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  1. Aortic valve closure is related to an increased pressure in the aorta relative to the left ventricle.

    True or False.
    True: The left ventricle empties throughout systole, and the change in pressure with ventricular relaxation forces closure or the aortic valve.
  2. The amplitude of aortic root motion has been used to assess:

    A.) The degree of aortic stenosis.
    B.) The degree of aortic insufficiency.
    C.) The vigor of left ventricular contraction.
    D.) The size of the left atrium.
    C.) The aortic root undulates with motion of the left ventricle.
    (this multiple choice question has been scrambled)
  3. Findings consistent with aortic stenosis seen on the M-mode echocardiogram include:

    A.) A dilated left atrium
    B.) Hyperdynamic left ventricular contractility.
    C.) Thickened aortic leaflets.
    D.) Normal thickness of the left ventricular wall.
    C.) The aortic valve leaflets are thickened. The left ventricular walls are hy0pertrophied, not normal thickness. The size of the left atrium is not affected by the aortic stenosis. The left ventricle has normal, not hypercontractile motion.
    (this multiple choice question has been scrambled)
  4. The M-mode findings of a young patient with congenital aortic stenosis frequently demonstrate:

    A.) Normal leaflet separation.
    B.) Systolic doming of the cusps.
    C.) Diastolic separation of the cusps.
    D.) Thickened, restricted cusps.
    A.) The M mode cannot display doming, which can be seen only on the two-dimensional echocardiogram. The cusps frequently show normal separation and are not thickened or restricted. Diastolic separation of the cusps is seen in aortic regurgitation, not aortic stenosis.
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  5. Aortic insufficiency can alter the motion or appearance of the mitral valve by:
    A.)Fluttering the leaflets in diastole.
    B.) Decreading cusp seperation.
    C.) Reducing the closing velocity of the mitral leaflets.
    D.) producing shaggy echoes around the mitral valve.
    A.) b.) and d.) Shaggy echoes are noted with vegetations depending on the size and position of the jet(s) of aortic insufficiency, the mitral leaflet may flutter. If the volume of aortic insufficiency is such that the left ventricular pressure is increased, decreased separation of the mitral cusps as well as the decrease in the closing velocity can be seen.
    (this multiple choice question has been scrambled)
  6. Similar spectral patterns can be seen with aortic insufficiency and mitral stenosis. The best way(s) to differentiate the two when both are present is/ are to :

    A.) Use the smallest feasible sample volume and carefully evaluate the area.
    B.) Rotate the patient more laterally.
    C.) Use continuous-wave Doppler from the suprasternal notch.
    D.) Be aware that aortic insufficiency will have a less intense signal than mitral stenosis.
    D.) and c.) Rotating the patient does not necessarily help differentiate the source of the jets. continuous-wave Doppler will show all signals simultaneously and will not distinguish the source. The Intensity of the signal is less in aortic insufficiency than in mitral regurgitation; careful sampling in the left ventricular outflow tract and in the inflow tract should enable the operator to discern the correct source.
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  7. The M-mode criterion that is not useful for defining aortic stenosis is:

    A.) Left ventricular hypertrophy.
    B.) A reduced "box" opening.
    C.) Diastolic aortic valve oscillation
    D.) Dense, thick aortic valve echoes.
    C.) Aortic stenosis is defined by abnormal systolic echoes.
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  8. The best two-dimensional view used for imaging and calculating the aortic valve orifice is the:

    A.) Apical two-chamber view.
    B.) Apical four-chamber view.
    C.) Parasternal long-axis view.
    D.) Parasternal short-axis view.
    D.) The parasternal short-axis view best defines the AV orifice, but the reliability of quantitation is debatable.
    (this multiple choice question has been scrambled)
  9. The best approach for continuous-wave Doppler analysis of aortic stenosis is the:

    A.) Parasternal
    B.) Suprasternal.
    C.) Apical.
    D.) Subcostal
    B.) The suprasternal view provides the closest and most direct angle to AV outflow.
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  10. Overstimation of Doppler peak gradients in aortic stenosis occur with coexistent:

    A.) Tricuspid regugitation
    B.) Mitral regurgitation
    C.) Mitral stenosis
    D.) Aortic insufficiency
    D.) The aortic flow velocity is increased with coexistent aortic insufficiency which leads to overestimation of the gradient.
    (this multiple choice question has been scrambled)
  11. The Doppler formula 4x(V2-V2) is important in:
    2 1
    A.) Aortic stenosis
    B.) Mitral stenosis
    C.) Mitral regurgitation
    D.) left venricular outflw tract obstruction
    A.) and c.) This formula is important in calculating pressure drop when there is an increase in velocity in the left ventricular ouutflow tract and across the aorticf valve, i.e. acorss stenosis and left ventricular outflow obstruction
    (this multiple choice question has been scrambled)
  12. In patients with aortic stenosis and
  13. In patients with aortic stenosis and low peak velocity due to poor left ventricular function (low flow state), the continuous-wave Doppler waveform should be analyzed for:

    A.) Time to peak velocity
    B.) Intensity of signal.
    C.) Mean velocity
    D.) Shape of the spectral waveform
    A.) and b.) In patients with critical aortic stenosis but small gradients due to low stroke volume, the continuous-wave Doppler spectrum will demonstrate a later peak and symmetrical confuguration.
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  14. High velocity recorded below the baseline on the Doppler spectrum when imaging from the apex by continuous-wave Doppler could be related to:

    A.) Left ventricular outflow tract obstruction
    B.) Aortic stenosis.
    C.) Mitral regurgitation.
    D.) Aortic regurgitation
    B.) c.) and d.) all but aortic regurgitation will produce a high-velocity signal below the baseline when imaged from the apex. Aortic regurgitation will appear as a high velocity signal above the baseline.
    (this multiple choice question has been scrambled)
  15. The criterion that is not helpful for defining aortic stenosis is:

    A.) Left ventricular hypertrophy.
    B.) Aortic postvalvular dilatation
    C.) Left ventricular enlargement.
    D.) Diastolic oscillations of the aortic cusps.
    D.) Diastolic oscillations may not be associated with aortic steosis.
    (this multiple choice question has been scrambled)
  16. Bicuspid aortic stenosis is a congenital abnormality.

    True or False
    True. Sclerotic valves tend to be dense but mobile.
  17. Valve mobility may be the most helpful factor in defining the difference between aortic stenosis and sclerosis:

    True or False
    True: Sclerotic valvesv tend to be dense but mobile.
  18. Aortic regurgitation can best be defined by the M-mode criterion of:

    A.) Left ventricular hypertrophy
    B.) Aortic root dilatation.
    C.) High-frequency oscillations of the aortic valve
    D.) High-frequency oscillations of the mitral valve.
    D.) Aortic regurgitation jets occur in the left ventricular outflow tract where the anterior leaflet of the mitral valve opens in diastole and the resultant flutter is noted on the Mmode.
    (this multiple choice question has been scrambled)
  19. One of the first indications of aortic regurgitation noted by two-dimensional echo is:

    A.) Left atrial enlargement.
    B.) Thickened aortic valve.
    C.) Left ventricular enlargement.
    D.) Left ventricular hypertrophy
    C.) Left ventricular size may be expanded owing to the volume of aortic regurgitation.
    (this multiple choice question has been scrambled)
  20. Aortic regurgitation is best evaluated by Doppler in the:

    A.) Apical four-chamber view.
    B.) Parasternal long-axis view.
    C.) parasternal short-axis view.
    D.) Subcostal four-chamber view.
    D.) This view is used because the angle of incidence is closest to 0 degrees which gives the optimum Doppler angle and the greatest multiplier.
    (this multiple choice question has been scrambled)
  21. Paradoxical septal motion is most commonly associated with aortic regurgitation.

    True or False
    False: This is not a finding associated with aortc regurgitation.
  22. Aortic regurgitation may be associated with bacterial endocarditis of the aortic valve.

    True or False
    True: The bacterial infiltration may lead to poor closure ofr aortic cusps.
  23. Color flow examinations of the aortic valve flow in patients with aortic stenosis should be performed from with view:

    a.) High right parasternal.
    b.) High left parasternal
    c.) Apical.
    d.) Suprasternal notch.
    e.) all of the above.
    e.) all of the above.: the sonographer should attempt all views, but usually the apical view is the least successful.
  24. The Doppler recording can underestimate aortic stenosis peak velocity if:

    A.) The angle of incidence is greater than 20 degrees.
    B.) The maximum jet is not recorded.
    C.) There is reduced cardiac output
    D.) There is associated aortic regurgitation.
    C.) c.) and d.) Underestimation occurs with reduced cardiac output when the maxumum jet is not recorded and when the angle of incidence is increased.
    (this multiple choice question has been scrambled)
  25. Early closure of the mitral valve in patients with acute aortic insufficiency is due to:

    A.) Reduced left ventricular compliance.
    B.) Elevated left ventricular diastolic pressure.
    C.) Reduced cardiac output.
    D.) The regurgitant jet restricting mitral valve motion.
    B.) The reason for early mitral valve closure in acute aortic insufficiency is elevated left ventricular diastolic pressure. Neither reduced cardiac output nor reduced left ventricular compliance affect mitral valve closure. The regurgitant jet of aortic insufficiency may affect mitral valve opening but will not cause early closure.
    (this multiple choice question has been scrambled)
  26. The effect of aortic regurgitation on the left ventricle is:

    A.) Septal flutter.
    B.) Increased septal motion.
    C.) Left ventricular dilatation.
    D.) Concentric left ventricular hypertrophy.
    B.) c.) and d.) Concentric left ventricular hypertrophy is related to aortic stenosis, not insufficiency. The effects of aortic regurgitation are increased septal motion, left ventricular dilatation, and sometimes septal flutter.
    (this multiple choice question has been scrambled)
  27. The M-mode findings in patients with aortic regurgitation may include:

    A.) Fine systolic flutter of the aortic cusps.
    B.) Systolic flutter of the interventricular septum.
    C.) Fine diastolic flutter of the aortic cusps.
    D.) Diastolic echoes in the left ventricular outflow tract.
    C.) and c.) Systolic flutter of the aortic leaflets is a normal finding. Flutter of the interventricular septum caused by aortic insufficiency is a diastolic, not a systolic, phenomenon. Diastolic leaflet flutter and diastolic left ventricular outflow tract echoes are seen with aortic insufficiency.
    (this multiple choice question has been scrambled)
  28. Reverse doming of the anterior mitral valve leaflet can be observed in:

    A.) Mitral regurgitation
    B.) Idiopathic hypertrophic subaortic stenosis.
    C.) Aortic regurgitation
    D.) Aortic Stenosis.
    C.) The term reverse doming refers to the convex curve sometimes observed on the two-dimensional echo of the mitral valve inthe parasternal long-axis and/or apical view of patients with aortic regurgitation.
    (this multiple choice question has been scrambled)
  29. Methods used in quantitating the severity of aortic insufficiency are:

    A.) Taking the peak velocity of regurgitation, using a continuous-wave Doppler system, and putting it into the modified Bernoulli equation.
    B.) Calculating the pressure half-time from the continuous-wave Doppler waveform.
    C.) mapping the flow disturbance with a pulsed-wave system.
    D.) Using color-flow imaging to evaluate thickness of the regurgitant stream at its origin.
    C.) c.) and d.) Traditionally, aortic insufficiency is evaluated by the pulsed mapping technique. With insufficiency, the gradient does not help to determine the severity. A rapid pressure half-time means severe insufficiency. Last, color flow imaging of the thickness at the regurgitant stream at the valve is an accurate way of determining severity.
    (this multiple choice question has been scrambled)
  30. In combined aortic stenosis and insufficiency, the continuous-wave aortic waveform must be carefully analyzed so that the severity of the aortic stenosis will be correctly assessed. A mild gradient may be expected if:

    a.) A high peak velocity is recorded with an early-peaking, asymmetrical, rapidly descending spectrum.
    b.) A high peak velocity is recorded with a later-peaking, symmetrical spectrum.
    c.) A low peak velocity is recorded with a late-peakin, symmetrical waveform.
    d.) a low peak velocity is recorded with early- peaking, asymmetrical waveform.
    a,) and d.) The Doppler aortic spectral waveform in significant aortic stenosis is late-peaking and symmetrical. If the aortic stenosis is less severe, the spectral waveform shows early peaking and a rapid descent, becoming asymmetrical. This is important in cases of combined aortic stensosis and insufficiency and also in cases of poor left ventricular function.
Card Set
Evaluation of The Aortic Valve
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