal (TI)

7. The three thermal indexes are (more than one correct answer):
A. TIS
B. TIC
C. TIB

8. A less than ___________ degree C increase in temperature is assumed to be safe.
A. 2
B. 3
C. 4
D. 5

9. True or False: There have been no proven bioeffects for unfocused beams less than 100 mW/cm2 SPTA or focused beams 1 W/cm2 SPTA.

10. True or False: The maximum intensity for modern ultrasound equipment is 720 mW/cm2 SPTA.

11. True or False: CW Doppler presents the highest risk for thermal bioeffects because it is nonscanned.

12. True or False: Hydrophones are commonly used to evaluate power.

13. True or False: In vitro implies “in a tube.”

14. True or False: In vivo implies animal or plant.

15. True or False: Epidemiology is the study of the prevalence of disease.

16. True or False: A cracked transducer will lead to electrical shock to the patient.

Cardiovascular Principles Review: Cardiac Evaluation Methods Review (cont.)

1. The pulse associated with cardiac tamponade (drop of blood pressure with inspiration) is called:
A. Pulsus alternans
B. Pulsus bisfierens
C. Pulsus paradoxus
D. Pulsus parvus et tardus

2. A S ________ is an abnormal early diastolic heart sound indicating increased diastolic filling (e.g.; severe MR, AR)
A. 1
B. 2
C. 3
D. 4

3. A mid-systolic click with a late systolic murmur suggests:
A. MS
B. MVP
C. Flail
D. Cleft

4. A fixed split S2 suggests an:
A. ASD
B. VSD
C. PDA
D. Coarctation

5. A systolic ejection murmur (SEM) suggest:
A. AS
B. MS
C. TS
D. Coarctation

6. A holosystolic murmur heard best at the cardiac apex suggests:
A. MR
B. TR
C. PR
D. AR

7. All of the following are diastolic murmurs EXCEPT:
A. AS
B. MS
C. AR
D. PR

8. A continuous (machinery-like) murmur my suggest (more than one correct answer):
A. PDA
B. ASD
C. Sinus of Valsalva aneurysm (ruptured)
D. VSD

9. ST segment elevation on EKG suggests:
A. Acute injury (infarction)
B. Ischemia

10. ST segment depression suggests:
A. ischemia
B. Infarction

Adult Echo: Diseases of the Aorta

1. The most common location for aortic aneurysm is the:
A. Aortic root
B. Ascending aorta
C. Aortic arch (transverse aorta)
D. Aortic isthmus
E. Descending thoracic aorta
F. Abdominal aorta (infra-renal)

2. True or False: In general, the top normal dimensions of the aorta are: Ascending aorta: 4.0 cm; Aortic arch (transverse aorta): 3.5 cm; Descending thoracic aorta: 3.0 cm; Abdominal aorta: 3.0 cm.

3. Expansion or dilatation of the aorta which measures normally is called:
A. Aneurysm
B. Dissection
C. Ectasia
D. Idiopathic

4. A tear in the intimal lining of an artery is called:
A. Coarctation
B. Prolapse
C. Dissection
D. Tumor

5. An aortic dissection is confined to the ascending aorta. This is a DeBakey type:
A. I
B. II
C. III

6. Check the following if NOT associated with aortic dissection:
_______ Marfan’s syndrome, systemic hypertension, bicuspid aortic valve, iatrogenic
_______ Aortic dilatation
_______ Intimal flap
_______ True and false lumen
_______ Pericardial effusion (ominous sign)
_______ Pleural effusion (ominous sign)
_______ Aortic regurgitation
_______ Rupture of the aorta
_______ Medical emergency

7. All of the following are types of supravalvular aortic stenosis (SAS) EXCEPT:
A. Hourglass (most common)
B. Membranous
C. Strand
D. Hypertrophic

8. True or False: SAS hourglass type is common in Williams syndrome.

9. The most common location for sinus of Valsalva aneurysm (ruptured or unruptured) is:
A. Right
B. Left
C. Non

Cardiac Transplantation

10. True or False: Biatrial dilatatation is a normal finding for cardiac transplantation.

11. True or False: The echo findings which may suggest cardiac transplant rejection include reduced global/segmental systolic function, ventricular hypertrophy (increased mass), severe valvular regurgitation, diastolic dysfunction and pericardial effusion.

12. True or False: The evaluation of diastolic function is difficult in transplant because there are two SA nodes present.

Hemodynamics Review

1. Determine the peak systolic pressure gradient for an AS patient with a peak systolic velocity of 3.3 m/s: ___________ mm Hg Severity: __________ (Pocket Reference page 35)

2. Determine the MVA for a pressure half time of 198 msec. ________ cm2 Severity: _______ (Pocket Reference page 9)

3. Determine AVA: LVOT diameter: 2.0 cm; LVOT VTI: 20 cm; AoV VTI: 100 cm: AVA: _________ Severity: _____________

4. Determine AVA: LVOT diameter: 2.0 cm; LVOT peak velocity: 1.0 m/s; AoV peak velocity: 4 m/s: __________cm2 Severity _________

5. The LVOT diameter is 2.0 cm. The LVOT VTI is 20 cm. The SV is: _________. Normal: ______

Questions You Have!

1. ________________________________________________

2. _________________________________________________

3. _________________________________________________

4. __________________________________________________

5. __________________________________________________

Vascular Ultrasound Peripheral Arterial

The following peak velocities were obtained:

Severity: __________ (Pocket Reference page 416)

Common femoral (CFA): 100 cm/s
Proximal superficial femoral (SFA): 90 cm/s
Mid-SFA: 380 cm/s
Distal SFA: 88 cm/s
Popliteal: 70 cm/s

ANSWERS 03/01/10

2010-03-01T07:26:00.000-08:00

Ultrasound Physics

1. Reverberation

2. Refraction

3. False

4. Side , grating

5. grating

6. ring

7. Comet Trail

8. far

9. Shadowing

10. Enhancement

Cardio Principles

1. C

2. B

3. A

4. D

5. A

6. B

7. B

8. D

9. B

10. E

Adult Echo CHD

1. C

2. B

3. all should be marked

4. B

5. C

6. C

7. A

8. C

9. C

10. C

11. C

12. B

13. E

Hemodynamics

1. 3.0:1

2. 1:1

3. 2:1

Peripheral Vascular Ultrasound

1. Claudication

2. True

3. True

4. Mod. occlusion

Identify following

1. Aorta

2. Cia

3. External iliac

4. Internal iliac

5. CFA

6. Deep profunda

7. SFA

8. Popliteal

9. Anterior tibial

10. trunk

11. posterier tibial

12. peroneal

Written Test due 3/1/10

2010-02-23T08:14:00.000-08:00

Written Test Name: ___________________

Ultrasound Physics Artifacts

1. _________________ are multiple echoes equally spaced usually located close to the transducer.

2. ________________ is the change in the direction of sound travel and may result in lateral displacement and duplicate structures (e.g. two aortic valves in the parasternal short axis of the aortic valve).

3. True or False: There is no such artifact called resolution artifact.

4. ___________ lobes and ____________ lobes are extraneous sound energy.

5. ____________ lobes originate from electronic transducers.

6. ____________ down is a type of reverberation artifact associated with a gas bubble.

7. ______________ is a type of reverberation artifact associated with a highly reflective structure (e.g.; bullet)

8. The propagation speed of a material is 1480 m/s. The structure will be placed too __________ from the transducer.

9. ______________ involves a highly attenuating structure (e.g.; calcium, PHV) which results in low amplitude echoes.

10. __________ involves a low attenuating structure which results an increase in brightness.

Cardiovascular Principles REVIEW! Cardiac Evaluation Methods

1. A patient presents with chest pain radiating to the back and a normal EKG. The most likely diagnosis is:
A. Acute MI
B. Pericarditis
C. Aortic dissection
D. Myxoma

2. The general wasting away due to long standing heart disease is called:
A. Downs
B. Cachexia
C. Amaurosis fugax
D. TIA

3. The most common cause of CHF is:
A. Systolic dysfunction due to CAD
B. Pressure overload (e.g.; systemic hypertension)
C. Volume overload (e.g.; severe MR, severe AR)
D. Diastolic dysfunction

4. Right heart failure due to pulmonary disease is called:
A. CHF
B. Cachexia
C. Amaurosis fugax
D. Cor pulmonale

5. All of the following may result in pulmonary edema EXCEPT:
A. Significant TR
B. Acute MI
C. Severe acute MR
D. Ruptured papillary muscle

6. A patient presents with fever, chills, new murmur and positive blood cultures. The sonographer should especially evaluate for:
A. Dissection
B. Vegetation
C. Valve stenosis
D. LV pseudoaneurysm (false aneurysm)

7. The depression of the sternum towards the spine is called:
A. Pectus carinatum
B. Pectus excavatum
C. Scoliosis
D. Kyphoscoliosis

8. Jugular venous distention may be caused by all of the following EXCEPT:
A. Severe TR
B. Constrictive pericarditis
C. Cardiac tamponade
D. MAC

9. The coughing or spitting up of blood is called:
A. Hemolysis
B. Hemoptysis
C. Hypertension
D. Heart block

10. Which of the following is associated with syncope (Pocket Reference page 276)?
A. AS
B. HOCM
C. Myxoma
D. Acute MI
E. All of the above

Adult Echo Congenital Heart Disease (CHD)

1. The view of choice for ASD is:
A. Parasternal long axis
B. RA-RV view
C. Subcostal four chamber
D. Suprasternal long axis

2. RV dilatation with paradoxical septal motion represents:
A. LVVO
B. RVVO

3. Check the following if required in determining Qp/Qs: (Pocket Reference page 355, 356)
_____ LVOT diameter (early systole)
_____ LVOT VTI (PW Doppler)
_____ RVOT diameter (early systole)
_____ RVOT VTI (PW Doppler)

4. There is an ostium primum ASD, inlet VSD with a common AV valve. The diagnosis is:
A. Marfans
B. Complete AV canal (complete endocardial cushion defect)
C. Tetralogy of Fallot
D. Truncus arteriosus

5. The most common type of VSD is perimembranous. It may be closed with TV tissue creating a:
A. Pseudoaneurysm
B. True aneurysm
C. Ventricular septal aneurysm (VSA)
D. Hematoma

6. The systolic blood pressure is 120 mm Hg. The peak systolic velocity of a perimembranous VSD is 5.0 m/s. The RVSP and SPAP is (Pocket Reference page 334):
A. 120 mm Hg
B. 5 mm Hg
C. 20 mm Hg
D. 30 mm Hg

7. A continuous (machinery-like) murmur is heard. The most likely diagnosis is:
A. PDA
B. MVP
C. ASD
D. VSD

8. The view of choice for Ebstein’s anomaly is the:
A. Parasternal long axis
B. RA-RV
C. Apical four
D. Suprasternal long axis

9. Valvular pulmonary stenosis is a:
A. RV volume overload
B. LV volume overload
C. RV pressure overload
D. LV pressure overload

10. The combination of RVH, over-riding aorta, mal-alignment VSD and RVOT obstruction is called:
A. Truncus Arteriosus
B. DSS
C. TOF
D. MVP

11. The CW Doppler pattern for aortic coarctation is called:
A. To and fro
B. Continuous
C. Saw-tooth
D. Abbreviated

12. The reversal of a shunt due to increased pulmonary vascular resistance is called _______ syndrome.
A. Marfans
B. Eisenmengers
C. Downs
D. Turners

13. A thin membrane is located beneath the aortic valve. This suggests: (Pocket Reference page 253)
A. ASD
B. VSD
C. PDA
D. TOF
E. DSS

Hemodynamics

1.Determine the Qp/Qs for an ASD (Pocket Reference page 355-356)
LVOT diameter: 2.0 cm
LVOT VTI: 15 cm
RVOT diameter: 3.0 cm
RVOT VTI: 20 cm

Qp/Qs: ______________

Normal Qp/Qs: _____________

Significant Qp/Qs: ___________

Peripheral Vascular Ultrasound

1. “Leg pain” is called: ___________________

2. True or False: Blue toe syndrome indicates that an abdominal aorta exam is required.

3. True or False: The normal ABI is 1.0

4. An ABI of .60 is acquired. This suggests: ________________ (Pocket Reference page 431)

5. Identify the anatomy shown below:

ANSWERS 02/22/10

2010-02-22T07:58:00.000-08:00

Ultrasound Physics: Color Flow Doppler

1. "Red ALWAYS indicates flow towards the transducer" should be marked

Review

1.D

Cardiovascular Principles Review

1. A

2. C

3. B

4. C

5. D

6. C

7. A

8. A

9. A

10. all choices should be marked

Adult Echo LV Systolic and Diastolic Function

1. 57

2. No

3. 75

4. Yes

5. moderate

6. severe

7. Yes

8. 4-8

9. 11

10. moderate

11. moderate

15. True

16. True

17. 8; 715

BONUS

1. Yes

2. Yes

Carotid Ultrasound

Right: less than 50%

Left: 50-69%

Written Test 2/22/10

2010-02-16T09:29:00.000-08:00

Written Test Name: ____________________

Ultrasound Physics: Color Flow Doppler (VIP!!!!!!!!!!!!!)

1. Check the following if NOT TRUE concerning color flow Doppler:
_________ PW Doppler technique
_________ Multigate
_________ Displays the mean velocity
_________ Aliasing (apparent flow reversal) will occur even with normal flow present
_________ PRF is lower then PW Doppler and imaging
_________ Frame rates are lower than imaging
__________Black represents no Doppler shift detected
__________ Red ALWAYS indicates flow towards the transducer
__________ Packet size is the number of pulses used to create one line of color
__________ A minimum packet size of three is needed to create one line of color
_________ Uses a rapid technique called autocorrelation to convert Doppler shift information into color
_________Mosaic represents disturbed/turbulent flow
_________ With variance map on, green represents disturbed/turbulent flow
_________ Ghosting/flash artifact is the placement of color flow on tissue
_________ Decreasing image depth, decreasing the field of view, decreasing packet size, decreasing scan line density increases color flow Doppler frame rate

REVIEW QUESTION

1. Axial resolution is dependent upon all of the following EXCEPT:
A. Transmit frequency
B. Spatial pulse length (SPL)
C. Pulse duration (PD)
D. Beam width

Cardiovascular Principles REVIEW Cardiac physiology (cont.)

1. Which has a greater resistance?
A. Systemic circulation
B. Pulmonary circulation

2. The pulmonary wedge pressure (PWP) is a __________ heart catheterization which predicts ________ heart pressures.
A. Left; left
B. Right; right
C. Right; left
D. Left; right

3. Between which two cardiac chambers the pressure gradient the greatest?
A. LA and LV diastole
B. LA and LV systole
C. RA and RV systole
D. RA and LA systole

4. The oxygen saturation of the pulmonary veins is _________?
A. 5
B. 60
C. 98
D. 100

5. The strain phase of the Valsalva maneuver _____________ venous return while the release phase_________ venous return.
A. Decreases; decreases
B. Increases; increases
C. Increases; decreases
D. Decreases; increases

6. The Valsalva strain phase is most useful for the sonographer to use when evaluating:
A. PFO with saline contrast injection
B. ASD with saline contrast injection
C. HCM
D. MVP

7. Inspiration ___________ venous return.
A. Increases
B. Decreases

8. With normals, inspiration ____________ TV flow and ___________ MV flow.
A. Increases; decreases
B. Decreases, decreases
C. Increases; increases
D. Decreases; increases

9. The normal heart sound S ____________ is a result of MV and TV closure.
A. 1
B. 2
C. 3
D. 4

10. Check the following of correct concerning the coronary arteries:
_________ Flow primarily occurs during diastole
_________ 70% diameter reduction suggests severe CAD
_________ LAD supplies the anterior IVS, anterior LV and cardiac apex
__________ Circumflex supplies the lateral wall of the LV
__________ PDA (most often a branch of the RCA) supplies the inferior IVS, inferior LV, inferior RV
__________ LAD lies in the anterior interventricular sulcus
__________ Kawasaki’s may result in coronary artery aneurysm

Adult Echocardiography LV Systolic and Diastolic Function

1. Determine the fractional shortening: LVIDd: 7.0 cm; LVIDs: 3.0 cm. ________%

2. Yes No Is the above normal (assume male) (Pocket Reference page 177)

3. Determine the EF: EDV = 100 ml; ESV = 25 ml: _________% Is it normal? _____

4. Yes No The ejection fraction for a female is 53%. Is this normal? (Pocket Reference page 177)

5. Yes No The IVSd and LVPWd measure 1.4 cm for a male. How severe is the concentric LVH? (Pocket Reference page 178) ___________

6. Yes No The LVIDd measures 6.8 cm for a female. How severe is the LV dilatation? (Pocket Reference page 177) ___________

7. Yes No The LV mass adjusted for BSA measured 100g/m2 for a male. Is this normal? (Pocket Reference page 178)

8. The normal cardiac output is __________ lpm.

9. The top normal peak velocity for the LVOT is: _____________ m/s. (Pocket Reference page 330).

10. The LA diameter measured for a female was 4.4 cm. This indicates ____________ LAE (Pocket Reference page 175).

11. The LA volume adjusted for BSA measured 38 ml/m2. This is ___________ LAE. (Pocket Reference page 175)

12. Draw grade 1 (PW and TDI) ____________________________

13. Draw grade II (pseudonormal) (PW and TDI):_____________________

14. Draw grade III (restrictive): PW and TDI): ___________________________

15. True or False: Placement of the PW Doppler sample volume can alter the E/A ratio and the E/A ratio should be confirmed with CW Doppler.

16. True or False: LAE is an important indicator of heart disease.

17. A(n) E/E’ of less than ___________ suggest normal filling pressures while a E/E’ of ________suggests increased filling pressures.

BONUS:

1. Yes No: Can you measure dP/dT (Pocket Reference page 349)

2. Yes or No: Can you measure index of myocardial performance (IMP)? (Pocket Reference page 368)

Carotid Ultrasound

RIGHT: _______________ LEFT: ____________

ANSWERS 02/15/10

2010-02-15T08:22:00.000-08:00

Ultrasound Physics: DOPPLER

1. A

2. D

3. B

4. 100

5. yes

6. A,B,C

7. A

8. C

9. A

10. H

11. B

12. B

13. A

14. A

15. A thru G should be circled "all" of them

16. True

Review Question

1. C

Cardiovascular Principles Review

1. Check the follow if UNTRUE: NONE should be checked

2. E

Adult Echocardiography Cardiac Tumors/Masses

1. A

2. E

3. B

4. F

5. B

6. A, B, C, D

7. C

8. A

9. All of them should be marked

Diatology Review

Bonus:

All should be marked

Written Test 02/15/10

2010-02-09T08:14:00.000-08:00

Written Test Name: ____________

Ultrasound Physics: DOPPLER (VIP!!!!!!!!!!!!)

1. The Doppler ____________ states that there will be a change in the frequency of sound relative to the motion of the source and/or the observer.
A. Principle (effect)
B. Shift

2. When will there be no Doppler effect?
A. Stationary source, moving observer
B. Moving source, stationary observer
C. Moving source, moving observer
D. Stationary source, stationary observer

3. The Doppler _____________ is the difference between the transmit frequency and the receive frequency.
A. Principle (effect)\
B. Shift

4. Calculate the Doppler shift: Transmit frequency: 2,000,000 Hz; Received frequency: 2,001,000. ________________ Hz

5. Is the above Doppler shift in the audible range? ________

6. According to the Doppler equation, the magnitude of the Doppler shift is dependent upon: (more than one correct answer):
A. Velocity of the red blood cells
B. Transmit frequency
C. Doppler incident angle
D. Transducer type

7. The best incident angle to maximize the Doppler shift is: ______ degrees because the cosine is 1.
A. 0
B. 60
C. 90
D. 120

8. The best incident angle for imaging is:
A. 0
B. 60
C. 90
D. 120

9. The ____________ is the method of spectral analysis for conventional Doppler.
A. FFT
B. Autocorrelation

10. Which of the following information is provided by the FFT?
A. Time (x axis)
B. Velocity (y axis)
C. Shades of gray (spectral strength) (z axis)
D. Flow direction
E. Peak velocity
F. Mean velocity
G. Mode (modal) velocity
H. All of the above

11. Spectral broadening which results in window fill-in suggests ___________ flow.
A. Laminar
B. Turbulent

12. A Doppler high pass filter eliminates: _____________ and ________________ signals.
A. Low amplitude, high velocity
B. High amplitude. low velocity

13. All of the following are TRUE concerning CW Doppler EXCEPT:
A. One piezoelectric element
B. Primary advantage is able to resolve high velocity flow (no aliasing)
C. Primary disadvantage is range ambiguity

14. All of the following are TRUE concerning PW Doppler EXCEPT:
A. Two piezoelectric elements
B. Primary advantage is range resolution (range discrimination)
C. Primary disadvantage it has a inherent sampling rate (aliasing)

15. How may the sonographer avoid aliasing (more than one correct answer)?
A. Alter the velocity scale (PRF) (VIP clinically)
B. Reduce image depth (increases PRF) (theory)
C. Reduce the transmit image frequency (reduces the Doppler shift) (theory)
D. Shift the baseline (VIP clinically)
E. Increase the incident angle (not recommended)
F. Use high PRF (VIP clinically)
G. Use CW Doppler (VIP clinically)

16. True or False: You cannot pass the SPI exam without doing well in the Doppler section.

REVIEW QUESTION
1. When will refraction occur?
A. Perpendicular incidence; propagation speeds of the two media are equal
B. Oblique incidence; the impedance values of the two media are different
C. Oblique incidence; the propagation speeds of the two media are unequal
D. Perpendicular incidence; the two impedances are unequal

Cardiovascular Principles Review: Cardiac Physiology

Check the following if UNTRUE: ______ Automaticity suggest the heart has the ability to begin and maintain rhythmic activity
______ Calcium causes contraction to occur
______ There will be no response during the absolute refractory period
______ Starling is the law of the heart
______ Increase preload, increase length, increase tension (contraction)
______ Preload is represented by the EDV or EDP of a chamber
______ Afterload is the resistance to the ejection of blood
______ CO = SV x HR
______ SV by Doppler is CSA x VTI
______ SV by M-mode or 2-D is EDV - ESV

2. Which intracardiac pressure is incorrectly matched?
A. RA: 0 to 8 mm Hg
B. RVSP: 18 to 25 mm Hg (less than 30 mm Hg)
C. SPAP: 18 to 25 (less than 30 mm Hg)
D. LA: 4 to 12 mm Hg
E. LV: 120/80 mm Hg
F. Aorta (BP): 120/80 mm Hg

Adult Echocardiography Cardiac Tumors/Masses

1. The most common primary benign intracardiac tumor in the adult is the:
A. Myxoma
B. Papilloma
C. Lipoma
D. Fibroma

2. The most common primary benign intracardiac tumor in the child is the :
A. Myxoma
B. Papilloma (papillary fibroelastoma)
C. Lipoma
D. Fibroma
E. Rhabdomyoma

3. The most common primary cardiac valve tumor is the:
A. Myxoma
B. Papilloma (papillary fibroelastoma)
C. Rhabdomyoma
D. Sarcoma

4. The most common primary malignant tumor in the adult is the:
A. Myxoma
B. Papilloma
C. Lipoma
D. Fibroma
E. Rhabdomyoma
F. Sarcoma

5. The most common tumor of the heart is:
A. Primary
B. Metastatic (secondary)

6. Which of the following are TRUE concerning myxoma (more than one correct answer)?
A. Most often located in the LA
B. Most commonly attach to the IAS in the region of the fossa ovalis
C. May result in functional MS
D. Medical emergency

7. The interatrial septum (IAS) appears to be thick except in the area of the fossa ovalis. This suggests:
A. Myxoma
B. Fibroma
C. Lipomatous hypertrophy
D. Rhabdomyoma

8. Carcinoid heart disease most likely will result in all of the following EXCEPT:
A. AS
B. TR
C. Functional TS
D. PR
E. Functional PS

9. Check the following if a possible intracardiac mass or could be mistaken as a mass:
_________ Tumor
_________ Vegetation
_________ Valve excrescence (Lambl’s)
_________ Thrombus
_________ Ectopic chordae
_________ Chiari network
_________ Eustachian valve
_________ Crista terminalis
_________ Pacer wire
_________ Pectinate muscle (atria)
_________ Adipose tissue (especially in the region of the TV annulus)
_________ Moderator band
_________ Trabeculations (ventricles)

Diastology Review

Draw the PW Doppler and TDI for the following:

1. Grade 1: _________________________________

2. Grade 2: _________________________________

3. Grade 3: ______________________________

BONUS
Check the systolic function formula if correct:
__________ FS: LVIDd – LVIDs / LVIDd x 100
__________ EF: LVEDV – LVESV / LVEDV x 100
__________ SV: EDV – ESV
__________ SV: CSA x VTI
__________ CO: SV x HR__________ CI: CO/BSA

Answers 02/08/10

2010-02-08T07:34:00.000-08:00

Written Test
Ultrasound Physics
1. "all" should be marked
2. D
3. "all" should be marked
4. C
5. A
6. B
7. B
8. C, D, E
9. True
10 True
11. True

Review
1. C

Cardiovascular Principles (CHD)
1. B
2. C
3. A
4. F
5. C
6. E
7. True
8. E
9. C
10. C
11. B

Adult Echo Coronary Artery Disease
1. Ischemic
2. Infarction
3. B
4. C
5. B
6. "all" should be marked
7. C
8. True
9. True
10. True
11. True
12. True
13. Yes
14. Yes
15. Yes

Bonus
1. A

Carotid Ultrasound TOP 5
1. True
2. True
3. True
4. True
5. True

AHI Report Sheet
Right: Total occlusion
Left: 50-69%

Written test 2/8/10

2010-02-02T08:02:00.000-08:00

Written Test Name: ________________

Ultrasound Physics

1. Check the following if a component of an ultrasound machine:
_______Transducer
_______ Pulser
_______ Receiver
________Memory
________ Display

2. The ___________ is the heart of the memory.
A. Transducer
B. Pulser
C. Receiver
D. Digital scan converter
E. Display

3. Check the following if TRUE concerning the digital scan converter (memory):
_______ It is a computer.
_______It uses the binary number system.
_______The two symbols of the binary system are 0, 1
_______ The binary number column are multiples of 2
_______ The memory is made up of a series of checkerboards called a matrix(s).
_______ One matrix (checkerboard) is made up of 262,144 pixels
_______ One pixel can store one binary digit (either a 0 or 1)
_______ Increasing the number of bits per pixel can increase the number of shades of gray (2x)

4. Predict the number of shades of gray a 3 bit memory can hold and display.
A. 2
B. 4
C. 8
D. 16

5. __________ occurs before memory.
A. Preprocessing
B. Postprocessing

6. __________ occurs in the memory or after memory.
A. Preprocessing
B. Postprocessing

7. The sonographer freezes the image to measure the EF using Simpson’s biplane MOD. _________ is being used.
A. Preprocessing
B. Postprocessing

8. Which of the following allow the sonographer to choose the number of shades of gray that will be displayed? (more than one correct answer)
A. Transmit frequency
B. PRF
C. Postprocessing
D. Compression
E. Dynamic range

9. True or False: The ADC allows conversion of the analog signal coming from the tissue into a number (digital) which allows storage of that signal in memory.

10. The DAC allows conversion of the binary number coming out of memory into a(n) analog signal that can be displayed.

11. True or False: I can explain the diagram shown on page 26 page of the SCU workbook.

REVIEW QUESTION
1. Of the following gains listed, which is the only gain which increases the risk of bioeffects?
A. Receiver gain
B. Overall gain
C. Transmit gain
D. Time gain compensation (TGC)

Cardiovascular Principles REVIEW: Congenital Heart Disease (CHD)

1. A hole in the central portion of the interatrial septum is found. This type of ASD is:
A. Ostium primum
B. Ostium secundum
C. Sinus venosus
D. Coronary sinus type

2. The sonographer notices that the RA and RV are increased in dimension. All of the following should be included in the differential diagnosis EXCEPT:
A. ASD
B. VSD (initially)
C. Ebstein’s anomaly
D. Uhl’s anomaly
E. Significant TR

3. A VSD is found beneath the right coronary aortic valve cusp. The type of VSD present is:
A. Perimembranous
B. Inlet
C. Outlet
D. Trabecular
E. Malalignment

4. All of the following are TRUE concerning VSD EXCEPT:
A. Most common is perimembranous
B. Initially a left heart volume overload (LAE, LVE)
C. May eventually result in a RV pressure overload (Eisenmenger’s)
D. May be closed surgically with a patch
E. Perimembranous and outlet may result in AR
F. Medical emergency

5. All of the following are TRUE concerning aortic coarctation EXCEPT:
A. Most often located at the aortic isthmus
B. Considered a left ventricular pressure overload resulting in concentric LVH
C. Subcostal 4 chamber is view of choice
D. May present as systemic hypertension
E. Bicuspid aortic valve is a common finding (up to 80%)
F. Balloon angioplasty may be treatment

6. The four defects of tetralogy of Fallot include all of the following EXCEPT:
A. RVH
B. Overriding aorta
C. Malalignment VSD
D. RVOT obstruction (e.g., PS)
E. Ostium secundum ASD

7. True or False: PFO has been implicated in stroke (CVA), TIA and migraine headaches.

8. All of the following are TRUE concerning Ebstein’s anomaly EXCEPT:
A. Defined as abnormal displacement of the TV towards the cardiac apex with RV dysplasia
B. TR is common
C. Functional TS is common
D. PFO/ASD is common
E. Parasternal long axis is the view of choice to evaluate

9. Which of the following would NOT result in Eisenmenger’s?
A. Ostium primum ASD
B. Outlet VSD
C. Aortic coarctation
D. Patent ductus arteriosus

10. ________________ syndrome may result in coronary artery aneurysm.
A. Downs
B. Marfans
C. Kawasaki
D. Turners

11. ______________ syndrome is strongly associated with aortic coarctation.
A. Williams
B. Turners
C. Noonans
D. Kawasaki

Adult Echocardiography Coronary Artery Disease (CAD; Ischemic Heart Disease)

1. ____________ is the lack of blood flow to the heart.

2. ____________ is the death of myocardial tissue.

3. The most important finding in echo for CAD is:
A. Wall motion
B. Systolic wall thickening
C. Diastolic wall thickness

4. A wall score of 3 represents:
A. Normal or hyperkinetic
B. Hypokinetic
C. Akinetic
D. Dyskinetic
E. Aneurysm

5. A patient presents with Dressler’s syndrome. The sonographer should look for:
A. MVP
B. Pericardial effusion
C. Myxoma
D. Aortic dissection

6. Check the following if a possible complication of CAD:
_________ CHF
_________ Ischemic cardiomyopathy
__________ MR
__________ Pericardial effusion
__________ Dressler’s syndrome
__________ True aneurysm
__________ Pseudoaneurysm (false aneurysm)
__________ Thrombus
__________ Ventricular septal rupture (VSR)
__________ RV infarction

7. Where are most true aneurysm’s and pseudoaneurysm’s located?
A. Basal LV
B. RV
C. Cardiac apex
D. Inferior IVS

8. True or False: There must be a wall motion abnormality(SWMA, RWMA) present in order to call a thrombus present.

9. True or False: Papillary muscle dysfunction (PMD) is a general term that may infer papillary muscle fibrosis/calcification, LV dilatation or partial/complete rupture.

10. True or False: The two types of stress echocardiography are exercise (e.g., treadmill) or pharmacological (e.g., Dobutamine).

11. True or False: The primary finding for a positive stress echo is a new or worsening systolic wall motion abnormality.

12. True or False: The standard 2-D views for stress echo (pre and post) are parasternal long axis, parasternal short axis of the LV, apical four chamber and apical two chamber.

13. Can echocardiography visualize the proximal right and left coronary arteries? Yes or No

14. Can transpulmonary contrast (e.g., Definity; Optison) aid in the evaluation of segmental wall motion abnormalities?

15. Is diastolic dysfunction common in CAD? Yes or No

BONUS!
1. The most common primary benign intracardiac tumor in the adult is:
A. Myxoma
B. Rhabdomyoma
C. Sarcoma
D. Lipoma

Carotid Ultrasound TOP 5

1. True or False: The primary goal of a carotid exam is to determine the presence of atherosclerosic plaque, its location and its severity.

2. True or False: Once plaque is noted during the exam, 2-D and Doppler must be used to categorize the severity using the Concensus Criteria (Pocket Reference page 396).

3. The CCA, ICA, vertebral are low resistance vessels (increased diastolic flow) and the ECA is a high resistance vessel (minimal diastolic flow).

4. The treatment for carotid artery disease is endarterectomy or balloon with stent.

5. True or False: The primary goal of the vertebral exam is to determine the presence of subclavian steal syndrome.

BONUS: Are you ready for Gail Size????????Yes No

AHI Report Sheet

Right %ICA stenosis: ____________ Left %ICA stenosis: ____________

ANSWERS 02/01/10

2010-02-01T07:57:00.000-08:00

1. A
2. B
3. E
4. A
5. C
6. C
7. C
8. E
9. C
10. False
11. True

Review Questions
1. E

SPI Registry Review
1. B
2. C
3. A
4. A
5. 1 db/cm , 5

Cardiovascular Principles Cardiac Embryology REVIEW
1. C
2. A
3. D
4. B
5. C
6. True
7. True
8. True
9. False

Adult Echo: Cardiomyopathy
1. ALL should be marked
2. ALL should be marked
3. only "Normal diastolic function is usually present" should be marked
4. "Normal diastolic function" and "Won't be able to make the TOPS HCM screening on May 1
5. only "Normal EKG" should be marked
6. True
7. True

Carotid Duplex Scanning
1. True
2. True
3. True
4. True
5. True
6. ALL should be marked
7. ALL should be marked
8. True
9. True
10. True

Right ICA Stenosis: greater than 70% Left ICA Stenosis: 50-69%

Written Test 02/01/10

2010-01-26T07:46:00.000-08:00

Written Test Name: __________________

1. ___________ represents returning echoes as spikes with the taller the spike the greater the strength of the returning echo.
A. A
B. B
C. C
D. D
E. M

2. ____________ mode represents returning echoes as bright dots with the brighter the dot the greater the returning amplitude of the echo.
A. A
B. B
C. C
D. D
E. M

3. _________ mode uses B-mode to represent the motion of the reflectors, the distance of the reflectors in respect to time.
A. A
B. B
C. C
D. D
E. M (T-M-mode)

4. A _____________ is a collection of pulses.
A. Frame
B. Display
C. Cathode ray tube
D. Computer screen

5. A frame contains approximately ______________ scan lines (pulses).
A. 1
B. 10
C. 100
D. 500

6. The standard frame rate is ____________ Hz (fps).
A. 1
B. 10
C. 30
D. 100

7. _____________ resolution is improved by increasing the frame rate.
A. Axial (LARRD)
B. Lateral (LATA)
C. Temporal
D. Contrast
E. Elevational (slice thickness)

8. How may the sonographer increase the frame rate which improves temporal resolution.
A. Decrease image depth
B. Decrease the field of view
C. Decrease the number of focuses
D. Decrease line density
E. All of the above

9. TDI (tissue Doppler imaging) requires a high frame rate. How can you increase the frame rate when sampling the mitral valve annulus in the apical four chamber view with TDI?
A. Decrease image depth
B. Decrease field of view
C. Both A and B
D. None of the above

10. True or False: The frame rate is generally higher when using color flow Doppler.

11. True or False: Frame rate (temporal resolution) is important in echocardiography.

REVIEW QUESTION
1. All of the following physics “R” words are correctly defined EXCEPT:
A. Rarefaction: region of low pressure; low density
B. Reflection: sound energy returned to the source
C. Refraction: change in the direction of sound as it crosses a boundary
D. Reverberation: multiple echoes, equally spaced
E. All are correct

SPI Registry Review (List found in front of SCU Physics workbook)#1 – 6)
1. Sound is a mechanical, ____________ wave.
A. Transverse
B. Longitudinal
C. Shear
D. Refracted

2. All of the following are TRUE concerning sound EXCEPT:
A. Mechanical, longitudinal wave
B. Requires a medium
C. Audible range is less than 20 Hz
D. Clinical imaging frequency range is 2 to 15 MHZ

3. ____________ is the number of cycles which occur per second.
A. f
B. wavelength
C. T
D. c
4. As frequency increases, attenuation: __________
A. Increases
B. decreases
C. Remains the same
D. cannot be predicted

5. Determine the attenuation coefficient for the following frequencies:
2 MHz: _____________ db/cm
10 MHz: ___________

Cardiovascular Principles Cardiac Embryology REVIEW!

1. The heart appears on day __________ and is completely formed by day _____.
A. 1; 2
B. 2; 3
C. 23; 43
D. 110; 270

2. The heart tube normally loops anterior and to the _______.
A. Right
B. Left

3. The foramen ovale becomes the:
A. Ligamentum arteriosus
B. Ligamentum teres
C. Ductus arteriosus
D. Fossa ovalis

4. The ductus arteriosus becomes the:
A. Ligamentum teres
B. Ligamentum arteriosus
C. Conus
D. Endocardial cushions

5. The two components of the interatrial (IAS) septum are:
A. Membranous; muscular
B. Outlet; inlet
C. Septum primum; septum secundum
D. Truncus arteriosus; endocardial cushions

6. True or False: The endocardial cushions contribute to the formation of the atrioventricular (MV; TV) valves.

7. True or False: The truncus arteriosus becomes the aorta and pulmonary artery.

8. True or False: The bulbus cordis becomes the RV.

9. True or False: The shunt across the foramen ovale and ductus arteriosus in fetal circulation is left to right.

Adult Echocardiography: Cardiomyopathy (VIP!)

1. Check the following if a category (type) of cardiomyopathy:
_________ Dilated
_________ Hypertrophic
_________ Restrictive
_________ RV type
_________ Unspecified

2. Check the following if description of type is correct:
_____ Dilated: four chamber dilatation with reduced global LV systolic function
_____ Hypertrophic: Inappropriate (unexplained) hypertrophy (usually ASH)
_____ Restrictive: Abnormal diastolic function due to infiltrative/myocardial disease
_____ RV type: Uhl’s anomaly, ARVC, Ebstein’s anomaly are examples
_____ Unspecified: Noncompaction of the LV is an example

3. Check the following if UNTRUE for dilated cardiomyopathy:
________ Four chamber dilatation with reduced global LV systolic function
________ Etiologies include: idiopathic, familial, alcohol, viral, ischemic, post-partum
________ Thrombus is common finding (especially at the cardiac apex)
________ MR and TR are common findings (functional regurgitation)
________ Pulmonary artery pressures are important
________ Normal diastolic function is usually present

4. Check the following if UNTRUE concerning Hypertrophic cardiomyopathy (HCM)
_____ ASH is most common finding
_____ SAM causes the LVOT obstruction (HOCM)
_____ MR is common due to the SAM
_____ CW Doppler demonstrates “dagger-shaped” flow pattern
_____ Valsalva, Amyl nitrate may be required to reduce venous return and promote obstruction
_____ Normal diastolic function
_____ Most common cause of sudden death in young athletes
_____ Treatment includes propanolol, verapamil, alcohol ablation, myotomy/myectomy
_____ Won’t be able to make the TOPS HCM screening on May 1

5. Check the following if UNTRUE concerning cardiac amyloidosis
______ Most common restrictive cardiomyopathy in the US
______ Thick walls with ground glass appearance
______ Thick valves
______ Biatrial dilatation
______ Pericardial/pleural effusion
______ Abnormal diastolic function
______ Normal EKG

6. True or False: The primary characteristic of the RV type of cardiomyopathy (e.g., Uhl’s, ARVC) is RV dysplasia.

7. True or False: The primary findings of noncompaction of the LV is deep recesses of the LV especially at the cardiac apex with reduced global systolic ventricular function.

Carotid Duplex Scanning TOP 10!!!! (Pocket Reference Pages 379-396)

1. True or False: The primary goal in the ultrasound evaluation of the carotid arteries is to determine the presence, location and severity of atherosclerotic plaque.

2. True or False: The most common location for atherosclerotic plaque in the carotid artery is in the area of the carotid bulb and bifurcation.

3. True or False: Common reasons for a carotid ultrasound exam include CVA (stroke), TIA, carotid bruit, amaurosis fugax.

4. True or False: The treatment for significant internal carotid artery (ICA) disease is carotid endarterectomy (surgical) or balloon with stent (catheter)

5. True or False: Once total occlusion occurs, there is no surgical treatmentor /stent treatment possible.

6. Check the following if TRUE:
__________ The ICA is a low resistance vessel (increased diastolic flow)
__________ The ECA is a high resistance vessel (minimal diastolic flow)
__________ The CCA is a low resistance vessel (increased diastolic flow)
__________ The vertebral artery is a low resistance vessel (increased diastolic flow)

7. Check the following if a way to describe the ultrasound characteristics of plaque:
__________ Smooth; irregular; ulcerated
__________ Homogeneous; heterogeneous, calcific

8. True or False: Carotid IMT may be a way to predict the presence of coronary artery plaque.

9. True or False: Significant ICA stenosis is greater than 70%.

10. True or False: Subclavian steal results in flow reversal of the vertebral artery (usual left vertebral).

AHI Carotid Report
Right ICA stenosis: ___________ Left ICA stenosis: ______________

ANSWERS 01/25/10

2010-01-25T07:50:00.000-08:00

Ultrasound Physics
1. "all" should be marked
2. A
3. True
4. C
5. A
6. B
7. C
8. A
9. D
10. E
11. A

Review Questions
1. C

Cardiovascular Principles
1. NONE should be checked

Adult EchoSystemic Hypertestion (Htn) and Pulmonary Hypertension
1. ALL should be marked
2. ALL should be marked
3. B
4. Yes to all
5. Yes

Bonus
1. ALL should be marked

Diatstolic Function
1. True
2. True
3. I, PW / TDI
4. II, PW / TDI
5. III, PW/TDI
6. True

Carotid Duplex Scanning
1. NL (both)

Written Test 01/25/10

2010-01-19T07:24:00.000-08:00

Written Test Name: __________________

Ultrasound Physics

1. Check the following of a component of the ultrasound machine:
________ Transducer
________ Pulser
________Receiver
________Memory
________ Receiver
________ Display

2. The ______________delivers the electrical voltage (up to 100 V) to the transducer.
A. Pulser
B. Beam former
C. Receiver
D. ADC
E. Memory
F. DAC
G. Display

3. True or False: Only one pulse can travel in the body at one time. The pulser must wait for a pulse to return before sending out another pulse.

4. The _______________ provides amplification, compensation, compression, demodulation and rejection.
A. Pulser
B. Transducer
C. Receiver
D. Memory
E. Display

5. ____________ amplifies all signals regardless of depth.
A. Amplification (gain, receiver gain, overall gain)
B. Compensation (TGC, DGC)
C. Compression (dynamic range)
D. Demodulation
E. Rejection

6. ____________ compensates for attenuation.
A. Amplification (gain, receiver gain, overall gain)
B. Compensation (TGC, DGC)
C. Compression (dynamic range)
D. Demodulation
E. Rejection

7. ______________ reduces the dynamic range.
A. Amplification (gain, receiver gain, overall gain)
B. Compensation (TGC, DGC)
C. Compression (dynamic range)
D. Demodulation
E. Rejection

8. ________________ is the range of echo amplitudes displayed.
A. Dynamic range
B. Amplification
C. Compensation
D. Rejection

9. Rectification and smoothing are the two components of:
A. Amplification (gain, receiver gain, overall gain)
B. Compensation (TGC, DGC)
C. Compression (dynamic range)
D. Demodulation
E. Rejection

10. ______________ eliminates low level amplitude signals and noise.
A. Amplification (gain, receiver gain, overall gain)
B. Compensation (TGC, DGC)
C. Compression (dynamic range)
D. Demodulation
E. Rejection

11. The sonographer decides to increase the dynamic range or compression. The range of echo amplitudes seen on the display will:
A. Increase
B. Decrease
C. No change
D. Cannot be determined

REVIEW QUESTION

1. Which is the only type of focusing the sonographer may alter during an exam?
A. Internal
B. External
C. Transmit
D. Receive (dynamic)

Cardiovascular Principles
1. Check the following if NOT TRUE concerning cardiac anatomy:
________ Eustachian valve, Chiari network, crista terminalis are RA structures
________ RV: triangular, heavily trabeculated, contains the moderator band, thin walled
________ LV: Bullet shaped, less trabeculated, thick walled
________ MV is the only valve with 2 leaflets normally
________ Aortic isthmus: common location for coarctation; type 2 dissection
________ The 2 LV papillary muscle groups are anterolateral; posteromedial
________ LAD: supplies the anterior IVS, anterior LV, cardiac apex
________ Cx: supplies the lateral wall of the LV
________ PDA is most often a branch of the RCA
________ RCA: supplies inferior IVS, inferior LV, RV
________ Conduction system: SA -AV–His bundle-Bundle branches-Purkinje fibers
________ Layers: Endocardium-Myocardium-Epicardium (visceral)-Space-
Fibrous (parietal)
________ Aorta is inferior, posterior and to the right of the pulmonary artery

Adult Echocardiography Systemic Hypertension (Htn) and Pulmonary Hypertension

1. Check the following if associated with systemic hypertension (high blood pressure Greater than 120/80 mm Hg)):
________ LVH
________ LAE
________ MAC
________ Dilated aortic root/aorta/aortic dissection
________ AR
________ Diastolic dysfunction (Grade I, II or III)

2. Check the following if associated with pulmonary hypertension: (increased pulmonary artery pressures)
_________ Common complication of left heart diseased, smoking history
_________ Absent a wave/flying W (M-mode of the PV)
_________ RVH/RVE
_________ Flattened (“pancaking” of the IVS)
_________ TR
_________ PR
_________ Shortened RVOT PW Doppler acceleration time (less than 100 msec)

3. A 38 year old female presents with shortness of breath. An echo is performed where RVE, RAE,
IVC/hepatic vein dilatation is demonstrated. The peak velocity of the TR is 4.3 m/s. The most likely explanation is:
A. Normal for age
B. Primary pulmonary hypertension
C. Aortic sclerosis
D. MAC

4. Are the following correctly matched?
Yes No: TR allows calculation of the RVSP and SPAP
Yes No: PR allows calculation of the MPAP and PAEDP
Yes No: RVOT acceleration time allows calculation of the MPAP

5. Are the normal values correct? Yes ________ No ______
SPAP: Less than 30 mm Hg
PAEDP: 4 to 12 mm Hg
MPAP: 9 to 18 mm Hg

BONUS:

1. Check the following if a type of cardiomyopathy:
_________ Dilated (four chamber dilatation with poor global systolic function)
_________ Hypertrophic (inappropriate hypertrophy usually involving the IVS)
_________ Restrictive (e.g., amyloidosis)
_________ RV type (e.g., Uhls)
_________ Unspecified (e.g., noncompaction)

Diastolic Function

1. True or False: The simple definition of diastolic dysfunction is the inability to fill the heart with normal pressures.

2. True or False: The primary echo/Doppler goal in the evaluation of diastolic function is to determine the presence of increased diastolic filling pressures (and not necessarily what diastolic grade the patient is in).

3. Review the MV PW Doppler tracing and the PW TDI of the mitral annulus tracings shown below: The diastolic grade is: ___________.

4. Review the MV PW Doppler tracing and the TDI of the mitral annulus tracing shown below. The diastolic grade is: _________________.

5. Review the MV PW Doppler tracing and the TDI of the mitral annulus tracing shown below. The diastolic grade is: ____________.

6. True or False: LAE is a common indicator of diastolic dysfunction.

Carotid Duplex Scanning

1. Review the AHI carotid worksheet shown below and determine the ICA percent stenosis using the criteria in the pocket reference (page 396)

ANSWERS 01/18/10

2010-01-15T07:43:00.000-08:00

Ultrasound Physics

1. A

2. True

3. B

4. A

5. B

6. A

7. B

8. D

9. C

10. C

11. E

12. D

13. A

14. B and D

15. True

16. B

Review Question

1. .5

Cardiovascular Principles

1. A

2. B

3. D

4. A

5. B

6. C

7. A

8. B

Adult Echo Pericardial Disease

1. True

2. True

3. True

4. True

5. C

6. A

7. True

8. all are true, none should be check marked

9. respiratory variation

10. True

11. True

12. True

13. "medical emergency" should be marked

BONUS
1. ALL should be marked

2. ALL should be marked

Carotid Ultrasound

Right ICA: less than 50% or nl

Left ICA: subclavian steal

Written Test Due 01/18/2010

2010-01-12T07:09:00.000-08:00

Written Test Name: ___________________

Ultrasound Physics
1. The number of pulses created per second is called:
A. PRF
B. PRP
C. SPL
D. PD
E. DF

2. True or False: Only one pulse can travel in the body at a time.

3. The sonographer increases the image depth ( e.g., 10 cm to 20 cm) , the PRF _________.
A. Increases
B. Decreases
C. Does not change
D. Cannot be predicted

4. The sonographer decreases the image depth (e.g., 20 cm to 10 cm). The PRF:
A. Increases
B. Decreases
C. Does not change
D. Cannot be predicted

5. The sonographer increases the image depth (e.g., 10 cm to 20 cm). The PRF __________ and the frame rate _____.
A. Increases; increases
B. Decreases; decreases
C. Increases; decreases
D. Decreases, increases

6. The sonographer decreases the image depth (e.g., 20 cm to 10 cm). The PRF _______ and the frame rate ________.
A. Increases; increases
B. Decreases; decreases
C. Increases; decreases
D. Decreases; increases

7. The PRF is 10 kHz. The Doppler shift frequency from a stenotic vessel is 4 kHz. Will aliasing occur?
A. Yes
B. No

8. PRF/2 predicts when aliasing will occur. This is called the __________:
A. Gorlin
B. Bernoulli
C. Doppler
D. Nyquist limit

9. The length of a pulse is called:
A. PRF
B. PRP
C. SPL
D. PD
E. DF

10. The duration of a pulse is called:
A. PRF
B. PRP
C. PD
D. SPL
E. DF

11. The percentage of time the machine spends producing a pulse is called:
A. PRF
B. PRP
C. SPL
D. PD
E. DF

12. The DF for CW is:
A. .1
B. .11
C. 100
D. 100%

13. The shorter the SPL (and PD), the better the: ________ resolution.
A. Axial (LARRD)
B. Lateral (LATA)
C. Temporal
D. Elevational
E. Contrast

14. How can the SPL (and PD) be shortened: (more than one correct answer)
A. Focusing
B. Damping
C. Increasing the PRF
D. Increasing the frequency

15. True or False: The shallower the image depth (16 cm instead of 20 cm) the better the temporal resolution.

16. The time it takes from the onset of one pulse to the onset of the next pulse is called:
A. PRF
B. PRP
C. PD
D. SPL
E. DF

REVIEW QUESTION
1. Determine the wavelength for a 3 MHz transducer (assume soft tissue). (Ultrasound Physics book page 15) __________________ mm

Cardiovascular Principles (Wiggers Diagram)

1. _______________ occurs from the closure of the atrioventricular valves(MV, TV) to the opening of the semilunar valves (AoV, PV).
A. Isovolumic contraction
B. Isovolumic relaxation (IVRT)

2. ______________ occurs from the closure of the semilunar valves to the opening of the atrioventricular valves.
A. Isovolumic contraction
B. Isovolumic relaxation (IVRT)

3. The IVRT can be measured with:
A. PW Doppler
B. CW Doppler (recommended by ASE)
C. TDI
D. All of the above

4. Can the isovolumic contraction period be measured using TDI?
A. Yes
B. No

5. The ______________ represents closure of the semilunar valves.
A. S1
B. S2
C. Dichrotic notch
D. IVRT

6. All of the following heart sounds are correctly matched EXCEPT:
A. S1: closure of the atrioventricular valves; normal heart sound
B. S2: closure of the semilunar valves; normal heart sound
C. S3: early rapid diastolic filling heart sound; normal heart sound
D. S4: late diastolic heart sound; abnormal heart sound

7. The cardiac catheterization tracing shown below is:
A. MS
B. AS
C. MR
D. AR
8. The cardiac catheterization tracing shown below is:
A. MS
B. AS
C. MR
D. AR
Adult Echocardiography Pericardial Disease

1. True or False: For echocardiography, a clear space that is present during ventricular diastole and ventricular systole is the definition of pericardial effusion.

2. True or False: A clear space anterior to the descending thoracic aorta (DTA) suggest the presence of a pericardial effusion.

3. True or False: A clear space located posterior to the DTA suggests a pleural effusion.

4. True or False: A clear space located only anterior suggests adipose tissue (fat pad) with one exception: post cardiac surgery.

5. A clear space is seen anterior and posterior and measures 1 to 2 cm. This is a _______ pericardial effusion. (Pocket Reference page 88).
A. It is physiologic
B. Small
C. Moderate
D. Large

6. A clear space is seen only during ventricular systole. This is a ________ pericardial effusion
A. It is physiologic
B. Small
C. Moderate
D. Large

7. True or False: Post cardiac surgery patients, chronic renal failure patients, cancer patients, patients with CHF due to poor global systolic function, post-acute MI patients often have pericardial effusion.

8. Check the following if NOT TRUE concerning cardiac tamponade:
_______ Increased intrapericardial pressures which interferes with diastolic filling
_______ Medical emergency
_______ Beck’s triad
_______ Moderate to large pericardial effusion (usually)
_______ RA diastolic collapse
_______RV diastolic collapse/compression
_______ IVC plethora
_______ Respiratory variation of the AV valves

9. A patient presents with cardiac tamponade. Predict the PW Doppler of the AV (mitral and tricuspid valves) flow pattern:_____________________________________.

10. True or False: You should let the nurse know and contact the physician (and document that you did) when you find a moderate to large pericardial effusion.

11. True or False: Constrictive pericarditis is a difficult echo diagnosis to make.

12. True or False: constrictive pericarditis is the thickening of the pericardium which interferes with the diastolic filling of the heart.

13. Check the following if NOT TRUE concerning constrictive pericarditis:
_________ History of pericardial damage (e.g., CABG surgery)
_________ CHF with normal systolic function
_________ Abnormal IVS motion (bounce, buckle)
_________ Small atria
_________ IVC plethora
_________ Respiratory variation of the AV valves
_________ Hepatic vein flow reversal during expiration
_________ Normal E’ on TDI (greater than 8 cm/s)
_________ Normal E/E’
_________ Medical emergency

BONUS!!
1. Check the following if associated with systemic hypertension (high blood pressure):
________ LVH
________ LAE
________ MAC
________ Dilated aortic root/aorta/aortic dissection
________ AR
________ Diastolic dysfunction (Grade I, II or III)

2. Check the following if associated with pulmonary hypertension: (increased pulmonary artery pressures)
_________ Common complication of left heart diseased, smoking history
_________ RVH/RVE
_________ Flattened (“pancaking” of the IVS)
_________ TR
_________ PR
_________ Shortened RVOT PW Doppler acceleration time (less than 100 msec)

Carotid Ultrasound

Review the AHI carotid report sheet and determine the ICA stenosis category

Right ICA: _______________ Left ICA: _________________

Anwers for Written test 01/11/2010

2010-01-11T07:45:00.000-08:00

Ultrasound Physics
1. B
2. C
3. B
4. B

Bonus
5. A
6. B
7. B
8. D
9. B
10. C
11. D
12. A

Review
1. E

Cardiovascular Principles
1. C
2. B
3. D
4. D
5. E
6. A
7. B
8. B
9. B
10. A, B and D
11. A
12. 2
13. A

Prosthetic Heart Valves
1. G
2. E
3. B
4 True
5. True
6. True
7. True
8. True
9. True

Carotid Ultrasound
Right ICA: total occlusion
Left ICA: noral or less than 50%

Written Test DUE 01/11/2010

2010-01-05T07:44:00.000-08:00

Written Test Name: _________________

Ultrasound Physics

1. The range equation predicts:
A. Propagation speed
B. Distance to a reflector
C. Pressure gradients
D. Harmonics

2. It takes ________________ microseconds for an ultrasound pulse to travel 1 cm round trip in soft tissue.
A. 1
B. 3
C. 13
D. 26

3. The pulse round trip time in soft tissue is 26 microseconds. The reflector depth is:
A. 1 cm
B. 2 cm
C. 5 cm
D. 10 cm

4. The reflector depth is doubled. The pulse round trip time will:
A. Halve
B. Double
C. Triple
D. Quadruple

BONUS!!!
5. The ____________ is the number of pulses created per second.
A. PRF
B. SPL
C. PD
D. DF

6. As image depth increases, PRF:
A. Increases
B. Decreases
C. Unaffected
D. Cannot be predicted

7. The PRF is 6 kHz. The Doppler shift is 2 kHz. Will aliasing occur (has the Nyquist limit been exceeded)?
A. yes
B. No

8. Changing the image depth will affect all of the following EXCEPT:
A. PRF
B. Frame rate
C. Nyquist limit
D. Transmit frequency

9. The length of a pulse is called:
A. PRF
B. SPL
C. PD
D. DF

10. The duration of a pulse is called:
A. PRF
B. SPL
C. PD
D. DF

11. The percentage of time the machine actually spends producing a pulse is called:
A. PRF
B. SPL
C. PD
D. DF

12. The shorter the pulse (SPL or PD) the better the ___________ resolution.
A. Axial
B. Lateral
C. Temporal
D. Contrast
E. Elevational

REVIEW
1. Increasing the transmit frequency will result in a decrease in all of the following EXCEPT:
A. Image depth
B. Spatial pulse length (SPL)
C. Axial resolution (numerical)
D. Lateral resolution (numerical)
E. Temporal resolution

Cardiovascular Principles

1. SV x HR =
A. EF
B. FS
C. CO
D. CI

2. The normal CO is:
A. 4 to 8
B. 4 to 8 lpm
C. 4 to 8 ml
D. 4 to 8 cc

3. The 2-D method used to determine volumes is:
A. Bernoulli
B. Doppler
C. Gorlin
D. Simpson MOD biplane

4. All of the following intracardiac pressures are correctly matched EXCEPT:
A. RA: 0 to 8 mm Hg
B. RV: 18 to 25 (up to 30)/0 to 8 mm Hg
C. PAP: 18 to 25(up to 30) / 4 to 12 mm Hg
D. LV: 100 to 120/70 to 90 mm Hg
E. Ao (BP): 120/80 mm Hg

5. The oxygen saturations are all correct EXCEPT:
A. RA: 75%
B. RV: 75%
C. PA: 75%
D. Coronary sinus: 60%
E. Pulmonary veins: 75%
F. LA: 98%
G. LV: 98%
H. Ao: 98%

6. The pulmonary wedge pressure (PWP) reflects the___________ pressure.
A. LA
B. LV systolic
C. RA
D. RV systolic

7. Which regurgitation allows prediction of the PWP?
A. TR
B. PR
C. AR
D. None of the above

8. The strain phase of the Valsalva maneuver ___________ venous return and enhances the obstruction in hypertrophic cardiomyopathy (HOCM).
A. Increases
B. Decreases

9. Which phase of the Valsalva maneuver is most useful in a(n) agitated saline contrast study ruling out a patent foramen ovale (PFO)?
A. Strain phase
B. Release phase

10. Which of the following DECREASES venous return (more than one correct answer)?
A. Strain phase of the Valsalva
B. Amyl nitrate inhalation
C. Inspiration
D. Expiration

11. MV and TV closure creates the normal S_________ heart sound.
A. S1
B. S2
C. S3
D. S4

12. Closure of the aortic and pulmonary valves create the S _______ normal heart sound.

13. All of the following are TRUE concerning the coronary arteries EXCEPT:
A. Flow occurs primarily during ventricular systole
B. Significant CAD is a 70% diameter reduction
C. LAD lies in the anterior interventricular sulcus
D. LAD supplies thr anterior IVS, anterior wall of the LV, cardiac apex
E. Circumflex (Cx) supplies the lateral wall of the LV
F. PDA is a branch of the RCA in 80% of humans
G. PDA supplies the inferior IVS, inferior LV, inferior wall of the RV

Adult Echocardiography
Prosthetic Heart Valves

1. A patient presents with an aortic valve replacement (AVR). The sonographer should:
A. Measure the LVOT in the parasternal long axis
B. Trace the PW Doppler of the LVOT with the sample volume approximately 1 cm from the aortic annulus
C. Trace the CW Doppler (Imaging, Pedoff) for the peak velocity, peak pressure gradient, mean pressure gradient
D. Calculate the velocity (dimensionless) ratio
E. Determine the presence and severity of AR
F. Check the values acquired with the Pocket Reference PHV tables
G. All of the above

2. A patient presents with a mitral valve replacement (MVR). The sonographer should:
A. Trace the CW Doppler of the MV to determine peak velocity, peak pressure gradient, mean pressure gradient
B. Measure the slope to determine PHT and MVA (EOA)
C. Determine the presence of MR including using PISA and Pedoff due to flow masking (shadowing)
D. Check the values acquired with the PHV tables in the Pocket Reference
E. All of the above

3. A patient presents with a mitral valve replacement (MVR for evaluation for MR. Which test is better?
A. TTE
B. TEE

4. True or False: In general, a peak E MVR velocity of less than 2.0 m/s suggests a normal MVR.

5. True or False: According the new PHV guidelines just published by the American Society of Echocardiography (ASE), in general for a MVR, a peak velocity greater than or equal to 2.5 m/s, a MVA (EOA) less than 1.0 cm2 and/or a PHT greater than 200 msec suggests an abnormal MVR.

6. True or False: In general, a peak AVR velocity of less than 3.0 m/s suggests a normal AVR.

7. True or False: According to the new PHV just published by the American Society of Echocardiography (ASE), in general for a(n) AVR, a peak velocity greater than 4 m/s, a mean pressure gradient greater than 35 mm Hg, a velocity ratio less than .25, a(n) AVA (EOA) less than 0.8 cm2 suggests an abnormal AVR.

8. True or False: It may be a good idea to review the new ASE recommendations position paper concerning PHV. (ASE website: guidelines and recommendations))

9. True or False: In general, the patient becomes there own reference point if they have a(n) AVR or MVR.

Carotid Ultrasound

Determine the severity of the ICA stenosis using the AHI carotid report form:

Right ICA: _______________ Left ICA: ______________

ANSWERS 01/04/2010

2009-12-23T09:33:00.000-08:00

Ultrasound Physics

1. A
2. B
3. C
4. D
5. YES

Ultrasound Physics REVIEW

1. C

Cardiovascular Principles

1. A
2. A
3. C
4. C
5. A
6. A
7. A
8. B
9. E
10. E

Adult Echo

1. only "stenosis" should be check marked
2. True
3. B

Bonus

1. E
2. A
3. F
4. B
5. C
6. A
7. B

Carotid Ultrasound

Right ICA: greater than 70%

Left ICA: NL

Written Test DUE 01/04/2010

2009-12-21T09:14:00.000-08:00

Written Test Name: ___________________________

Ultrasound Physics

1. The _____________________ transducer is described as a relatively large transducer which fires groups of the elements sequentially to create a linear display.
A. Linear sequenced array
B. Phased array
C. Annular array
D. Mechanical

2. The ___________________ transducer is a relatively small transducer most often used in cardiac imaging which fires all of the elements but with a time delay in order to steer and focus the beam.
A. Linear sequenced array
B. Sector phased array
C. Annular array
D. Mechanical

3. The ____________ transducer arranges the elements in a circle and fires the elements electronically but moves them mechanically and is considered to have the best lateral resolution due to the beam shape.
A. Linear sequenced array
B. Sector phased array
C. Annular array
D. Mechanical

4. An element is placed on a motor and is fixed (internal or external) focus. This is the : __________ transducer.
A. Linear sequenced array
B. Sector phased array
C. Annular array
D. Mechanical

5. Are all of the following correctly defined?A. Yes B. No
1. Beam steering means that the sound beam is being moved through the tissue either mechanically or electronically.
2. Beam scanning means that the beam is being moved by hand through the tissue.
3. Beam focusing means that the beam diameter is being reduced in the near field with internal, external or transmit focusing.

Ultrasound Physics Review Question

1. All of the following are TRUE concerning sound EXCEPT:
A. Mechanical, longitudinal wave
B. Creates regions of compression and rarefaction
C. Can travel in a vacuum
D. 20 Hz to 20 kHz is in the audible range

Cardiovascular Principles

1. _____________ is the ability of the cardiac cell to begin and maintain rhythmic activity.
A. Automaticity
B. Conductivity
C. Contractility
D. Excitability

2. Which ion causes actual contraction to occur?
A. Calcium
B. Sodium
C. Potassium

3. There will be no response of the cardiac cell during the absolute refractory period. This occurs between (the):
A. P wave and onset of the QRS complex
B. Onset of the QRS complex to the end of the T wave
C. Onset of the QRS complex to the onset of the T wave
D. End of the T wave to the onset of the QRS complex

4. _______________ law is the law of the heart.
A. Doppler
B. Bernoulli
C. Starlings
D. Gorlin

5. As cardiac fiber length increases, the force of contraction improves to a certain physiologic limit. This is called: _____________ law.
A. Starlings
B. Gorlin
C. Bernoulli
D. Doppler

6. The end diastolic volume (EDV) of the LV is increased in a patients with significant MR and/or AR. The ejection fraction (EF) according to Starlings law should initially:
A. Increase
B. Decrease
C. Not affected

7. _______________ is the amount of volume in the chamber (e.g., LV)
A. Preload
B. Afterload

8. _____________ is the resistance to the ejection of blood.
A. Preload
B. Afterload

9. Which of the following would LEAST likely increase preload?
A. AR
B. PR
C. TR
D. MR
E. AS

10. Which of the following would LEAST likely increase afterload?
A. AS
B. PS
C. Aortic coarctation
D. Supravalvular aortic stenosis
E. MR

Adult Echocardiography
1. Check the following if NOT associated with infective endocarditis (IE):
___________ Vegetation
___________ Regurgitation
___________ Stenosis
___________ Abscess
___________ Perforation
___________ Flail leaflet
___________ Fistula
___________ Prosthetic heart valve (PHV) dehiscence
___________ Premature closure of the MV (acute severe AR)
___________ Pericardial effusion
___________ Heart failure (most likely due to severe regurgitation)

2. True or False: When the sonographer receives an echo request to evaluate a patient for infective endocarditis, valvular vegetation and valvular regurgitation are very important to be looking for during the exam.

3. The test of choice for infective endocarditis is:
A. TTE
B. TEE
C. CT
D. MR

BONUS Prosthetic Heart Valves
1. All of the following prosthetic heart valves are correctly matched EXCEPT:
A. Starr Edwards: mechanical ball and cage
B. St. Jude’s: mechanical bileaflet tilting disc
C. Medtronic Hall: mechanical single disc
D. Carpentier-Edwards: tissue (pericardial or bovine) valve
E. Hancock: mechanical floating disc

2. A patient presents with a mitral valve replacement (MVR). The sonographer should do all of the following EXCEPT:
A. Planimeter the mitral valve orifice in the parasternal short axis of the MV
B. Trace the CW Doppler traccing of the MV obtained from the apical four chamber view
C. Measure the slope to determine the PHT
D. Understand the artifact called masking (shadowing)
3. A patient presents with an aortic valve replacement (AVR). The sonographer should:
A. Measure the LVOT diameter in the parasternal long axis
B. Trace the PW Doppler of the LVOT with the sample volume placed 1 cm from the aortic annulus
C. Trace the CW Doppler of the aortic valve replacement (Imaging or Pedoff) to determine peak velocity, peak pressure gradient, mean pressure gradient
D. Look up in the Pocket Reference to determine if normal
E. Determine the presence and severity of aortic regurgitation
F. All of the above
G.
4. _____________ is the increased motion of a PHV most likely due to infective endocarditis.
A. Masking
B. Dehiscence
C. Pannus
D. Stenosis

5. Excessive ingrowth of tissue which may result in PHV stenosis and/or regurgitation is called:
A. Dehiscence
B. Masking
C. Pannus
D. Prolapse

6. True or False: the first question to ask a patient with a tissue valve is:
A. “When did you have your valve implanted?”
B. “Have you been taking your Coumadin?”

7. The first question to ask a patient with a metal (mechanical) valve is:
A. “When did you receive your new valve?”
B. “Have you been taking your Coumadin?”

Carotid Ultrasound

Review the AHI report sheet and determine ICA stenosis severity:

Right ICA: _____________ Left ICA: __________

ANSWERS 12/21/09

2009-12-21T09:02:00.000-08:00

Ultrasound Physics

1. B

2. C

3. A

4. F

5. A

6. C

7. C

8. True

9. True

Review Question

1. A

Cardiovascular Principles Cardiac Embryology

1. B

2. C

3. B

4. D

5. B

6. D

Tricuspid Valve Disease

1. A

2. D

3. D

4. B

5. C

6. D

7. B

8. B, C

9. E

Pulmonary Regurgitation

1. "Occurs during ventricular systole" and CW peak velocity is useful to determine severity of PR

2. E

3. C

Carotid Duplex scanning

Right ICA severity : 50-69%

Left ICA severity: NL

Right ICA: NL

Left ICA: 50-69%

Written Test DUE 12/21/2009

2009-12-15T07:48:00.001-08:00

Written Test Name: ______________________

Ultrasound Physics
1. How close two structures can be perpendicular to the sound beam and still be resolved may be called all of the following EXCEPT:
A. Lateral
B. Longitudinal
C. Angular
D. Transverse
E. Azimuthal
F. LATA

2. Lateral resolution primarily depends upon:
A. SPL
B. PD
C. Beam width (diameter)
D. TGC

3. Beam width (diameter) may be reduced by all of the following EXCEPT:
A. Damping
B. Increasing transducer frequency
C. Focusing
D. Increasing transducer diameter (manufacturer)
E. Harmonics

4. All of the following are TRUE concerning lateral resolution EXCEPT:
A. Units are mm
B. Equal to the sound beam width
C. Varies with the distance from the transducer
D. Lower the number the better the lateral resolution
E. Best at the focal point
F. Superior to axial resolution

5. How close two structures can be parallel to the sound beam direction is called all of the following EXCEPT:
A. Lateral
B. Longitudinal
C. Axial
D. Radial
E. Range
F. Depth
G. LARRD

6. All of the following may improve axial resolution EXCEPT:
A. Increase transmit frequency (reduces SPL, PD)
B. Damp (manufacturer)
C. Focus

7. The spatial pulse length is 4 mm. The axial resolution is equal to:
A. 4 mm
B. 3 mm
C. 2 mm
D. 1 mm

8. True or False: The shorter the pulse duration (or spatial pulse length) the better the axial resolution.

9. True or False: The narrower the sound beam, the better the lateral resolution.

REVIEW QUESTION:
1. All of the following are TRUE statements concerning acoustic impedance EXCEPT:
A. A reflection will occur at the boundary of two media if the media impedances are equal
B. The IRC for a soft tissue – air interface is 99%
C. The ITC for fat – muscle interface is 99%
D. In general, air is a great reflector

Cardiovascular Principles Cardiac Embryology
1. The heart tube appears on:
A. Day 1
B. 23 day
C. 43 day
D. At birth

2. The heart is completely formed by day:
A. 1
B. 23
C. 43
D. 90

3. The foramen ovale becomes the:
A. PFO
B. Fossa ovalis
C. Ligamentum teres
D. ligamentum arteriosum

4. The ductus arteriosus becomes the:
A. Ligamentum teres
B. PFO
C. Fossa ovalis
D. Ligamentum arteriosus

5. The shunt in fetal circulation across the foramen ovale and ductus arteriosus are normally:
A. Left to right
B. Right to left
C. Bidirectional
D. Cannot be predicted

6. All of the following are correct EXCEPT:
A. The aortic sac becomes the ascending aorta
B. The atrial septum is comprised of the septum primum and septum secundum
C. The endocardial cushions contribute to the formation of the atrioventricular (MV, TV) valves
D. Marfans syndrome is strongly associated with complete endocardial cushion defect (complete AV canal)

Tricuspid Valve Disease (TS, TR, TVP, Ebstein’s anomaly, Carcinoid)

1. The most common etiology of tricuspid stenosis (TS) is:
A. Rheumatic
B. Congenital
C. Idiopathic
D. Iatrogenic

2. All of the following are TRUE concerning tricuspid stenosis (TS) EXCEPT:
A. A TV peak velocity of greater than 1.0 m/s suggests TS
B. Mean pressure gradient is useful to determine severity
C. Trace and measure slope (PHT) allows calculation of peak velocity, peak pressure gradient, mean pressure gradient and TVA
D. Most common TV disease

3. The most common etiology of tricuspid regurgitation (TR) is:
A. TS
B. Tricuspid valve endocarditis (vegetation)
C. TVP
D. Pulmonary hypertension (functional)

4. Significant chronic TR may result in all of the following EXCEPT:
A. RAE
B. LAE
C. RVE
D. RVVO (paradoxical IVS motion with RVE)
E. IVC/hepatic vein dilatation

5. The classic PW and color flow Doppler finding for the hepatic veins in patients with significant TR is:
A. Increased S wave
B. Decreased D wave
C. Systolic flow reversal in the hepatic vein
D. A wave reversal

6. The TR peak velocity is 3.0 m/s. The RVSP and SPAP is:
A. 3 mm Hg
B. 9 mm Hg
C. 36 mm Hg
D. 46 mm Hg

7. The most common method used to determine the severity of TR is:
A. 4 x V2
B. RJA/RAA
C. CSA x VTI
D. LVIDd – LVIDs / LVIDd x 100

8. Which two views are required for the evaluation of tricuspid valve prolapse (TVP)? (2 answers)
A. Parasternal long axis
B. RA-RV view
C. Apical 4 chamber view
D. Apical five chamber

9. The tricuspid valve is thick, immobile, whitish in appearance with severe TR. This suggests the presence of:
A. TS
B. TVP
C. Ebstein’s anomaly
D. Uhls anomaly
E. Carcinoid heart disease

Pulmonary Regurgitation (PR)

1. Check the following if INCORRECT concerning PR:
______ Occurs during ventricular systole
______ May be acute or chronic
______ Most common etiology is pulmonary hypertension (functional)
______ May result in RVVO
______ JW/RVOTW is a useful color flow Doppler parameter to determine severity
______ CW peak velocity is useful to determine severity of PR

2. The PR end diastolic velocity is 2.0 m/s. The IVC is normal. The pulmonary artery end diastolic pressure (PAEDP) is:
A. 2 mm Hg
B. 4 mm Hg
C. 16 mm Hg
D. 21 mm Hg
E. 26 mm Hg

3. The normal PAEDP is:
A. 0 to 8 mm Hg
B. 18 to 25 mm Hg
C. 4 to 12 mm Hg
D. 100 to120 mm Hg

Carotid Duplex Scanning

Right
CCAd: 80/18 cm/s
ECA: 122/5 cm/s
ICAp: 217/58 cm/s
ICAd: 101/21 cm/s
Vertebral: Antegrade
ICA severity: ____________________

Left
CCAd: 89/25 cm/s
ECA: 90/4 cm/s
ICAp: 119/28 cm/s
ICAd: 67/32 cm/s
Vetebral: Antegrade
ICA severity: _____________

AHI Carotid report Sheet: Determine the ICA severity based on the information on the report sheet shown below:
Right ICA: _________________ Left ICA: _______________

ANSWERS Written Test 12/14/09

2009-12-14T09:29:00.000-08:00

Answers Written Test 12/14/09
Ultrasound Physics
1. C
2. B
3. C
4. A, B
5. A
6. B
7. D
8. C
9. C
10. B

Review
1.B

Cardio Principles (CHD)
1. D
2. A
3. C
4. C
5. F
6. B, C, D
7. B
8. C
9. C
10. A

Adult Echo (AS) (Review)
Case 1
answer: Severe

AR
1. only "Chronic AR is considered a LV pressure overload resulting in LVH" should be checked

BONUS
Tricuspid valve Disease
1. A
2. D
Right side: 50-69%
Left side: less than 50%

Written Test DUE 12/14/2009

2009-12-08T07:41:00.000-08:00

Written Test Name: ________________________

Ultrasound Physics
1. The sound beam region located from the transducer face to the focus may be referred to as all of the following EXCEPT:
A. Near field
B. Near zone
C. Fraunhofer zone
D. Fresnel zone

2. The narrowest portion of the sound beam is called the:
A. Near field
B. Focus (focal point)
C. Far zone

3. The sound beam diverges beyond the focus. This may be referred to as all of the following EXCEPT:
A. Far field
B. Far zone
C. Fresnel zone
D. Fraunhofer zone

4. Which of the following will increase near field length? (2 correct answers)
A. Increase transducer diameter
B. Increase transmit gain
C. TGC
D. Increase transmit frequency

5. For pediatric echocardiography, the transducer footprint (diameter) should be:
A. Small
B. Large

6. The Pefoff CW Doppler probe footprint (diameter) is small. This ___________ the near field length and _____________ the beam diameter.
A. Increases; reduces
B. Decreases; increases
C. Increases; increases
D. Decreases; decreases

7. ____________ reduces the beam diameter in the near field.
A. Gain
B. Power
C. TGC
D. Focusing

8. Which of the following types of focusing are INCORRECTLY matched?
A. Internal: element is curved
B. External: curved lens is placed
C. Transmit: receiver gain
D. Receive (dynamic): delay lines are used

9. Which of the following types of focusing is the only one that the sonographer can influence?
A. Internal
B. External
C. Transmit
D. Receive

10. All of the following are TRUE concerning focusing EXCEPT:
A. Improves lateral resolution
B. Extends the near field
C. Transmit focusing is an important for the sonographer to use
D. The intensity of the sound beam is greatest at the focal point

REVIEW
1. Which of the following measures of sound strength statements is INCORRECT?
A. Amplitude represents the strength of the outgoing or returning signal; units are dB; controlled by transmit gain
B. Power: units are W/cm2 ; controlled by receiver gain
C. Intensity: Power/area; controlled by transmit gain; no bioeffects for focused beams with intensity less than 1 W/cm2 SPTA
D. Gain (receiver gain) has replaced transmit gain in the modern ultrasound machine

Cardiovascular Principles Congenital Heart Defects (CHD)
1. Which of the following is an INCORRECT statement concerning atrial septal defect (ASD)?
A. Ostium secundum is located in the center of the interatrial septum (IAS); most common ASD
B. Ostium primum is located in the lower (inferior) portion of the IAS; associated with cleft mitral valve
C. Sinus venosus is usually located in the upper (superior) portion of the IAS; commonly associated with PAPVR
D. Patent foramen ovale is considered an ASD
E. ASD’s are considered right heart volume overload (RAE, RVE, RVVO)

2. The most common ventricular septal defect (VSD) in adults is:
A. Perimembranous
B. Trabecular
C. Inlet
D. Outlet

3. A perimembranous VSD may be visualized in all of the following views EXCEPT:
A. Parasternal long axis
B. Parasternal short axis of the aortic valve
C. Apical 4 chamber
D. Apical 5 chamber
E. Apical long axis

4. Which of the following is most strongly associated with aortic coarctation?
A. Ostium secundum ASD
B. Perimembranous VSD
C. Bicuspid aortic valve
D. Ebstein’s anomaly

5. All of the following are associated with tetralogy of Fallot EXCEPT:
A. RVH
B. Over-riding aorta
C. Malalignment VSD
D. RVOT obstruction
E. Cyanosis
F. Ostium secundum ASD

6. Which of the following are TRUE concerning patent foramen ovale? (PFO) (more than one correct answer).
A. Rare
B. May be explanation for stroke (CVA-cerebrovascular accident)
C. May be explanation for migraines
D. May require agitated saline for diagnosis by transthoracic echo (TTE) or transesophageal echo (TEE) with release phase of Valsalva

7. Which maneuver is most useful to use during a saline agitated contrast study for PFO?
A. Valsalva (strain phase)
B. Valsalva (release phase)
C. Hand grip
D. Treadmill exercise

8. The abnormal insertion of the tricuspid valve towards the cardiac apex with RV dysplasia is called:
A. Uhl’s anomaly
B. Tetralogy of Fallot
C. Ebsteins anomaly
D. Turner’s

9. RV dysplasia with normal insertion of the TV is called:
A. Ebsteins anomaly
B. Tetralogy of Fallot
C. Uhls anomaly
D. Noonan’s syndrome

10. Reversal of a shunt (e.g., ASD, VSD, AV canal) due to increased pulmonary pressures is called:
A. Eisenmengers
B. Turners
C. Downs
D. Noonan’s

Adult Echocardiography
Aortic Stenosis (AS) (Review)

Case 1
A 67 year old male presents with syncope. On EKG LVH is present. There is a SEM at the RUSB upon auscultation. The M-mode and 2-D echo demonstrate a thickened aortic valve with reduced excursion. The following 2-D and Doppler information is acquired:

EF: 58%
LVOT diameter: 2.0 cm
LVOT VTI: 20 cm
LVOT peak velocity: 1.0 m/s
AoV VTI: 100 cm
Aortic valve peak velocity: 4.2 m/s
Peak pressure gradient: 71 mm Hg
Mean pressure gradient: 45 mm hg
AVA: .62 cm2

How severe is the AS (page 35): _______________

Aortic Regurgitation (AR)
1. Which of the following is INCORRECT concerning aortic regurgitation (AR)?
_______ Occurs during ventricular diastole
_______ May be acute or chronic
_______ Is usually holodiastolic
_______ Least common of the valve regurgitations found in normals
_______ Most common cause of acute AR is infective endocarditis
_______ Chronic AR is considered a LV pressure overload resulting in LVH
_______ Fine diastolic flutter of the MV is a classic finding
_______ Premature closure of the MV in acute AR may suggest increased LVEDP
_______ LVVO may be present
_______ 2-D may provide anatomic cause (e.g., thickened aortic valve; dilated root)
_______ Color flow parameters include JW/LVOTW; JSAA/LVOTA; Holodiastolic flow
reversal in the DTA or AA
_______ CW AR PHT may be useful
_______ AR PHT less than 200 msec suggests mild AR

Carotid Ultrasound

RIGHT
CCAd: 100/19 cm/s
ECA: 88/5 cm/s
ICAp: 238/47 cm/s
ICAd: 101/13 cm/s
Vertebral: Antegrade
Percent ICA stenosis: ____________________

LEFT
CCAd: 89/22 cm/s
ECA: 66/3 cm/s
ICAp: 107/23 cm/s
ICAd: 67/13 cm/s
Vetebral: Antegrade
Percent ICA stenosis: ___________

ANSWERS Written Test 12/07/09

2009-12-07T11:13:00.000-08:00

ANSWERS Written Test Due 12/07/09
Ultrasound Physics
1. D
2. A
3. A
4. C
5. C
6. B
7. D
8. F
9. A
10. A
11. A
12. C
Review Question
1.D

Cardiovascular Principles
1. C
2. C
3. B
4. C
5. B
6. B
Bonus (Cardiac Catheterizona)
7. C
8. B

Adult Echo: MVP
1. E

Valvular Aortic Stenosis
1. True
2. All should be marked
3. A, B, C, D (all)
4. A
5. D

BONUS (AR)
6. all should be marked EXCEPT "Is always holosystolic"
7. B
8. B
Carotid Ultrasound
Right: greater than 70%
Left: 50-69%

Written Test Due 12/07/09

2009-12-01T07:55:00.000-08:00

Ultrasound Physics (There are 120 physics questions on the SPI exam) Name: ___

1. ______________ is the loss of amplitude and intensity as sound travels through a medium.
A. Frequency
B. Period
C. Amplitude
D. Attenuation

2. The primary reason for attenuation in soft tissue is:
A. Absorption
B. Reflection
C. Scatter
D. Diffraction

3. ________________ is the conversion of sound energy into heat.
A. Absorption
B. Scatter
C. Reflection
D. Diffraction

4. The transmit frequency is 2 MHz. The attenuation coefficient for soft tissue is:
A. 1
B. 1 dB
C. 1 dB/cm
D. 2 dB

5. The formula used to determine attenuation coefficient in soft tissue is:
A. 0.5 x f x path length
B. LVIDd – LVIDs / LVIDd x 100
C. 0.5 x f (0.5dB/cm/MHz)
D. Propagation speed ( c ) / frequency (f)

6. The transmit frequency is 2 MHz. The path length is 20 cm. The total attenuation for soft tissue is:
A. 20
B. 20 dB
C. 20 dB/cm
D. 400 dB

7. As frequency increases, all of the following increase EXCEPT:
A. Attenuation
B. Attenuation coefficient
C. Total attenuation
D. Depth of penetration

8. Which of the following are components of the ultrasound transducer?
A. Filler material
B. Matching layer
C. Piezoelectric element(s)
D. Damping material (block)
E. Cable
F. All of the above

9. Which of the following has the greatest effect on the transmit frequency?
A. Thickness of the piezoelectric element
B. Thickness of the matching layer
C. Impedance value of the damping material
D. Location of the damping material

10. All of the following are TRUE concerning the matching layer EXCEPT:
A. Reduces the ringing of the element(s)
B. Placed in front of the element
C. Reduces the impedance difference between the element and the soft tissue to improve transmission and reception
D. Thickness of the matching layer is ¼ wavelength

11. All of the following are TRUE concerning the damping material EXCEPT:
A. Placed in front of the element
B. Reduces the ringing of the element
C. Allows for short pulses to be produced
D. Improves axial resolution
E. Increases bandwidth (BW)
F. Decreases quality factor (f/BW)

12. Modern transducers are:
A. Wide bandwidths; high Q’s
B. Narrow bandwidths; low Q’s
C. Wide bandwidths; low Q’s
D. Narrow bandwidths; high Q’s

Review Question
1. All of the following units are correctly matched EXCEPT:
A. Frequency: Hz
B. Propagation speed: m/s; mm/us, km/s; cm/s
C. Amplitude: dB
D. Power: dB
E. Intensity: W/cm2
F. Acoustic impedance: Rayls
G. Attenuation Total attenuation: dB
H. Attenuation coefficient: dB./cm

Cardiovascular Principles (Cardiac Evaluation Methods cont.)

1. The normal PR interval range is:
A. 12 to 20
B. 1.2 to 2.0
C. .12 s to .20 s
D. 120 s to 200 s

2. The normal QRS duration is:
A. .12
B. .12 msec
C. .12 s
D. 120 m

3. ST segment elevation may indicate:
A. Normal
B. Acute injury (acute myocardial infarction, AMI)
C. Ischemia
D. Old MI

4. ST segment depression may suggest:
A. Normal
B. Acute MI
C. Ischemia
D. Old MI

5. Pathologic Q waves may suggest:
A. Acute MI
B. Old MI
C. Ischemia
D. Normal

6. All of the following diagnostic procedures are correctly matched EXCEPT:
A. Mediastinal widening on CXR: Aortic dissection
B. Cardiomegaly on CXR: AMI
C. MUGA: Nuclear EF
D. Nuclear perfusion study: Evaluation of CAD

BONUS (Cardiac catheterization)
7. All of the following cardiac catheterization procedures are correctly matched EXCEPT:
A. Cardiac output: Fick or thermodilution
B. Ventriculography: Evaluation of MR, Global and segmental systolic function
C. Gorlin equation: Severity of AR
D. Aortography: Evaluation of the aorta and AR

8. The cardiac catheterization peak to peak gradient will be ___________ the cardiac Doppler peak (maximum) gradient.
A. Equal to
B. Less than
C. Greater than
D. cannot be predicted

Adult Echocardiography: Mitral Valve Prolapse (MVP)

1. All of the are TRUE concerning MVP EXCEPT:
A. May be mid to late systolic or holosystolic
B. May be referred to as click-murmur syndrome
C. Parasternal long axis is the gold standard view
D. In classic MVP, the valve is thick, redundant, myxomatous
E. Associated with Downs syndrome
F. May result in MR

Valvular Aortic Stenosis (AS)

1. True or False: AS is the primary pathology that must be presented for ICAEL accreditation.
2. Check the following if TRUE concerning AS:
______ Most common etiology is degenerative (senile)
______ Considered an LV pressure overload resulting in LVH
______ Auscultation is SEM at the right upper sternal border
______ “Doming” may be seen in bicuspid aortic valves
______ We need to know page 35

3. A patient presents with known AS. You should (more than one correct answer):
A. Measure the LVOT in the parasternal long axis in early systole
B. Trace the LVOT PW Doppler tracing acquired in the apical 5 chamber view with the sample volume 0.5 cm to 1.0 cm from the aortic valve annulus)
C. Trace the aortic valve CW Doppler tracing acquired from the apical 5 chamber
D. Use the Pedoff probe from apical, suprasternal, right parasternal

4. A patient presents with a thickened aortic valve with a CW Doppler peak velocity of 1.8 m/s. This suggests:
A. Aortic sclerosis
B. Aortic stenosis

5. A patient with AS and a(n) ejection fraction (EF) of 22% presents. The peak velocity is 2.7 m/s, the peak pressure gradient is 29 mm Hg, mean pressure gradient is 17 mm Hg and the aortic valve area (AVA) is 0.68 cm2. How severe is the AS? (Using page 35 may help).
A. Normal
B. Mild
C. Moderate
D. Severe

BONUS! Aortic Regurgitation (AR)
Aortic Regurgitation (AR)
6. Check the following if TRUE concerning AR:
________ may be acute or chronic
________ Is always holosystolic
________ Most common cause of acute AR is infective endocarditis
________ Chronic AR is considered a LV volume overload resulting in LVE
________ Fine diastolic flutter of the MV is the classic M-mode finding
________ Premature closure of the MV suggests increased LVEDP

7. All of the following are useful in determining the severity of AR EXCEPT:
A. LV diastolic and systolic dimension (> 55 mm LVIDs indicates AVR)
B. Peak velocity
C. AR PHT using CW Doppler
D. JW/LVOTW
E. JSAA/LVOTA
F. Holodiastolic flow reversal in the DTA or AA

8. The CW Doppler AR PHT is 680 msec. This suggests ________ AR. (page 44)
A. Trace
B. Mild
C. Moderate
D. Severe

Carotid Ultrasound
Right
CCAd: 88/12 cm/s
ECA: 100/5 cm/s
ICAp: 367/ 112 cm/s
ICAd: 121/26 cm/s
Vertebral: Antegrade
ICA severity: __________________

Left
CCAd: 90/21 cm/s
ECA: 68/6 cm/s
ICAp: 144 / 48 cm/s
ICAd: 87/22 cm/s
Vetebral: Antegrade
ICA severity: __________

ANSWERS DUE 11/30/09

2009-11-30T09:00:00.000-08:00

1. A
2. D
3. A
4. D
5. C
6. B
7. A
8. B
9. C
10. B

CARDIOVACASULR PRINCIPLES ANSWERS
1. B
2. A
3. C
4. A
5. D
6. B
7. A
8. A
9. E

BONUS
SINUS TACHYCARDIA
PVC
A-FIB
V-TACHYCARDIA
V-FIBRILIATION

ADULT ECHO
MR
1. may be accute or chronic
etiology may include functional or anatomic
pulmonary hypertension is a possible complication
chronic significant MR may result in LAE, LVE, LVVO
Acut severe MR may result in pulmonary edema
murmur is holosystolic heard best at the apex/axilla
M-mode/2D findings include LAE, LVE, LVVO
Pulmonary vein S wave reversal may indicate severe MR
MR CW Doppler spectral strength and duration are useful
RJA/LAA, PISA, vena contracta are useful color flow parameters

BONUS
MVP
2. ALL are true
3. C

BONUS

1. ALL are true

BONUS

1. all true EXCEPT "occurs during ventricular systole" (second line)

Carotid Ultrasound

Right: greater than 70

Left: 50-69

Written Test Physics 11/30/2009

2009-11-17T08:19:00.000-08:00

Test (there are 120 multiple choice questions on the ARDMS SPI exam)

Ultrasound Physics (SPI)

1. All of the following are TRUE concerning acoustic impedance EXCEPT:
A. Reflection will occur at the boundary of two media if the media impedances are equal
B. The intensity reflection coefficient (IRC) for soft tissue – air is 99%
C. The intensity transmission coefficient (ITC) for fat – muscle is 99%
D. The greater the acoustic impedance difference the greater the strength of the returning signal

2. All of the following are examples of specular reflectors EXCEPT:
A. Cardiac valve leaflets (e.g., mitral valve, aortic valve)
B. Carotid artery
C. Abdominal aorta
D. Red blood cells

3. The preferred angle of incidence for specular reflectors is:
A. Normal
B. Oblique
C. Obtuse
D. Critical

4. Which of the following are TRUE concerning scatter reflectors?
A. Small compared to the wavelength or rough surfaced
B. Frequency dependent and not angle dependent
C. Tissue cells and red blood cells are examples
D. All of the above

5. [Z2 – Z1 / Z2 + Z1 ]2 predicts
A. Pressure gradients
B. Flow through a tube
C. Percentage of reflection at the boundary of two media
D. Valve area

6. The incident angle is 60 degrees. The reflected angle is:
A. Less than 60 degrees
B. Equal to 60 degrees
C. Greater than 60 degrees
D. Cannot be predicted

7. _____________ is the change in the direction of sound as it crosses a boundary.
A. Refraction
B. Reflection
C. Reverberation
D. Range ambiguity

8. When will refraction NOT occur?
A. When the impedances of two media are equal
B. When the propagation speeds of two media are equal
C. When the impedances of two media are different
D. When the propagation speeds of two media are different

9. Which artifact is created by refraction?
A. Reverberation
B. Side lobe
C. Lateral displacement
D. Enhancement

REVIEW
10. All of the following are TRUE concerning propagation speed EXCEPT:
A. Determined by the medium (stiffness and density)
B. Influenced by the transmit frequency
C. AVERAGE speed of sound in soft tissue is 1540 m/s (1.54 mm/us)
D. Air, soft tissue, bone are arranged in increasing order

Cardiovascular Principles: Cardiac Evaluation Methods

1. Angina pectoris (chest pain) suggests:
A. Rheumatic fever
B. CAD
C. IV drug abuse
D. Aneurysm

2. The most likely explanation of chest pain is:
A. CAD
B. MVP
C. MS
D. Pulmonary embolism

3. Chest pain radiating to the back with a normal EKG suggests:
A. Pericarditis
B. MVP
C. Aortic dissection
D. AS

4. The primary (common) cause of CHF is:
A. Systolic dysfunction (e.g., CAD)
B. Volume overload (e.g., severe MR)
C. Pressure overload (e.g., systemic hypertension)
D. Diastolic dysfunction (e.g., CAD, systemic hypertension)

5. The patient presents with fever, new murmur and a history of IV drug abuse. You should look for:
A. Stenosis; regurgitation
B. Wall motion abnormality; valve stenosis
C. Aneurysm; regurgitation
D. Vegetation; regurgitation

6. A depression of the sternum toward the spine is called:
A. Pectus carinatum
B. Pectus excavatum
C. Kyphoscoliosis
D. Normal

7. The most likely cause of syncope is:
A. AS (LVOT obstruction)
B. MVP
C. MS
D. AAA

8. The pulse associated with cardiac tamponade is:
A. Pulsus paradoxus
B. Pulsus alternans
C. Bisfierens pulse
D. pulsus parvus et tardus

9. All of the following heart sounds and murmurs are correctly matched EXCEPT:
A. Mid systolic click and late systolic murmur: MVP
B. Fixed split S2: ASD
C. Early systolic murmur: VSD
D. Systolic ejection murmur (SEM): AS
E. Holosystolic murmur heard best at the apex: AR
F. Continuous murmur: PDA; Ruptured sinus of Valsalva aneurysm

BONUS: Identify the following EKG patterns shown below:

Adult Echocardiography
Mitral Regurgitation (MR)

1. Check the following if TRUE concerning mitral regurgitation (MR):
_______ May be acute or chronic
_______ Occurs during ventricular diastole
_______ Etiology may include functional or anatomic
_______ Pulmonary hypertension is a possible complication
_______ Chronic significant MR may result in LAE, LVE, LVVO
_______ Acute severe MR may result in pulmonary edema
_______Murmur is holosystolic heard best at the apex/axilla
_______ M-mode /2D findings include LAE, LVE, LVVO pattern
________ Pulmonary vein S wave reversal may indicate severe MR
________ MR peak velocity indicates severity
________ MR CW Doppler spectral strength and duration are useful
________ RJA/LAA, PISA, vena contracta are useful color flow parameters

BONUS: Mitral Valve Prolapse (MVP)
2. Check the following if TRUE concerning MVP:
_______ May be mid to late or holosystolic
_______ May be classic or non-classic
_______ Parasternal long axis is the gold standard view
_______Terms used to describe the valve are thick, redundant, myxomatous
_______ Associated with AVP, TVP, PVP
_______ MR is a common cardiac Doppler finding
_______ Associated with Marfan’s syndrome

3. All of the following are associated with Marfan’s syndrome EXCEPT:
A. Aortic root/proximal aorta dilatation/aneurysm
B. MVP
C. Valvular stenosis
D. MR
E. AR
F. Aortic dissection

BONUS Aortic Stenosis (AS):
1. Check the following if TRUE concerning AS:
_______ Most common cause is aging (degenerative)
_______ LV pressure overload resulting in LVH
_______ Stenotic bicuspid aortic valve dome’s during systole
_______ Sonographer must determine peak velocity, peak pressure gradient, mean
pressure gradient, aortic valve area (AVA)
_______ Sonographer should know page 35 in the Pocket Reference
_______ Aortic valve replacement (AVR) is considered to be AS

BONUS: Aortic Regurgitation (AR)
1. Check the following if TRUE concerning aortic regurgitation (AR)
_______ May be acute or chronic
_______ Occurs during ventricular systole
_______ Most common cause of acute AR is infective endocarditis
_______ May result in LVVO (left ventricular volume overload)
_______ May indicate VSD (perimembranous, outlet), discrete subaortic stenosis
_______ Classic M-mode finding is fine diastolic flutter of the MV
_______ Premature closure of the MV may indicate increased LVEDP in acute AR
_______ 2-D provides anatomic basis for the AR (e.g., aortic valve thickening)
_______ JW/LVOTW, JSAA/LVOTA, holodiastolic flow reversal in the DTA are useful color flow parameters
_______CW PHT is a useful CW Doppler parameter

Carotid Ultrasound

1. Determine the severity of the ICA stenosis (Use Table 59, page 396 in the Pocket Reference)

Written Test due 11/16/09

2009-11-10T08:44:00.000-08:00

Written test due November 16, 2009

Ultrasound Physics

1. All of the following are TRUE statements concerning sound EXCEPT:
a. Travels as a longitudinal, mechanical wave
b. Creates regions of high pressure, high density (compression, condensation)
c. Creates regions of low pressure, low density (rarefaction)
d. Can travel in a vacuum

2. The AVERAGE speed of sound in soft tissue may be expressed by all of the following EXCEPT:
a. 15.40 m/s
b. 1.54 mm/us
c. 15400 cm/s
d. 1.54 km/s

3. Which of the following is correctly arranged from lowest to highest propagation speed?
a. Air, bone, soft tissue
b. Soft tissue, air, bone
c. Air, soft tissue, bone
d. Bone, soft tissue, air

4. The propagation speed primarily depends upon the:
a. f
b. Wavelength
c. Transducer
d. Stiffness of the medium (bulk modulus)

5. All of the following are TRUE concerning amplitude (A) EXCEPT:
a. Represents the strength of the outgoing or returning signal
b. Units are decibels (dB)
c. Increase as sound travels through a medium
d. Can be affected by transmit gain

6. The units for power (P) are:
a. m/s
b. cm2
c. mm
d. W
e. W/cm2

7. Power divided by area is:
a. f
b. Wavelength
c. P
d. 1

8. True or False: There have been no proven biological effects for ultrasound for unfocused beams below 100 mW/cm2 or for focused beams below 1 W/cm2.

9. All of the following may be affected by transmit gain EXCEPT:
a. Amplitude (A)
b. Power (P)
c. Intensity (I)
d. Frequency (f)

Review Question(s)

10. Which of the following is NOT true concerning frequency (f)?
a. Number of cycles per second
b. Units are Hz
c. Audible range is 20 Hz to 20 kHz
d. Increasing the f decreases the depth of penetration but improves resolution
e. Can be altered with transmit gain
f. Harmonics transmits a low frequency (e.g. 1.8 MHz) and displays a higher frequency (e.g. 3.6 MHz)

Cardiovascular Principles
1. According to Poiseulle's law, which has the greatest effect on flow volume through a tube?
a. Pressure gradient
b. Radius (diameter)
c. Viscosity
d. Length of the tube

2. _________ flow is normal flow.
a. Laminar
b. Disturbed
c. Turbulent
d. None of the above

3. The laminar core (thickness of the jet) of a turbulent jet is called the:
a. PISA (flow convergence)
b. Vena contracta
c. Turbulent region
d. Relaminarization

4. The ________ predicts the pressure difference (gradient, drop) between two chambers.
a. Bernoulli
b. Continuity
c. Doppler
d. Gorlin

5. The peak velocity across a stonotic aortic valve is 3.0 m/s. The peak pressure gradient is:
a. 3 mm Hg
b. 9 mm Hg
c. 36 mm Hg
d. 46 mm Hg

6. All of the following are correct concerning pressure overload EXCEPT:
a. AS: pressure overload of the LV resulting in LVH
b. PS: pressure overload of teh RV resulting in RVH
c. MS: pressure overload of the LA resulting in LAE and systemic venous hypertension
d. TS: pressure overload of the RA resulting in RAE and systemic venous hypertension
e. Coarctation: pressure overload of the LV resulting in LVH
f. Pulmonary hypertension: pressure overload of the RV resulting RVH/RVE
g. Systemic hypertension: pressure overload of the LV resulting in LVH
h. Pulmonary embolism: pressure overload of the RV resulting in RVE

7. All of the following are correct cocerning volume overload EXCEPT:
a. Chromic AR: volume overload of the LV resulting in LVE
b. Chronic PR: volume overload of the RV resulting in RVE
c. Chronic MR: volume overload of the LA and LV resulting in LAE and LVE
d. Chronic TR: voulume overload of the RA and RV resulting in RAE and RVE
e. ASD: volume overload of the RA and RV resulting in RAE and RVE
f. VSD: volume overload of the RA and RV resulting in RAE and RVE
g. PDA: volume overload of the LA and LV resulting in LAE and LVE

Adult Echocardiography
Mitral Stenosis (MS)

1. The most common etiology of mitral stenosis (MS) is:
a. Rheumatic fever
b. Congenital
c. Severe MAC (functional MS)
d. Idiopathic

2. Two common secondary findings for MS are:
a. LAE; pulmonary hypertension
b. LAE; LVH
c. LVH; reduced global LV systolic function
d. RAE; LVE

3. All of the following are classic M-mode findings for MS EXCEPT:
a. Thickened leaflets
b. Decreased E-F slope
c. Anterior motion of the posterior mitral valve leaflet
d. Increased D-E excursion

4. All of the following are 2-D findings for MS EXCEPT:
a. Thickened leaflets (especially at the leaflet tips)
b. Diastolic doming
c. LAE
d. LVH

5. For cardiac Doppler, a peak mitral valve E velocity greater than __ suggests MS.
a. 0.5 m/s
b. 1.0 m/s
c. 1.2 m/s
d. 1.5 m/s

6. For MS, the sonographer shuld (more than one correct answer):
a. Planimeter the MV in the short axis of the MV
b. Use CW Doppler and trace for peak velocity, peak pressure gradient, mean pressure gradient
c. Measure the slope to determine PHT and MVA
d. Determine the RVSP and SPAP using the TR peak velocity

7. The formula used to determine MVA is:
a. CSA x VTI
b. 220/PHT
c. LVEDV - LVESV / LVEDV x 100
d. ICA/CCA

8. The treatment for MS includes all of the following EXCEPT:
a. Mitral valve replacement (MVR)
b. Balloon valvuloplasty
c. Surgical commissurotomy
d. ELG (endoluminal graft)

The following were not discussed (MR and MVP) in class so they are BONUS!!!!
Mitral Regurgitation (MR)

1. Which of the following are causes of MR?
a. MAC
b. MVP
c. Ruptured chordae tendineae
d. Fibrocalcific papillary muscle(s)
e. LV dilatation (functional MR)
f. All of the above

2. Which of the following is most likely to result in acute MR?
a. MS
b. Ruptured chordae tendineae resulting in flail mitral valve
c. Thickening of teh MV due to aging
d. LV dilatation (functional MR)

3. Mitral regurgitation (MR) occurs during:
a. Ventricular diastole
b. Atrial systole
c. Ventriuclar systole
d. Ventricular diastasis

4. Chronic significant MR may result in (more than one correct answer):
a. LAE
b. LVE
c. LVVO (LV dilatation with hyperkinesis)
d. Pulmonary hypertension
e. RVVO (RVE with paradoxical septal motion)

5. The murmur of MR is described as (a):
a. Holodiastolic decrescendo murmur heard best at the right upper sternal border
b. Holosystolic murmur heard best at the apex radiating to the axilla
c. Systolic ejection murmur heard best at the right upper sternal border
d. Continuous (machinery-like) murmur

6. The pulmonary vein finding in significant MR is:
a. Increased A wave peak velocity
b. Increased A wave duration
c. Increased S wave
d. S wave reversal

7. CW Doppler is useful in determining the severity of MR by using (two correct answers):
a. Peak velocity
b. Mean pressure gradient
c. Spectral density (strength)
d. Flow duration

8. All of the following are color flow Doppler methods used to determine the severity of MR EXCEPT:
a. RJA/LAA
b. Peak velocity
c. PISA
d. Vena contracta

9. Calculate the regurgitant volume (RV), reguritant fraction (RF) and effective regurgitant orifice (ERO) for the following (Pocket Reference pages 347-348)
Mitral valve annulus (diastole)" 3.0 cm
Mitral valve VTI (PW Doppler): 20 cm
LVOT diameter (systole): 2.0 cm
LVOT VTI (PW Doppler): 15 cm
MR VTI (CW Doppler): 200 cm

RV: _________ml RF: _________% ERO:________cm2 Severity: ________

10. Calculate the MR ERO and RV using the PISA method (Pocket Reference page 344):
PISA radius: 1.0 cm
Aliasing velocity: 40 cm/s
MR peak velocity: 500 cm/s
MR VTI: 150 cm

ERO: ________ mm2 RV: ___________ ml Severity: ____________

Mitral Valve Prolapse (MVP)
11. The mitral valve moves past the mitral annular plane by more than 2 mm in the parasternal long axis. This is MV:
a. NS
b. MR
c. MVP
d. Normal

12. Mitral valve prlapse (MVP) is referred to as:
a. Austin Flint
b. Graham Steell
c. Click-murmur syndrome
d. Iatrogenic

13. The two typels of MVP are:
a. Holosystolic; Holodiastolic
b. Holosystolic; continuous
c. Mid to late; Holosystolic
d. Mid to late diastolic; Holodiastolic

14. The 2-D view of choice for diagnosing MVP is the:
a. parasternal long axis
b. Parasternal short axis of teh MV
c. Apical 4 chamber
d. Aprilc 2 chamber

15. The cardiac Doppler finding for MVP is:
a. AR
b. MR
c. TR
d. PR

16. Check the following if associated with Marfan's syndrome:
_____ Aortic root/ascending aorta aneurysm
_____ MVP
_____ AR
_____ MR
_____ Aortic dissection

Identify the following:

_______________________________

______________ _______________

RVVO or LVVO _____________

Abominal Aorta

1. An AAA is present when the anterior-posterior diameter exceeds: ____cm.

a. 0.5

b. 1

c. 2

d. 3

2. The treatment for AAA is:

a. Valve replacement

b. Valvupolpasty

c. ELG

d. CABG

3. The protocol for examing the abdominal aorta is _____ first.

a. Longitudinal

b. Transverse

Carotid Ultrasound

1. The ECA supplies teh face and neck and is considered a _____ resistance vessel.

a. High

b. Low

2. The ICA supplies the brain which is considered a _______ resistance vessel.

a. High

b. Low

3. The carotid exam begins on the right side with _____ and color flow Doppler first.

a. Transverse

b. Longitudinal

4. The primary reason to examine the carotids is for:

a. Plaque

b. Aneurysm

c. Tumor

d. Dissection

5. The distal CCA is 70 cm/s. The proximal ICA is 120 cm/s. The ICA/CCA ratio is: ___.

Is this normal? _______

Identify:

1. __________ 4. ___________

2. __________ 5.___________

3. _________ 6. ___________

Written Test due 11/09/09

2009-10-26T11:15:00.000-07:00

Ulrtrasound Physics Review: Frequency (f)

1. Check the following if true concerning f:

_____ Number of cycles per second

_____ Units are Hertz (Hz)

_____ Audible sound range is 20 Hz to 20 kHz

_____ As f increased, depth of penetration decreases; resolution improves

_____ Harmonics transmits a low f; displays a higher f

Cardiovascular Principles

1. True or False: Laminar flow is normal flow

2. The four components of turbulent flow are:

a. PISA (flow convergence)

b. Vena contracta (jet width)

c. Turbulent region (jet area)

d. Relaminarization (pressure recovery)

e. All of the above

3. The _____ equation allows calculation of the pressure difference (drop; gradient) between two chambers.

a. Bernoulli

b. Continuity

c. LVIDd - LVIDs / LVIDd x 100

d. LVEDV - LVESV / LVEDV x 100

4. All of the following are correct statements EXCEPT:

a. AS: pressure overload; LV; LVH

b. PS: pressure overload; RV; RVH

c. MS: pressure overload; LA and systemic venous system; LAE

d. TS: pressure overload; RA and systemic venous system; RAE

e. Coarctation: pressure overloadl LV; LAE

f. Systemic hypertension: pressure overload; LV; LVH

g. Pulmonary hypertension: pressure overload; RV; RVH/RVE

5. All of the following are correct statements EXCEPT:

a. Chronic AR: volume overload; LV; LVE

b. Chronic PR: volume overload; RV; RVE

c. Chronic MR: volume overload; LA; LAE

d. Chronic TR: volume overload; RA and RV; RAE and RVE

e. ASD: volume overload; RA and RV; RAE and RVE

f. VSD: volume overload; LA and LV; LAE and LVE

g. PDA: volume overload; LA and LV; LAE and LVE

h. Partial anomalous pulmonary venous return: volume overload; RA and RV; RAE and RVE

6. True or False: The continuity equation allows calculation of aortic valve area (AVA)

M-mode

1. True or False: The three aortic root M-mode measurements are: aortic root diameter at end-diastole, ACS in early systole, LA at end systole.

2. True or False: The MV EPSS is a way to help predict EF.

3. True or False: Measurement of the LVIDd and LVIDs on the LV M-mode (and the LV on the parasternal long axis) will allow calculation of fractional shortening (FS) and ejection fraction.

2-D

1. The view of choice for aortic coarctation is:

a. Parasternal long axis

b. Parasternal short axis of the mitral valve

c. Apical 4 chamber

d. Suprasternal long axis of the aorta

Cardiac Doppler

1. The mitral valve pressure half time is 87 msec. The mitral valve area is:

a. 87 / 220

b. 220 / 87

c. 220 x 87

d. 220 + 87

Pathology

Identify the following:

1. ___________________________________

2. ______________ 3. _______________

4. ____________________________