Echocardiography Board Review: 500 Multiple Choice Questions With Discussion

Chapter 25

Questions

1.  481. This still-frame image of a four-chamber view shows:c25f001

1.  A. Secundum atrial septal defect

2.  B. Primum atrial septal defect

3.  C. Sinus venosus atrial septal defect

4.  D. None of the above

2.  482. The still-frame image of an apical five-chamber view shows:c25f002

1.  A. Artifact

2.  B. Anomalous coronary artery

3.  C. Coronary sinus

4.  D. Biventricular pacer lead

3.  483. This parasternal short-axis view shows:c25f003

1.  A. Normal aorta and pulmonary artery

2.  B. Imaging artifact

3.  C. Anomalous coronary artery

4.  D. Artifact from pulmonary prosthesis

4.  484. This is a 51-year-old Armenian male admitted with complaints of chest pain. He underwent an echocardiogram. The still frame of 2D and color images show:c25f004

1.  A. ASD

2.  B. An inferior septal VSD

3.  C. Muscular VSD

4.  D. None of the above

5.  485. The continuous wave Doppler shows:c25f005

1.  A. A PDA

2.  B. Coarctation of the aorta

3.  C. Coronary fistula

4.  D. None of the above

6.  486. This is a still-frame image of a subcostal view. The image shows:c25f006

1.  A. Myxoma

2.  B. Lipoma

3.  C. Lipomatous hypertrophy of the interatrial septum

4.  D. Thrombus attached to the interatrial septum

7.  487. This is a still-frame of a four-chamber view. The color flow shows:c25f007

1.  A. Muscular VSD

2.  B. Apical cannula flow of an LVAD

3.  C. Psuedoaneurysm

4.  D. None of the above

8.  488. The color flow obtained from parasternal short-axis and suprasternal views show:c25f008

1.  A. Pulmonary regurgitation

2.  B. PDA

3.  C. Coronary fistula

4.  D. Flow in the coronary artery

9.  489. This image was obtained from the subcostal view. This is an image from a 41-year-old male with complaints of diarrhea, flushing, and weight loss. The image shows:c25f009

1.  A. Normal heart and liver

2.  B. Carcinoid masses in the liver

3.  C. Liver cysts

4.  D. None of the above

10. 490. This is a still-frame image of an apical long axis image. The image shows:c25f010

1.  A. Normal appearance of the heart

2.  B. Hypertrophy of the septum

3.  C. Apical hypertophic cardiomyopathy

4.  D. Apical thrombus

11. 491. The still-frame image of a parasternal short-axis and parasternal long-axis view is shown. This is a 40-year-old male with a history of Marfan syndrome. What surgical procedure did this patient undergo:c25f011

1.  A. Coronary artery bypass

2.  B. Bentall

3.  C. Ascending aortic graft

4.  D. None of the above

12. 492. A 22-year-old male had an echocardiogram as part of routine survellience. The short-axis image shows:c25f012

1.  A. Anomalous coronary artery

2.  B. Aneurysmal dilatation of the right coronary artery

3.  C. Sinus of valsalva aneurysm

4.  D. None of the above

13. 493. This is a 38-year-old male with complaints of fever, chills, and weight loss. The 2D and color flow of the parasternal long-axis images show:c25f013

1.  A. Vegetation of the aortic valve

2.  B. Abscess involving the aortic valve with fistula into the RV

3.  C. Vegetation of the mitral valve

4.  D. None of the above

14. 494. A 21-year-old male with a history of heart transplant had this echocardiogram. The short-axis and four-chamber color flow shows:c25f014

1.  A. Mild tricuspid regurgitation

2.  B. Moderate tricuspid regurgitation

3.  C. Severe tricuspid regurgitation

4.  D. None of the above

15. 495. The Doppler flow is suggestive of:c25f015

1.  A. Normal hepatic flow

2.  B. Severe TR

3.  C. Cardiac tamponade

4.  D. Constrictive pericarditis

16. 496. The subcostal image shows:c25f016

1.  A. Normal appearance of the liver

2.  B. Multiple cysts of the liver

3.  C. Multiple tumors in the liver

4.  D. None of the above

17. 497. The Continuous wave Doppler flow is suggestive of:c25f017

1.  A. Severe mitral regurgitation

2.  B. LV mid-cavity obliteration

3.  C. Dynamic outflow obstruction

4.  D. Severe aortic stenosis

18. 498. The apical four-chamber view and subcostal views show:c25f018

1.  A. Thrombus in the right atrium

2.  B. Tumor invasion of the RA through the IVC

3.  C. Myxoma of the RA

4.  D. Lipomatous hypertrophy of the atrial septum

19. 499. The subcostal view shows:c25f019

1.  A. Normal liver and gall bladder

2.  B. Gall stones

3.  C. Cysts in the liver

4.  D. Tumor of the liver

20. 500. This is a 55-year-old male with c/o shortness of breath, pedal edema, progressively worsening for 2 months. He had an echocardiogram. Representative four-chamber and short-axis views from his echocardiogram show:c25f020

1.  A. Normal left ventricle

2.  B. Apical hypertrophic cardiomyopathy

3.  C. Non compaction of the left ventricle

4.  D. Apical ballooning

Answers for chapter 25

1.  481. Answer: B.

The still-frame image shows a defect in the lower portion of the atrial septum. This constitutes a primum atrial septal defect. Often, this is associated with a cleft in the mitral valve. This is also known as a partial atrio-ventricular canal defect.

2.  482. Answer: B.

The still frame shows a tubular structure crossing across the ascending aorta. This is an anomalous coronary artery.

3.  483. Answer: C.

The parasternal short-axis image shows a tubular structure crossing across from the right coronary cusp to the left side. This is an anomalous left anterior descending artery arising from the right coronary cusp.

4.  484. Answer: B.

This patient who came with chest pain had an inferior myocardial infarction. The 2D image shows a defect in the inferior septum. The accompanying color flow image shows a left to side shunt across the inferior septum. This is a common mechanical complication to look for in patients with an inferior MI.

5.  485. Answer: B.

This is a continuous wave Doppler obtained from the suprasternal view. There is a prominent systolic component with a peak velocity of 4m/s, along with diastolic flow. This typical saw tooth pattern is seen in coarctation of aorta with significant stenosis.

6.  486. Answer: C.

This is a still-frame four-chamber view obtained from the subcostal view. The interatrial septum appears like a dumb bell with a thin fossa ovalis in the center. This is a typical appearance of lipomatuos interatrial septum.

7.  487. Answer: B.

The color flow image was obtained from the apical view. There is color flow seen at the apex. This represents flow through the apical inlet cannula of an LVAD.

8.  488. Answer: B.

The still frame of the parasternal short-axis view shows color flow in the pulmonary artery. The accompanying suprasternal view shows flow from the aorta into the left pulmonary artery. This is representative of PDA.

9.  489. Answer: B.

This subcostal image shows hyperechoic masses in the liver. These patients with complaints of flushing, diarrhea, and weight loss are representative of carcinoid disease.

10. 490. Answer: C.

The still frame of diastolic and systolic frame of the LV shows a thickened apex. The apex is usually a thin structure. Here, the apex measures about 1 cm in diastole. This demonstrates apical hypertrophy of the left ventricld.

11. 491. Answer: B.

The long-axis image shows a tube-like structure inside the aorta. This patient has undergone a Bentall procedure, which is a composite of an ascending tube graft and a prosthetic valve. The coronary arteries were also reimplanted.

12. 492. Answer: C.

This patient's echocardiogram reveals a dilated and aneurysmal right coronary artery. This is a result of Kawasaki disease. The disease causes inflammation in the walls of small and medium-sized arteries including the coronary arteries. It is also known as mucocutaneous lymph node syndrome as it affects lymph nodes, mucous membranes of nose, mouth, and throat. Echocardiogram typically shows aneurysmal dilatation of the coronary arteries.

13. 493. Answer: B.

The 2D image shows a hypoechoic structure involving the aortic valve. This bulging structure represents an abscess due to endocarditis. The color flow image shows a fistulous communication into the RV, which is due to the abscess rupturing into the RV.

14. 494. Answer: C.

The color flow images show an eccentric TR. The color flow is suggestive of severe TR. The color flow of TR is directed away from the septal leaflet. The eccentricity of the jet is suggestive of a probable flail of the septal leaflet. This could be due to multiple biopsies that these patients undergo.

15. 495. Answer: B.

The Doppler flow was obtained from the hepatic vein from the patient in the previous question. There is systolic flow reversal which is suggestive of severe TR.

16. 496. Answer: B.

The subcostal view of the liver shows multiple septations with hypoechoic areas. These hypoechoic areas are simple cysts of the liver. These occur in patients with polycystic disease, usually of the kidney and liver.

17. 497. Answer: B.

The continuous flow Doppler is obtained from apical view. There is evidence of mitral regurgitation flow (faint signal). Superimposed on and within this signal there is a late peaking, dagger-shaped systolic flow. This is due to midcavity obliteration.

18. 498. Answer: B.

There is a mass visible in the right atrium. The subcostal view shows tumor masses in the IVC, with direct extension into the RA.

19. 499. Answer: B.

The image shows dense structures in the gall bladder. There is shadowing across the gall bladder arising from these structures.

20. 500. Answer: C.

The echocardiogram shows noncompaction of the left ventricle. The lateral wall is heavily trabeculated. Noncompaction by echo can be diagnosed when the ratio of noncompacted myocardium to compacted myocardium is greater than 2 in diastole.