Davies--Clinical Indications

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Vaishali71
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166349
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Davies--Clinical Indications
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2012-09-11 03:05:10
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Davies
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  1. The ASE adopted the "leading edge" method of measurements because:

    * People were turning up the gain too much
    * nature of the interaction between ultrasound & anatomical interfaces make this advisable
    * the advent of gray scale M mode made this possible
    * it produces the most consistent and reproducible measurements
    it produces the most consistent and reproducible measurements
  2. The term basilar area of the ventricle refers to the:

    ventricular myocardium at the apex
    mid segments of the ventricle
    ventricular myocardium at the AV valves
    non of the above
    ventricular myocardium at the AV valves

    basilar area of the heart is at a level near the AV valves
  3. Dextracardia indicates:

    enlargement of all cardiac chambers
    an abnormal conduction system
    heart located in the right side of the chest
    dual chambers of the right ventricle
    heart located in the right side of the chest

    when all the organs are reversed
  4. In M mode, the structure used to pinpoint end systole for measurements is:

    R wave of the EKG
    maximum anterior motion of the LVPW
    maximun posterior motion of the IVS
    Q wave of the EKG
    maximum anterior motion of the LVPW
  5. T/F The coronary sinus returns blood to the left atrium
    False

    coronary sinus is the terminal portion of the great cardiac vein, and it returns blood to the right atrium
  6. The motion of the septum should be evaluated by M mode at the:

    basal level
    mitral level
    midventricular level
    apical level
    midventricular level
  7. T/F The ostium of the coronary arteries may sometime be visualized in a PSAX 2-D echo view at the level of the aortic valve.
    True

    narrow opening on the left coronary cusp of the AV valve at approx 4-5 o'clock may define the ostium(opening) of the left coronary artery
  8. What phase would be occuring during atrial filling?

    diastole
    systole
    isovolumic phase
    systole
  9. In the EKG cycle, late ventricular filling occurs after the:

    P wave
    Q wave
    R wave
    T wave
    P wave

    P wave on the EKG is the electrical stimulus that creates the mitral A wave, which coincides with the atrial kick and late diastolic filling
  10. T/F:  If a patient presents with an early diastolic murmur you would concentrate interest on the which to valves:

    aortic valve
    mitral valve
    tricuspid valve
    pulmonic valve
    aortic valve, pulmonic valve

    ealry diastolic murmurs are due to arotic or pulmonic insufficiency


  11. Which valve would you suspect to be abnormal if acuscultation revealed an Austin-Flint mumur?

    aortic valve
    mitral valve
    tricuspid valve
    pulmonic valve
    aortic valve

    Austin-Flint murmur is associated with aortic insufficiency
  12. The heart sound most often associated with mitral valve prolapse is:

    Gallop rhythm
    ejection sounds
    opening snap
    systolic click
    systolic click

    most important physical findings in patierns with mitral valve prolapse. clicks may be single or multiple and maybe brought out by changes in position or valsalva maneuver
  13. The heart sound associated with mitral and/or tricuspid stenosis is:

    Gallop rhythm
    ejection sound
    opening snap
    friction rub
    opening snap

    sounds are sharp & high pitched. In isolated MS increasing severity of the lesion causes highter atrial pressures and early opening of the valve, relatively short interval between the aortic component of the 2nd heart sounds & the opening snap implies severe MS. 
  14. T/F: Early diastolic murmurs are due to aortic or pulmonic insufficieny.
    True:  severity of the reg is often inversely related to the duration of the mumur. With servere reg, aortic diastolic psi falls rapidly and may equalize with ventricular psi relatively early, causing marked reduction of intensity or cessation of the murmur. AS may also cause diastolic rumble at the apex-Austin Flint murmur. PI is associated with 2 forms of murmurs. In PI due to pulmonary HTN, there is a large diastolic gradient, high pitched murmur, follows the 2nd heart sound immediately and continues throughout diastole. In PI caused by valvular disease, there is usually a silent period between the pulmonic 2nd heart sound & the initiation of the murmur, which is relatively low in frequency.
  15. T/F:  Myxomas are the most common type fo cardiac tumor. They comprise half of all reported cases. Which of the following is a true statement?

    * tumors can be located either inside or outside of the heart
    * Approx 40% of patients with LA myxomas have systemic emboli to the brain or extremities
    * myxomas occur only in the left atrium
    * females are affected slightly more often than males
    F, T, F, T

    these tumors are located only intarcardially, can occur in either atrium, on the mitral valve, or in the ventricles
  16. T/F:  Symptoms associated with pericardits include:

    * severe, sharp pain located precordially that may radiate into the shoulders and neck
    * ankle swelling.
    * changing positions and taking deep breaths increase the pain.
    * the pain is dull and radiates into the jaw.
    T, F, T, F
  17. True/False:  Symptoms noted with mitral valve prolapse syndorme include: 

    palpitations and sharp pain unrelated to exercise
    lower back pain and headache
    fatigue and dyspnea
    palpitations and dizzy spells
    T, F, T, T
  18. A pseudonym for mitral valve prolapse syndrome is:

    Ebstein's anomaly
    Barlow's syndrome
    Crohn's disease
    Prinzmetal angina
    Barlow's syndrome
  19. True/False:  The term trepopnea is the sensation of dyspnea or palpitation, or an uncomfortable feeling that may occur when patients with cardiac disease lie on their left side.
    True
  20. The term dyspnea refers to the condition of:

    difficulty in digesting food
    difficulty in breathing
    rapid breathing
    deep breathing
    difficulty in breathing
  21. If a patient awakens in the night with shortness of breath, 1 to 2 hours after falling asleep, what disease might be suspected?

    angina pectoris
    mitral valve prolapse
    constrictive pericarditis
    congestive heart failure
    congestive heart failure
  22. True/False: Anemia or cyanosis maybe a manifestation of serious underlying heart disease.
    True
  23. True/False: Dextrocardia can be detected by chest x-ray, percussion, EKG exam, auscultation and asking the patient:
    True
  24. True/False: Palpation of arterial pulses is a method used to help determine the presence or absence of diagnostic physical signs for certain cardiac diseases. Whicho f the following statements is/are correct?

    *heart failure, obstruction of flow by valvular stenosis, and constrictive pericarditis can cause a diminished stroke volume.
    * normal peripheral pulses arrive later then the carotid pulse
    * pulsus alternans implies impaired ventricular function and is often present in massive pericardial effusion, particularly pericardial tamponade
    * AR, & carotid atherosclerosis cause a large storke volume, wide pulse pressure, and lowered peripheral resistance with resultant bounding hyperkinetic pulses
    All are True
  25. True/False:  Which of the following signs are indicative but not diagnostic of heart disease?  

    sharp chest pains
    cyanosis
    clubbing
    obesity
    All of them

    all of the above may be indicators of cardiac disease but are not specifically diagnostic
  26. Which one of the following is most likely to cause a decrease in cardiac output?

    a decrease in peripheral resistance
    hyperemia
    decreased in LV stroke volume
    increase in heart rate
    hypertension
    decrease in LV stroke volume

    • LV stroke volume is directly realted to CO, therefore any decrease in LV stroke volume will reduce CO.
    • Coverserly, an increase in LV stroke volume will raise cardiac output
  27. A decrease in LV contractility secondary to acute myocardial infarction will:

    increase CO(Q) by increasing resistance(R)
    decrease CO(Q) by decreasing pressure(delta P)
    increase velocity of flow in the aorta
    decrease delta P with no effect on CO
    decrease CO(Q) by decreasing pressure(delta P)

    LV contractility will decrease delta P and in doing so will reduce cardiac ouptut
  28. In all other factors remain constant, you would expect a reduction in vessel diameter to:

    increase velocity
    decrease the likelihood of turbulence
    decrease viscosity
    decrease kinetic energy
    increase flow
    increase velocity

    • reduction in vessel diameter increases velocity within the constricted segment. 
    • reduction also increases the likelihood of turbulence, and if the diameter is sufficiently reduced flow will be reduced (critical stenosis)
  29. Which one of the following is most likely to cause turbulent flow of blood in the aorta?

    an increase in CO from 5L/min to 20L/min
    an increase in hematocrit
    decrease in cardiac output to one-half of normal
    an increase in arterial pressure of 5mmHG
    hypertensive episode
    an increase in CO from 5L/min to 20L/min
  30. True/False:  Which of the following are characteristics of turbulent flow?

    can be predicted by Reynold's number
    is responsible for murmurs, bruits and thrills
    it can increase pressure downstream
    it occurs where there are abrupt variations in vessel diameter
    is affected by velocity
    T, T, F, T, T
  31. A laboratory animal sudently develops 2:1 heart block, effectively reducing heart rate by one-half. Which one of the following responses would account for pressure being maintained at the same level as before the heart block?

    peripheral resistance decreased by one-half
    massive vasodilatation of the arterial sphincters
    peripheral resistance doubled
    arteriovenous shunting
    peripheral resistance doubled

    Ohm's Law. CO and pressure are governed not by how much blood the heart can put out in a given period but rather by how much blood the peripheral vessels are capable of accepting. With CO halved the peripheral resistance doubled, pressure remains the same.
  32. A subject has cardiac output of 5 L/M at a heart rate of 75 beats/min. If stroke volume reamins constant, what will be the effect of an increase in heart rate at 150 beats/min?

    CO would increase to 22.5 L/min
    CO would increase to 22 L/min
    CO would increase to 10 L/m
    nothing, cardiac out is independent of heart rate
    CO would triple
    CO would increase to 10 L/m
  33. The minimal pressure in the arterial system during a cardiac cycle is termed:

    systolic pressure
    pulse pressure
    diastolic pressure
    mean pressure
    mean pulse pressure
    diastolic pressure
  34. A subject has a cardiac output of 5 L/min at a heart rate of 75 beats/min. If stroke volume remains constant, what will be the effect of an increase in heart rate of 150 beats/min?

    CO would increase to 22.5 L/min
    CO would increase to 25 L/min
    CO would increase to 10 L/min
    Nothing, CO is independent of HR
    CO would triple
    CO would increase to 10 L/min
  35. In measuring human blood pressure, the first sound was heard at 130 mmHG, the second is 105, the third at 100, and the last at 95. What is the estimated mean blood pressure?

    118 mmHG
    115 mmHG
    122 mmHG
    107 mmHG
    107 mmHG
  36. Which ONE of the following is correct statement describing transmission of the arterial pressure wave?

    it originates at the level of the arterioles
    it slows with increasing age
    it slows with increasing calcification of the vessels
    it is caused in part by the inerita of blood in the aorta
    it is caused in part by the inerita of blood in the aorta
  37. In laminar flow, the velocity of the blood is:

    * directly proportional to the cross-sectional area of the vessel.
    * lowest when kinetic energy is highest
    * lowest at the center of the vessel
    * zero at the vessel wall
    * highest at the vessel wall
    zero at the vessel wall

    fact that normal blood flow is zero at the vessel wall and highest at center stream is one reason why CW doppler show wider frequency shifts (decreased windowing) when spectrally analyzed.
  38. The principal site of peripheral resistance in the vascular bed is determined to be in the arterioles because:

    blood pressure does not change across these vessels
    blood flow is slowest in the arterioles
    pressure drop across these vessels is greatest
    blood pressure is the highest here
    pressure drop across these vessels is greatest
  39. As the arterial pressure wave moves toward the periphery, all of the following occurs EXCEPT:

    pulse amplitude is increased by the presence of reflected waves
    speed of propagation disminishes
    pulsatile changes in arterioles and capillaries are dampened owing to vascular distensibility and resistance
    speed of propagation increases
    speed of propagation disminishes
  40. The incisura on the aortic pressure wave:

    indiates closure of the AV valves
    occurs when the aortic valve opens
    is inscribed just after the aortic valve closes
    occurs during rapid ventricular filling
    is inscribed just after the aortic valve closes
  41. Starling's law of the heart can best be expressed by which one of the following?

    * as heart rate increases, venticular contractility also increases
    * increasing the arterial pressure decrease the stroke volume
    * within limits, an increase in venous return resuts in an increase in stroke volume
    * the product of heart rate and stroke volume equals the cardiac output
    within limits, an increase in venous return resuts in an increase in stroke volume
  42. Which ONE of the following best describes the role of the heart as a pump?

    * regulating cardiac output
    * forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow
    * suctioning blood from the venous circulation
    * removing carbon dioxide from venous blood and supplying oxygen
    forcing blood from the venous to the arterial circulation, restoring energy necessary for the blood flow

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