Lange Review Ultrasonography Examination, 4th Edition

Questions

GENERAL INSTRUCTIONS: For each question, select the best answer. Select only one answer for each question, unless otherwise specified.

1. Which of the following should be the first step when performing a fetal echocardiogram?

(A) fetal heart rate

(B) fetal position

(C) gestational age

(D) amount of amniotic fluid present

2. What is the most important view when performing a fetal echocardiogram?

(A) aortic arch

(B) subcostal four-chamber view

(C) long-axis view of the aorta

(D) ductal arch

3. Pulsed Doppler can be used to interrogate all valves proximally for which of the following?

(A) stenosis

(B) atresia

(C) contractility

(D) insufficiency

4. In addition to a four-chamber view, all routine obstetrical ultrasound exams should include which views?

(A) aorta and pulmonary artery

(B) mitral and tricuspid valves

(C) anterior and posterior pulmonary veins

(D) aortic and ductal arches

5. To assess for a fetal dysrhythmia, the M-mode cursor should be placed simultaneously through which structures?

(A) mitral and tricuspid valves

(B) right and left ventricles

(C) atrial and ventricular wall

(D) foraminal flap

6. The normal direction of blood flow through the foramen ovale is from which direction?

(A) right atrium to left atrium

(B) left atrium to right atrium

(C) right ventricle to left ventricle

(D) left ventricle to right atrium

7. All are indications for performing a fetal echocardiogram, except

(A) mother with lupus

(B) mother with diabetes

(C) mother with cytomegalovirus

(D) mother with influenza

8. Which chromosomal abnormality carries the highest risk of an associated congenital heart defect?

(A) trisomy 21

(B) trisomy 18

(C) Turner syndrome

(D) DiGeorge syndrome

9. Equipment used for fetal echocardiography should be equipped with all of the following modalities, except.

(A) pulsed Doppler

(B) color Doppler

(C) power Doppler

(D) M-mode

10. Congenital cardiac abnormalities occur in approximately how many live births?

(A) 1/400

(B) 1/300

(C) 1/200

(D) 1/100

11. What is the most common type of congenital heart disease found in abortuses and stillbirths?

(A) atrial septal defect

(B) ventricular septal defect

(C) atrioventricular septal defect

(D) Coarctation of the Aorta

12. What is the most appropriate view to interrogate the interventricular septum?

(A) apical four chamber

(B) subcostal four chamber

(C) short axis of the great vessels

(D) three vessel view

13. A fetal echocardiogram should be performed at approximately how many weeks of gestation?

(A) 10–12 weeks

(B) 15–16 weeks

(C) 18–22 weeks

(D) 24–28 weeks

14. The apex of the normal heart points in which direction?

(A) toward the left

(B) toward the right

(C) superior

(D) posterior

15. Compared to midline, what is the angle of the normal fetal heart?

(A) 20°

(B) 45°

(C) 70°

(D) 90°

16. Which term describes the normal position of the heart?

(A) levocardia

(B) dextrocardia

(C) mesocardia

(D) dextroposition

17. The normal fetal heart occupies

(A) 1/4 of the chest

(B) 2/3 of the chest

(C) 1/3 of the chest

(D) 1/2 of the chest

18. The apical four-chamber view is obtained when the septae of the heart are positioned in which direction?

(A) toward the fetus’s right

(B) parallel to the ultrasound beam

(C) toward the fetus’s left

(D) perpendicular to the ultrasound beam

19. The apical four-chamber view is not the ideal view to visualize which of the following?

(A) all four chambers

(B) the mitral and tricuspid valves

(C) chamber size

(D) the interventricular septum

20. The sonographer has obtained a subcostal four-chamber view and then angles toward the fetus’s right shoulder. What view will be visualized first?

(A) cross-section view of the ventricles

(B) short-axis view of the aorta with the pulmonary artery crossing over

(C) right ventricular outflow tract

(D) long-axis view of the aorta

21. What is the correct orientation of the great vessels?

(A) run parallel to each other

(B) criss-cross

(C) join to form one vessel

(D) originate from the right ventricle

22. The moderator band can be identified in which cardiac chamber?

(A) left ventricle

(B) left atrium

(C) right ventricle

(D) right atrium

23. Which view is least accurate to identify interventricular septal defects?

(A) subcostal four-chamber view

(B) long axis of the proximal aorta

(C) short-axis view of the ventricles

(D) short-axis view of the great vessels

24. While demonstrating a short-axis view of the great vessels, the main pulmonary artery is often seen bifurcating into which structures?

(A) ductus arteriosus and the right pulmonary artery

(B) right and left pulmonary arteries

(C) ductus arteriosus and the left pulmonary artery

(D) ductus arteriosus and the aorta

25. Which does not describe the appearance of the aortic arch?

(A) Brachiocephalic vessels are visualized.

(B) It has an appearance of a candy cane.

(C) It is superior to the ductal arch.

(D) It has an appearance of a hockey stick.

26. Which abnormality can be identified in the portion of the aortic arch just distal to where the ductus arteriosus inserts?

(A) aortic valve insufficiency

(B) aortic coarctation

(C) aortic stenosis

(D) pulmonary valve insufficiency

27. The ductal arch is composed of all of the following except.

(A) the descending aorta

(B) the pulmonary artery

(C) the ascending aorta

(D) the ductus arteriosus

28. Which relative with history of heart defect puts the fetus at the greatest risk?

(A) one sibling

(B) the father

(C) the mother

(D) the paternal grandmother

29. Which is not an indication for a fetal echocardiography exam?

(A) non-immune hydrops

(B) maternal diabetes

(C) suspicion of abnormal chromosomes

(D) suboptimal heart views on a 12-week ultrasound

30. Which is not an advantage of using color Doppler during a fetal echocardiography exam?

(A) identifying areas of turbulence

(B) indicating direction of flow

(C) indicating peak velocity

(D) identifying small ventricular septal defects

31. In which situation is M-mode not helpful?

(A) measuring chamber size

(B) measuring wall thickness

(C) documenting dysrhythmias

(D) documenting direction of flow

32. In the fetus, much of the blood bypasses the liver by traveling through which structure?

(A) foramen ovale

(B) ductus venosus

(C) ductus arteriosus

(D) ligamentum venosum

33. Pulsed Doppler of the pulmonary veins is useful in determining flow in which direction?

(A) into the left atrium

(B) out of the left atrium

(C) into the right atrium

(D) out of the right atrium

34. What is the best Doppler angle when performing pulsed Doppler on the fetal heart?

(A) 90°

(B) 60°

(C) 30°

(D) 0°

35. The sample gate for the pulsed Doppler cursor is set

(A) small so that many vessels can be interrogated at once

(B) large so that many vessels can be interrogated at once

(C) large to ensure the vessel of interest is obtained

(D) small to avoid interference while obtaining the vessel of interest

36. Oxygenated blood flows from the placenta to the fetus by way of which structure?

(A) umbilical vein

(B) umbilical artery

(C) ductus venosum

(D) ductus arteriosus

37. Which describes the blood that enters the right atrium in the fetus?

(A) deoxygenated blood

(B) oxygenated blood

(C) oxygenated and deoxygenated blood

(D) maternal blood

38. Which is not a shunt present in the fetus?

(A) ductus venosum

(B) foramen ovale

(C) ductus arteriosus

(D) umbilical vein

39. Which modality is least useful in diagnosing a ventricular septal defect?

(A) 2D imaging

(B) color Doppler

(C) pulsed Doppler

(D) M-mode

40. An atrioventricular septal defect includes abnormal development of all of the following except.

(A) aortic arch

(B) interatrial septum

(C) interventricular septum

(D) atrioventricular valves

41. In hypoplastic left heart syndrome, what is a cause of the left ventricle becoming hypoplastic?

(A) decreased blood flow into or out of the left ventricle

(B) increased blood flow into or out of the left ventricle

(C) decreased blood flow due to a closed foramen ovale

(D) a large ventricular septal defect

42. In a fetus with hypoplastic left heart syndrome, abnormalities may be seen in which valves?

(A) aortic and pulmonary

(B) mitral and tricuspid

(C) tricuspid and pulmonary

(D) mitral and aortic

43. With hypoplastic left heart syndrome, blood flow through the ascending aorta is usually

(A) absent or reversed

(B) high velocity

(C) normal

(D) low velocity

44. Atrioventricular septal defects are commonly associated with which condition?

(A) lupus

(B) oligohydramnios

(C) polysplenia

(D) polyhydramnios

45. Which chromosomal abnormality is most commonly associated with an atrioventricular septal defect?

(A) trisomy 13

(B) trisomy 18

(C) trisomy 21

(D) Turner syndrome

46. Which heart anomaly has the best prognosis?

(A) Ebstein anomaly

(B) isolated ventricular septal defect

(C) truncus arteriosus

(D) undetected Coarctation of the Aorta

47. Which heart anomaly usually has the poorest prognosis?

(A) hypoplastic left heart syndrome

(B) hypoplastic right heart syndrome

(C) mild aortic stenosis

(D) isolated atrial septal defect

48. Which structure could be small with hypoplastic right heart syndrome?

(A) aortic valve

(B) pulmonary valve

(C) aorta

(D) pulmonary veins

49. What effect is demonstrated with pulse Doppler, when a valve is stenotic

(A) decreased velocity proximal to the valve

(B) decreased velocity distal to the valve

(C) increased velocity proximal to the valve

(D) increased velocity distal to the valve

50. Which is not visualized with hypoplastic right heart syndrome?

(A) antegrade flow through the foramen ovale

(B) large left-sided heart

(C) increased flow through the pulmonary artery

(D) dilated aortic root

51. Which condition is almost always present with a univentricular heart?

(A) transposition of the great vessels

(B) Coarctation of the Aorta

(C) hypoplastic left heart syndrome

(D) Ebstein anomaly

52. Which is not associated with a univentricular heart?

(A) two normal atrioventricular valves

(B) pulmonary stenosis

(C) asplenia

(D) polysplenia

53. Which describes Coarctation of the Aorta?

(A) absence of the aorta

(B) an aneurysm of the aorta

(C) narrowing of the aortic lumen

(D) enlargement of the aortic lumen

54. The majority of coarctations of the aorta occur between which structures?

(A) thoracic and abdominal aorta

(B) aortic valve and the ductus arteriosus

(C) right subclavian artery and the ductus arteriosus

(D) left subclavian artery and the ductus arteriosus

55. Which is not a sign of Coarctation of the Aorta?

(A) enlarged right ventricle

(B) enlarged left ventricle

(C) increased velocities in the aorta

(D) narrowing of the aorta

56. Coarctation of the Aorta is most common in which genetic condition?

(A) Turner syndrome

(B) Edwards syndrome

(C) trisomy 13

(D) trisomy 21

57. Which describes Ebstein anomaly?

(A) inferior displacement of the mitral valve

(B) superior displacement of the mitral valve

(C) inferior displacement of the tricuspid valve

(D) superior displacement of the tricuspid valve

58. Ebstein anomaly has been associated with maternal use of which substance?

(A) lithium

(B) alcohol

(C) codeine

(D) tobacco

59. Which defect is not seen in a newborn with tetralogy of Fallot?

(A) ventricular septal defect

(B) overriding aorta

(C) pulmonary stenosis

(D) aortic stenosis

60. Which tetralogy of Fallot defect may not be present in utero?

(A) large ventricular septal defect

(B) atrial septal defect

(C) right ventricular hypertrophy

(D) overriding aorta

61. Which defect is present with truncus arteriosus?

(A) Coarctation of the Aorta

(B) hypoplastic right heart

(C) atrial septal defect

(D) ventricular septal defect

62. What is an accurate description of truncus arteriosus?

(A) a single vessel arising from the heart; the pulmonary arteries arise from this great vessel

(B) a single vessel arising from the heart; the aorta arises from this great vessel

(C) two vessels arise from the heart; running parallel

(D) two vessels arise from the heart and criss-cross

63. A right-sided aortic arch is not seen in which condition?

(A) truncus arteriosus

(B) congenitally corrected transposition of the great vessels

(C) tetralogy of Fallot

(D) situs inversus above the diaphragm

64. Truncus arteriosus can be mistaken for which other anomaly?

(A) transposition of the great vessels

(B) tetralogy of Fallot

(C) Ebstein anomaly

(D) univentricular heart

65. Which view cannot be obtained with complete transposition of the great vessels?

(A) apical four chamber

(B) subcostal four chamber

(C) short-axis view of the great vessels

(D) aortic arch

66. With complete transposition of the great vessels

(A) the atria, ventricles, and valves are in the appropriate location; the aorta arises from the right ventricle, the pulmonary artery from the left ventricle

(B) the atria, ventricles, and valves are in the appropriate location; the aorta arises from the left ventricle, the pulmonary artery from the right ventricle

(C) the atria, ventricles, and valves are transposed; the aorta arises from the right ventricle, the pulmonary artery from the left ventricle

(D) the atria, ventricles, and valves are transposed; the aorta arises from the left ventricle, the pulmonary artery from the right ventricle

67. To identify congenitally corrected transposition of the great vessels, the moderator band can be seen in the

(A) right-sided left ventricle

(B) left-sided left ventricle

(C) right-sided right ventricle

(D) left-sided right ventricle

68. With congenitally corrected transposition of the great vessels

(A) the atria, ventricles, and valves are in the appropriate location; the aorta arises from the left ventricle, the pulmonary artery from the right ventricle

(B) the atria, ventricles, and valves are in the appropriate location; the aorta arises from the right ventricle, the pulmonary artery from the left ventricle

(C) the right atrium and left ventricle are connected, the left atrium and right ventricle are connected; the aorta arises from the right-sided left ventricle; the pulmonary artery from the left-sided right ventricle

(D) the right atrium and left ventricle are connected, the left atrium and right ventricle are connected; the aorta arises from the left-sided right ventricle; the pulmonary artery from the right-sided left ventricle

69. What is the best view to identify double outlet right ventricle?

(A) long-axis views of the aorta and pulmonary artery

(B) apical four-chamber view

(C) subcostal four-chamber view

(D) long-axis view of the pulmonary artery

70. With double outlet right ventricle, the great vessels run

(A) right to left

(B) left to right

(C) parallel

(D) perpendicular

71. When total anomalous pulmonary venous connection occurs, the pulmonary veins drain into which structure?

(A) right ventricle

(B) left ventricle

(C) right atrium

(D) left atrium

72. Which anomaly is most likely to be identified in utero if only a four-chamber heart view is obtained?

(A) double outlet right ventricle

(B) tetralogy of Fallot

(C) transposition of the great vessels

(D) hypoplastic left heart syndrome

73. In severe levocardia, the heart is pointed toward the

(A) left at a 45° angle

(B) left at an angle greater than 65°

(C) right at a 45° angle

(D) right at an angle greater than 65°

74. Which term is used when the apex of the heart is pointed toward the right side?

(A) levocardia

(B) levoposition

(C) dextrocardia

(D) dextroposition

75. The heart can be displaced to the right side of the chest due to all of the following except.

(A) tricuspid insufficiency

(B) diaphragmatic hernia

(C) cystic adenomatoid malformation

(D) hypoplastic right lung

76. What is the most common type of dysrhythmia?

(A) supraventricular tachycardia

(B) tachycardia

(C) atrial flutter

(D) premature atrial contractions

77. If supraventricular tachycardia is sustained, it can lead to which anomaly?

(A) hypoplastic right heart

(B) hypoplastic left heart

(C) oligohydramnios

(D) hydrops

78. Pressure from the transducer may cause which transient dysrhythmia?

(A) premature atrial contractions

(B) atrial flutter

(C) bradycardia

(D) tachycardia

79. Which of the following describes a second-degree heart block of 3:1?

(A) two atrial contractions for every one ventricular contraction

(B) three atrial contractions for every one ventricular contraction

(C) two ventricular contractions for every one atrial contraction

(D) three ventricular contractions for every one atrial contraction

80. Which is not associated with complete heart block?

(A) chordae tendineae

(B) atrial septal defect

(C) cardiac tumors

(D) polysplenia