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  1. Left atrial dilatation is associated with:
    a.) Significant mitral regurgitation.
    b.) Increased pulmonary pressures.
    c.) Patent Ductus arteriosus.
    d.) all of the above.
    d.) all of the listed abnormalities can affect the size of the atrium.
  2. The E-F slope of the mitral valve corresponds to which event in the cardiac cycle?
    A.) The "conduit phase"
    B.) Rapid diastolic filling.
    C.) Early systole.
    D.) Late systole.
    B.) In normal anatomy the mitral valve opens in diastole to low-pressure left ventricle and fills rapidly.
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  3. The posterior leaflet of the mitral valve appears to have a smaller excursion than the anterior leaflet because:
    A.) It's excursion is smaller.
    B.) It is intersected at an angle that does not show its full size.
    C.) the leaflet never completely opens.
    D.) The shape is different than that of the anterior leaflet.
    A.) and d.) The posterior leaflet of the mitral valve is smaller than the anterior leaflet and also scalloped.
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  4. Generally, the E-F slope of the mitral valve has been considered to provide a reliable assessment of:
    A.) Mitral stenosis
    B.) Left atrial enlargement.
    C.) Left ventricular function.
    D.) Left atrial myxoma.
    A.) and d.) Neither left atrial enlargement nor left atrial myxoma is indicated by the E-F slope. The pliability of the leaflets and free motion of the valve give an indication of any valvular stenosis. The rate of the slope will also be affected by changes in left ventricular function.
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  5. An increase in the size of the A wave of the mitral valve suggests:
    A.) Left ventricular enlargement.
    B.) Left ventricular hypokinesis.
    C.) Aortic insufficiency.
    D.) An increase in left ventricular end diastolic pressure.
    C.) and c.) Severe aortic insufficiency increases the left ventricular end-diastolic pressure pressure, thereby diminishing the D-E point separtation and highlighting the atrial component and the A kick.
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  6. Normal opening of the mitral valve is caused by the pressures being higher in the left ventricle than in the left atrium.
    True or False
    False: Higher atrial pressures open the mitral valve.
  7. The mitral valve is composed of :
    A.) Chordae tendineae.
    B.) Mitral annuli.
    C.) Papillary muscles.
    D.) Fibrous bands.
    A.) b.) and d.) The mitral apparatus is composed of the mitral valve leaflets, chordae tendineae, papillary muscles, and mitral annulus. Fibrous bands can be found in the pericardial space of some patients with pericardial effusions.
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  8. The M-mode criterion that defines mitral stenosis the least is :
    A.) A dense, thickened appearance of the valve.
    B.) A reduced E-F slope.
    C.) anterior movement of the posterior leaflet.
    D.) An increased A-C interval.
    D.) An increased A-C interval suggests increased left ventricular end-diastolic pressure (LVEDP) and possible poor left ventricular function.
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  9. The mitral two-dimensional echo view that best allows calculation of the mitral orifice is the:
    A.) Apical two-chamber view.
    B.) Parasternal short-axis view.
    C.) Subcostal four-chamber view.
    D.) Parasternal long-axis view.
    B.) With good imaging, measuring the mitral valve orifice in the parasternal short-axis plane provides reliable results.
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  10. Factors that influence the short-axis two-dimensional measurement of the mitral valve are :
    a.) The lateral resolution
    b.) Gain.
    c.) Transducer frequency.
    d.) The axial resolution.
    • a.) and b.) The lateral and medial walls appear wider because of lateral resolution. Too high a gain setting will make the orifice too small.
    • Transducer frequency and axial resolution do not affect the measurements.
  11. The color-flow examination of the stenotic mitral valve would typically display:
    A.) A central blue zone.
    B.) A central red zone.
    C.) A narrow jet.
    D.) Surrounding yellow and red hues.
    C.) b.) and d.) the color flow depiction of mitral stenosis shows a narrow jet with a blue central core ( aliasied ) surrounded by yellow and red hues. It has been compared to a candle flame.
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  12. The mitral two-dimensional echo view that is most used in continuous-wave Doppler imaging of mitral stenosis is the:
    A.) Parasternal short-axis view.
    B.) Parasternal long-axis view.
    C.) Apical four-chamber view.
    D.) subcostal four-chamber view.
    C.) The apical four-chamber view allows the best angle for evaluating mitral valve flow.
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  13. The criterion that is the most helpful in defining mitral stenosis is:
    A.) Aortic root dilatation.
    B.) Left ventricular hypertrophy.
    C.) Left ventricular enlargement.
    D.) Left atrial enlargement.
    D.) Left atrial enlargement is a direct physiological effect of mitral stenosis.
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  14. Following a mitral commissurotomy, the valve orifice can be accurately evaluated with the :
    A.) M mode, by defining the leaflet separation.
    B.) Doppler, by the velocity of the flow and Bernoulli's equation.
    C.) Two-dimensional echodardiography, by imaging the actual orifice.
    D.) Doppler, by estimating valve area using the pressure half-time formula.
    D.) The surgeon distorts the valve at the time of commissurotomy, and the resultant morphology is not well visualized by two-dimensional echo. M mode has never been optimal for valve orifice determinations, and the bernoulli equation gives velocity information but not orifice size. The most accurate way to determine valve size is with the pressure half-time equation.
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  15. Which of the following mitral conditions could couse mitral regurgitation?
    a.) Mitral stenosis.
    b.) Mitral prolapse.
    c.) Mitral vegetation.
    d.) all of the above.
    d.) All may cause improper closure of the valve.
  16. The aortic valve m-mode motion is often abnormal in patients with mitral regurgitation, demonstrating:

    A.) A flutter of the aortic leaflets in systole.
    B.) Early systolic closure.
    C.) Gradual closure during systole.
    d.) all of the above.
    B.) and c.) Flutter of the aortic leaflets in systole is frequently observed in normal subjects, so it is not considered to be abnormal motion. Early and also gradual systolic closure are frequently seen because of the reduced blood flow.
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  17. The M-mode findings in mitral regurgitation are:

    A.) Flutter of the posterior aortic root.
    B.) Left ventriculat dilatation.
    C.) Flutter of the interventriculat septum.
    D.) Left atrial enlargement.
    B.) b.) and d.) Flutter of the interventricular septum is seen in aortic insufficiency, not mitral insufficiency. The rest are true: Left ventricular and left atrial enlargement and also flutter of the posterior aortic root may be observed. Pulsations of the right atrial wall may also be observed.
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  18. Peak mitral regurgitation velocity tells the examiner:

    A.) maximum instantaneous pressure difference between the left ventricle and left atrium.
    B.) the severity of mitral regurgitation.
    C.) The cause of the mitral regurgitation.
    D.) The direction of the regurgitant jet.
    A.) The peak mitral regurgitant velocity tells nothing about the degree of regurgitation, its etiology, or its direction-- only the difference in pressure between the left ventricle and left atrium.
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  19. A two-dimensional echo criterion that can be very helpful in determining mitral regurgitation is:

    A.) Premature closure of the aortic valve.
    B.) High-frequency oscillations of the mitral valve.
    C.) Left ventricular hypertrophy.
    D.) Left ventricular enlargement.
    A.) Mitral regurgitation causes a reduction in left ventricular outflow, thus reducing the amount of flow through the opening of the valve. The valve closes early.
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  20. The two-dimensional echo view best for Doppler analysis of mitral regurgitation is:
    A.) The parasternal short- axis view.
    B.) The apical four-chamber view.
    C.) The parasternal long-axis view.
    d.) None of the above.
    B.) Usually this is the better Doppler angle in relation to true flow.
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  21. Left atrial enlargement could be a criterion for determining mitral regurgitation.
    True or False
    True: Left atrial enlargement is a direct physiological effect of mitral regurgitation.
  22. Mitral regurgitation is always associated with mitral valve prolapse.

    True or False
    False: Mitral regurgitation mahy be caused by a number of mitral valve problems. Mitral prolapse does not guarantee mitral regurgitation.
  23. Which of the mitral conditions listed below could be associated with mitral regurgitation?
    a.) rupture of the chordae.
    b.) Flail leaflet.
    c.) annular calcification.
    d.) All of the above.
    e.) None of the above.
    d.) All could relate to poor valve closure.
  24. The echo/Doppler findings in papillary muscle dysfunction are:
    a.) Left ventricular enlargement
    b.) Mitral regurgitation.
    c.) Mitral annulus dilatation.
    d.) Incomplete mitral valve closure.
    e.) All of the above.
    e.) all of the above: Each of the conditions described can be found in patients with papillary muscle dysfunction. The dilated mitral annulus may be the cause of the mitral regurgitation; the incomplete mitral closure is due to scarring of the papillary muscles secondary to myocardial infarction. And the papillary muscles shrink, pulling the chordae away from the mitral orifice.
  25. The term myxomatous degeneration used to describe a mitral valve prolapse denotes:

    A.) A myxoma in the vicinity of the mitral valve.
    B.) Redundancy of the mitral valve leaflets.
    C.) A vegetation on the mitral valve leaflets.
    D.) Thickening of the mitral valve leaflets.
    D.) The term myxomatous degeneration describes histologic changes seen in the mitral valve by the pathologist. The finging on echocardiography is thickening of the mitral leaflets.
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  26. M-mode findings with a flail mitral valve are:

    a.) Fine systolic flutter of the mitral valve.
    b.) Coarse, choatic diastolic flutter of the anterior or posterior mitral leaflet.
    c.) Mitral leaflets noted in the left atrium during systole.
    d.) Noncoaptation of the anterior and posterior mitral valve leaflets.
    e.) All of the Above.
    e.) All of the above: The listed findings can each be observed with flail mitral valve leaflets.
  27. Doming of the anterior mitral leaflet is seen in:

    a.) Mitral Stenosis
    b.) Redundant, floppy mitral valve.
    c.) Flail mitral leaflet
    d.) Vegetation/ mass involving free edge at the anterior leaflet.
    a.) b.) and d.) The only described instance that does not produce doming is the flail mitral leaflet, which exhibits exaggerated, eccentric motion.
  28. Which set of echocardiographic features best predicts the presence of mitral stenosis in combined mitral stenosis and mitral insufficiency?
    A.) Reduced E-F slope on the M mode.
    B.) Seperation of the mitral valve leaflets on the two-dimensional parasternal short-axis view.
    C.) ThicKened leaflets, seen on the apical four- chamber view.
    D.) Doming on the two-dimensional parasternal long-axis view.
    D.) The two-dimensional parasternal ong-axis view displays the doming of the leaflets in mitral stenosis; the short-axis view may show normal separation of the leaflets. The E-F slope is not a sensitive predictor of mitral stenosis because it is also reduced in other conditions such as reduced left ventricular compliance. Lastly, although thickening of the mitral leaflets in the apical four-chamber view is seen on the mitral stenosis, the doming seen on parasternal long axis is a much better predictor of mitral stenosis.
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  29. Mitral annular calcification may obscure the :

    A.) Anterior mitral valve leaflet.
    B.) Epicardial echoes.
    C.) Posterior mitral valve leaflet.
    D.) Endocardial echoes.
    C.) and c.) Mitral annular calcification can obscure the posterior mitral valve leaflet because of the close proximity of these structures. Because of acoustic shadowing, the posterior left ventricular endocardium may also be obscured.
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  30. M
  31. Mitral and tricuspid regurgitation are easily differentiated by Doppler because of :

    a.) Differenced in timing of valve opening and closing.
    b.) Different locations of the jets.
    c.) Different directions of the jets.
    d.) Differences in forward flow velocity curves.
    e.) All of the above.
    e.) All of the above.
  32. The normal brief posterior displacement of the interventricular septum with the onset of diastole (diastolic dip) may be exaggerated in:

    A.) Mitral insufficiency
    B.) Mitral stenosis
    C.) Aortic stenosis.
    D.) Aortic insufficiency.
    B.) In mitral stenosis, early diastolic left ventricular filling is restriced, whereas the right ventricle fills rapidly. Therefore the septum bulged toward the lect ventricle in the diastolu.
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  33. Common echo-doppler findings in patients with Marfan's syndrome are:

    A.) Mitral valve prolapse
    B.) Aortifc root dilatation
    C.) aortic regurgitation.
    D.) Pulmonary insufficiency.
    B.) b.) and d.) Patients with Marfan's syndrome exhibit a dilated aortic root with aortic regurgitation and mitral valve prolapse. Associated pulmonic regurgitation is not part of the syndrome.
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  34. Mitral leaflet motion is influenced by:

    a.) The relative pressures in the left atrium and left ventricle.A
    b.) The velocity and volume of blood flow through the mitral orifice.
    c.) Left ventricular diastolic compliance.
    d.) Systolic performance of the left ventricle.
    e.) All of the above.
    e.) All of the above
  35. In the M-mode recording of mitral stenosis, the posterior leaflet of the mitral valve moves anteriorly with the anterior leaflet:

    A.) In 80 to 90% of cases.
    B.) Always.
    C.) In 30 to 40% of cases.
    D.) Never.
    A.) The posterior leaflet usually moves anteriorly with the anterior leaflet, but if the leaflets are not fused, the posterior leaflet moves posteriorly.
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  36. A reduced E- F slope of the mitral valve on the M mode is seen with:

    A.) Reduced left ventricular compliance.
    B.) Mitral stenosis.
    C.) Aortic valve disease.
    D.) Dilated cardiomyopathy.
    C.) b.) and c.) Patients with aortic valve disease commonly exhibit a reduced E-F slope. This finding is believed to be related to a decreased rate of left ventricular filling associated with reduced left ventricular compliance. Mitral stenosis also exhibits a reduced E-F slope. In dilated cardiomyopathy, early closure of the mitral valve may be seen, but a reduced E-F slope is not.
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  37. Two-dimensional determination of the size of a stenotic mitral orifice is optimal only if:

    A.) Gain settings are carefully set.
    B.) Viewed in the parasternal short axis.
    C.) Doming of the anterior mitral leaflet is observed.
    D.) The scan plane is parallel to and passes directly throough the valve orifice.
    B.) b.) and d.) When imaging in the parasternal long-axis, the operator is prevented from adequately visualizing the valve orifice by doming of the anterior mitral leaflet. The parasternal short- axis is the proper position for measuring opening size. The operator must be careful with gain settings and ensure that the scan plane is parallel to and passes directly through the valve orifice.
    (this multiple choice question has been scrambled)
Card Set:
2010-05-29 18:36:38
Mitral Valve

Evaluation of the Mitral Valve
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