FM-quiz FATEadv

PSAX view at the mitral level. Which of the following statements about the PSAX view at the mitral level are correct?

The best position of the patient is supine
Inspiration will often improve the image quality
This view is perfect for the assessment of LV global function
The orientation marker should be aimed towards the left shoulder
Navigation between the different views is done predominantly by tilting the transducer and moving the tail to and away from the right shoulder

TEST 1: Assessment of cardiac output using Doppler. Which statements are true regarding the assessment of cardiac output using Doppler in the left ventricle outflow tract?

D is optimal for the assessment of cardiac output using Doppler echocardiography
C can be used for the assessment of cardiac output and right ventricular pressure
B is perfect for the Doppler curve recording to measure cardiac output
A is optimal for the Doppler recording of the velocity data and B for the diameter measurement to obtain the CSA
Both A and C but not B can be used for collection of the velocity data

PSAX view at the aorta level. Which of the following statements about the PSAX view at the aortic level are correct?

The best placement of the patient is 70-90 degrees left lateral position
Inspiration will often improve the image quality
The orientation marker should be directed towards the left shoulder
In contrast to the parasternal long axis view all three aortic cusps can be displayed
The pulmonary artery bifurcation will appear in the near field

TEST 2: Assessment of cardiac output using Doppler. Which of the following statements regarding the assessment of volume flow with Doppler are correct?

In theory all vessels can be used
Flow can be measured from the product of blood velocity time integral, heart rate and the corresponding CSA
The Doppler equation is not valid for the measurement of flow because the angle of insonation is too small
For the assessment of volume flow with PWD colour flow should always be superimposed on the 2D image
Tracing of the pulsed spectral Doppler curve provides the velocity time integral

Key points of the suprasternal view. Which of the following statements about suprasternal view are correct? Select all that apply.

The best position of the patient is supine
The position of the head is individually adjusted
Basal part of both right and left ventricular myocardium can be evaluated
The neck should be extended
Aortic dissection should not be considered in this view
The pressure drop across the aorta can generally not be estimated in this view

TEST 3: Cardiac output – CSA assessment. Where should the diameter be measured for the assessment of CO in the LVOT?

At A
At B
At C
At D
B and C are equally good

Cardiac output. Which of the following statements about cardiac output are correct? Select all that apply.

Assessment of cardiac output with Doppler in the clinical setting is extremely accurate and reliable
Continuous wave Doppler is theoretically as accurate as pulsed wave Doppler
The velocity data and cross sectional area should be measured at the same location
Aliasing risk is the reason that pulsed wave Doppler is recommended for the calculation of CO
The angle of insonation is not relevant for Doppler based cardiac output measurement
Even when using pulsed wave Doppler, the CO estimate can be quite inaccurate

Doppler modalities 1. Which of the following statements about the different Doppler modalities are correct?

An advantage of continuous wave Doppler is the measurement of velocities locally
An advantage of pulsed wave Doppler is the measurement of very high velocities
PWD requires only one piezo electric crystal
CWD requires two piezo electric crystals, one emitting and one receiving at the same time
In PWD emitting and receiving takes place at the same time

Diastolic function – mitral inflow curve. Which of the following statements about the assessment of diastolic function are correct? Select all that apply.

Mitral inflow patterns with PWD cannot be used for the assessment of diastolic function
Pulsed wave Doppler is an important method for the assessment of mitral inflow patterns
Continuous wave Doppler is not first choice for the assessment of mitral inflow patterns
A combination of PWD and CWD is mandatory for the assessment of LV diastolic function
PWD is one of many Doppler methods used in the assessment of diastolic function
The PWD sample volume should be placed in the aortic outflow tract

Doppler modalities. Which of the following statements about the different Doppler modalities are correct? Select all that apply.

An advantage of colour flow Doppler is the measurement of very high velocities
In pulsed wave Doppler the velocity limit is approximately 1.5 – 2 m/s
In colour Doppler, blue is away from the transducer and red is towards the transducer
Colour Doppler is based on the pulsed Doppler principle
On a spectral curve, positive velocities are displayed above the baseline
The PWD spectral Doppler curve has a smaller velocity band compared to CWD

Diastolic function – mitral inflow curve. Which of the following statements regarding the assessment of diastolic function are correct? Select all that apply.

An ECG signal is not relevant for the assessment of diastolic function with PWD
The best view for the recording of mitral inflow velocities is the apical 4 chamber view
A parasternal long axis view can be used in the case of a suboptimal apical view
The E wave corresponds to the early systolic contraction
The E wave corresponds to early diastolic filling and the A wave to atrial contraction
Deceleration time (DT) can be used as a substitute for E and A and E/A

Pressure estimation. Which of the following statements about pressure estimation are correct? Select all that apply.

For pressure estimation CW Doppler is generally used
PW Doppler can be used for pressure estimation but the velocity limit is low and not clinically relevant
Peak pressure can be estimated from squaring the maximum Doppler velocity alone
For pressure estimation across the aortic valve the left atrial pressure should be added
Clinically relevant pressure estimation with Doppler relies on the simplified Bernoulli equation
For right side pressure estimation across the tricuspid valve the right atrial pressure should be added

Diastolic function. Which of the following statements about diastolic function are correct? Select all that apply.

LV hypertrophy and LA enlargement are suggestive of impaired diastolic function
The E wave is generally higher than the A wave but this finding does not necessarily imply normal diastolic function
E/A normal range is 1-2
DT does not differentiate between a normal E/A and pseudonormalisation of E/A
DT is normally 140 to 240 ms and increases with the severity of diastolic dysfunction
In severely impaired diastolic function, the E/A can be normal but the DT is shorter typically <140 ms

Pressure estimation. Which of the following statements about Doppler pressure estimation are correct? Select all that apply.

Right ventricular (RV) peak pressure can be estimated across the mitral valve
RV systolic peak pressure across the tricuspid valve equals the pulmonary artery peak pressure if no PA stenosis is present
Measuring the right side peak pressure across the tricuspid valve, use colour Doppler to search for an insufficiency jet
The Doppler angle error always overestimates the velocity
A Doppler insonation angle of up to 60 degrees is clinically acceptable
A Doppler insonation angle of approx. 20 degrees equals an underestimation in peak pressure of approx. 6%

Diastolic function – PWD and TDI. Which of the following statements regarding diastolic function assessed by pulsed wave and tissue Doppler are correct?

E and E’ express the same entity and are interchangeable
Both E and E’ are diastolic events that occur before the P wave in the corresponding ECG
Both E/A and E’/A’ ratios change as diastolic dysfunction worsens
In severe diastolic dysfunction (restrictive filling), E/A >2
S is a tissue Doppler event and does not apply to mitral inflow recordings with PWD

Pressure estimation. Which of the following statements about the pressure estimation are correct? Select all that apply.

A small mitral regurgitation of no clinical relevance can easily be misinterpreted as a severe aortic stenosis (AS)
Very accurate peak aortic pressure can be assessed from both the apical 5 chamber view and the parasternal long axis view
The pressure drop across the aortic valve can be measured in the apical 5 chamber or apical long axis view
The target view for right side peak pressure estimation is the apical 5 chamber view
In severe AS, the default preset often requires adjustment of baseline shift or PFR in order to measure the peak velocity
RV pressure measured across the tricuspid valve should include the right atrial pressure

Diastolic function – PWD and TDI. Which of the following statements regarding diastolic function assessed by pulsed wave and tissue Doppler are correct?

E and A expressed as E/A ratio is sufficient for the evaluation of diastolic function
E combined with A’ is the best way to evaluate diastolic function
As diastolic dysfunction worsens the E’ decrease and the A’ increase in numeric velocity
Combining E with E’ is a much stronger tool for the evaluation of the diastolic function than E and E’ alone
E’ can be measured at the mitral annulus septal wall but not at the lateral wall

Colour gain. The picture shows two ultrasound images, where B is an optimised image of A. How is B optimised? Only one true answer

Colour gain is increased
Baseline is increased
Colour gain is decreased
Depth is decreased
Sector is narrowed

TEST 4: Spectral Doppler curves obtained across the aortic valve. The image shows 3 different spectral Doppler curves obtained across the aortic valve. Which of the following statements are correct?

A is a typical pulsed wave Doppler curve
B is a typical pulsed wave Doppler curve
C is a typical pulsed wave Doppler curve with a narrow velocity band measuring relatively low peak velocities
A and B are typically continuous wave Doppler curves and are used to measure relatively high peak velocities
In C an estimate of peak pressure can be given if the curve represents the highest velocity of interest

Doppler modalities. Which of the statements about Doppler modalities are correct? Select all that apply.

Pulsed wave Doppler and continuous wave Doppler can be active at the same time
2D imaging and colour Doppler can be active at the same time
Colour Doppler is typically superimposed on a 2D image
Colour Doppler is not possible on a dynamic 2D image
Baseline shift is not only a graphic optimisation but allows you to interrogate higher velocities
Baseline shift enables higher velocities to be measured in one direction at the expense of velocities in the opposite direction

Aortic peak pressure. Which of the following statements about the aortic peak pressure are correct? Select all that apply.

The 2D image at the top of the image is an apical long axis view
The red line should be used for assessment of the aortic peak pressure
The yellow line should be used for assessment of the aortic peak pressure
The peak pressure on the image is approx. 100 mmHg
From the image it cannot be justified whether the spectral display represents a PW or CW Doppler curve
The velocities represent blood moving away from the transducer (negative and displayed below the baseline)

Right place for measuring the diameter of IVC. Where should the IVC diameter be measured?

At 1
At 2
At 3
At 4
2 and 3 are equally good

Spectral Doppler curves obtained across the aortic valve. The image shows 3 different spectral Doppler curves obtained across the aortic valve. Which of the following statements are correct? Select all that apply.

In A, the maximum velocity is approx. 3 m/s which equals a pressure drop of 36 mmHg plus the left atrial pressure
In B, the maximum velocity is 5 m/s which equals a pressure drop of 100 mmHg minus the left atrial pressure
In C, the peak velocity is slightly less than 1 m/s and could be a pulsed wave spectral Doppler curve
In A, the maximum velocity is approx. 3 m/s which equals a pressure drop of 36 mmHg
In B, the maximum velocity is approx. 5 m/s which equals a pressure drop of 100 mmHg
In C, the left atrial pressure should be added to estimate the correct pressure drop

IVC statements 1. Which of the following statements about the IVC long axis view are correct ?

The subcostal IVC view is obtained by placing the transducer in the subcostal position, slightly to the right of the midline
The orientation marker on the transducer can advantageously be directed to the left
The orientation marker on the transducer should be directed cranially
The abdominal aorta is an important landmark in the correct IVC image
Pulsating pattern synchronously with ECG should lead to re-evaluation of the vessel as this is most likely the aorta

TEST 7: CW Spectral Doppler curves obtained across the aortic valve. The image shows a CW spectral Doppler curve across the aortic valve. Which of the following statements are correct?

The peak pressure can be estimated from the maximum velocity and is approx. 1 times 4 = 4mmHg
This is a pulsed wave spectral Doppler curve with aliasing and the pressure drop cannot be evaluated
The peak pressure is approx. -5 m/s times 5 and squared = 400mmHg
The peak pressure is approx. -5 m/s squared times 4 = 100 mmHg
A pressure estimate cannot be given because the left atrial pressure is missing

IVC statements 2

Which of the following statements about the IVC are correct? Select all that apply.

It is well known that the diameter of the IVC may not change with respiration in long distance runners
In the subcostal short axis view the aorta is to the right of the screen and the IVC to the left
IVC can advantageously be displayed through the spleen
IVC can often be displayed through the liver from position 4
50% variation of IVC during spontaneous inspiration is normal
In cardiology the OM is generally pointed crainallly

CW Spectral Doppler curves obtained across the tricuspid valve. The image shows a CW spectral Doppler curve across the tricuspid valve. Which of the following statements are correct? Select all that apply.

The green dotted horizontal line indicates the maximum velocity and the peak pressure is < 64 mmHg
The green dotted horizontal line indicates the maximum velocity and the pressure is approx. 4 mmHg
The maximum velocity is -4.47 m/s and equals a peak pressure drop of 80.01 mmHg
The green dotted horizontal line indicates V1 according to the Bernoulli equation and can be neglected
Assuming no pulmonary stenosis, the RV and pulmonary artery pressure are equal (approx. 80 mmHg plus RA pressure)
A pressure estimate cannot be given because V1 in the Bernoulli equation is missing

Key points of the extended apical views. Which of the following statements about the apical 2 chamber and long axis views are correct? Select all that apply.

The best position of the patient is generally 90 degrees left lateral position
From the apical 4CH view the transducer should be rotated 60 degrees counterclockwise to obtain the apical 2CH view
Together with the apical 4CH view, the apical 2CH and long axis view give a detailed evaluation of the left ventricular global and regional function
From the apical 2CH view the transducer should be rotated 60 degrees counterclockwise to obtain the apical long axis view
From the apical 4CH view tilting the transducer and directing the US beam anteriorly will optimise the apical 2CH and long axis view
The left ventricular outflow tract and aortic valve are key anatomical structures in the apical 2CH view

Right side peak pressure estimation. Which statements are correct about right side peak pressure from this 4 ch view? Select all that apply.

The colour bar is not correctly placed to guide alignment of the CW Doppler beam
The regurgitant jet at A should be used for alignment of the CW Doppler beam
The regurgitant jet at B should be used for alignment of the CW Doppler beam
Both A and B can be used to guide the alignment of the CW Doppler beam
Because the pressures in the atria are generally low, pulsed wave Doppler should be used
A very high pressure measured at B is normal whereas a very high pressure at A is pathologic

Key points of the extended apical views 2. Which of the following statements about the apical 5 chamber view are correct?

The best position of the patient is generally 45 degrees left lateral position
From the apical 4Ch view the transducer should be rotated clockwise to obtain the apical 5Ch view
The left atrium is perfectly evaluated from the apical 5Ch view
From the apical 4Ch view the ultrasound beam should be directed more anteriorly in order to obtain the apical 5Ch view
An approx. angle difference between the apical 4Ch and 5Ch view is 60 degrees

TEST 10: CW Doppler curves across the tricuspid valve. A-C represents CW Doppler curves across the tricuspid valve, which of the following statements are correct ?

C represents the highest right ventricular pressure of the 3 cases
In B, the red line represents the maximum velocity
In B, the velocities on the yellow line will underestimate the peak velocity
The right ventricular pressure is higher in A than in B if the right atrial pressure is the same in the two cases
In A, B and C, colour Doppler should be used to guide the alignment of the CW Doppler beam