TOE Mock Exam MCQ Written

With regards to the atheroma in the aorta, which one of the following is true?

TOE (when compared to CT and MRI) is inferior in diagnosing aortic atheromas1.

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Presence of high grade atheroma in descending aorta correlates with increased risk of stroke.

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Atheroma is stratified into 5 grades from 0 to 4.

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In the six segment model of the thoracic aorta, zones 5 and 6 are difficult to visualize in TOE

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The plaque thickness is measured from the luminal margin of the plaque to the inner edge of the vessel wall.

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The contraindications for the TAVI include the following except

Aortic annular size less than 18 mm

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Aortic annular size greater than 29 mm

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Symmetric Aortic Valve calcification

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Grade 5 atheroma in Ascending aorta

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Apical LV thrombus

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The following are true about Tricuspid valve except

The diameter and circumference of the tricuspid valve is greater than mitral valve.

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The 3 leaflets of the valve are Anterior, Posterior and Septal.

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The insertion of Septal leaflet is more apical than the other leaflets.

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Normally Septal leaflet is the largest leaflet.

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In ebsteins anomaly, Off the three leaflets septal leaflet is the one which is most apically displaced

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In assessing Tricuspid Regurgitation, one of the following is true.

Pulmonary systolic (PAP) can be calculated using the formula PAP = 4 x (peak TR velocity)2

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Presence of proximal flow acceleration indicates mild TR

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Accurate assessment of TR velocity should only be made from apical view

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In very severe (‘Free’) TR, the calculation of pulmonary pressure is invalid

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None of the above

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In Colour Doppler, Ghosting may be produced by

Rapidly moving structures

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Slowly moving structures.

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Stationary structures.

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Catheters

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All of the above.

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An 82 yr old female with a body surface area id 1.68 m2 underwent aortic valve replacement with a 19 mm bio prosthetic valve. Echo measurements after prosthetic valve implantation yielded a LVOT diameter of 1.8 cm, a VTI of 30 cm in the LVOT and VTI of 60 cm across the prosthetic aortic valve. These findings are consistent with

No Prosthetic-patient mismatching

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Mild Prosthetic-patient mismatching

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Moderate Prosthetic-patient mismatching

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Severe Prosthetic-patient mismatching

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Cannot determine.

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Mitral inflow volume is calculated by

Estimating the velocity time integral by placing the PW (Pulse wave) sample volume at the tip of the mitral leaflets multiplied by mitral valve area.

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Estimating the velocity time integral by placing the PW (Pulse wave) sample volume at the tip of the mitral leaflets multiplied by mitral valve diameter.

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Estimating the velocity time integral by placing the PW (Pulse wave) sample volume at center of the mitral annulus multiplied by mitral valve area.

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Estimating the velocity time integral with a continuous wave (CW) doppler at the tip of the mitral leaflets multiplied by mitral valve area.

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Estimating the velocity time integral with a continuous wave (CW) doppler at the center of the mitral leaflets multiplied by mitral valve area

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In a patient with concomitant severe Aortic Regurgitation and Calcific Mitral stenosis, the mitral valve area could be accurately measured from

Pressure half time

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Deceleration time

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Continuity equation

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2D planimetry

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None of the above

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Given the following data: LVOT area 2.5cm2, MV area 4.2cm2, LVOT VTI 20cm, MV VTI 21cm. Assuming that the pathology is limited to just one valve, Which of the following conclusions can be made

The patient suffers from Aortic stenosis.

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The patient suffers from Mitral regurgitation.

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The patient suffers from Mitral stenosis.

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The patient suffers from Aortic regurgitation.

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None of the above as they are normal values.

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Regarding aortic dissections: which of the following statement is true.

The intimal flap moves towards the true lumen in systole.

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A high velocity forward flow pattern is seen in the true lumen.

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The pathognomonic sign of aortic dissection is the presence of spontaneous ECHO contrast in the true lumen.

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There can never be a complete thrombosis of the false lumen.

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A high velocity forward flow pattern is seen in the false lumen

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Serious reported complications of TOE examination are all except

Esophageal tear.

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Splenic injury.

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Phrenic nerve injury.

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Vocal cord paralysis.

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Gastric bleeding

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In patients with acute myocardial ischemia, the initial change in the early mitral diastolic wave (E wave) is.

Increased E wave velocity with shortened deceleration time.

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Increased E velocity with prolonged deceleration time.

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Decreased E velocity with prolonged deceleration time.

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Decreased E velocity with shortened deceleration time.

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Increased E velocity with loss of A wave in the absence of AF

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The left ventricular walls seen from the standard mid esophageal 2 chamber view (90’) are

Inferior and Lateral

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Anterior and lateral

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Posterior and Anteroseptal

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Inferior and Anterior

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Septal and Lateral

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What would happen to the calculated mitral valve area by the pressure half time method if the patient has Mitral stenosis and concomitant severe AR or ASD respectively?

Overestimate Mitral valve area & Underestimate Mitral valve area

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Overestimate Mitral valve area & Overestimate Mitral valve area

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Underestimate Mitral valve area & Underestimate Mitral valve area

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Underestimate Mitral valve area & Overestimate Mitral valve area

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No effect & No effect

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Which of the following standard trans esophageal views allows the best alignment of the doppler ultrasound beam with the Tricuspid regurgitation?

Mid Esophageal four- chamber view

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Trans gastric RV inflow view

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Modified Mid Esophageal bicaval view

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Mid Esophageal aortic short axis view

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Trans gastric tricuspid short axis view

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The following are features of cardiac tamponade except

Collapse of right atrium

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Right ventricular collapse lasting more than one third of diastole

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Distension of Inferior Vena Cava

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Increased blood flow across tricuspid valve during inspiration in spontaneously breathing patients

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Decreased blood flow across Mitral valve during inspiration in a patient ventilated with positive pressure ventilation

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An abnormal LV relaxation pattern is consistent with:

Mean LA pressure of 10mmHg and LV end diastolic pressure (LVEDP) of 22mmHg

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Mean LA pressure of 22 mmHg and LVEDP of 10 mmHg

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Mean LA pressure of 10 mmHg and LVEDP of 12 mmHg

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Mean LA pressure of 28 mmHg and LVEDP of 30 mmHg

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Mean LA pressure of 28 mmHg and LVEDP of 40 mmHg

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When comparing TTE and TOE, the following statements are true except ..

Quantitative doppler assessment of prosthetic aortic valve is better with TTE

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In patients with mechanical prosthetic valves LV function is better analysed in TTE

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Posterior aortic root in patient with prosthetic aortic valve is seen better with TOE

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TTE is better in assessing the regurgitant lesions in mechanical mitral valve.

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Pulmonary regurgitation lesions seen better with TTE

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Focus or focal point:

Is the point of minimum beam intensity because it is the narrowest portion the sound beam

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Is the point of maximum beam intensity because it is the narrowest portion of the sound beam

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Has the same beam intensity as the rest of the sound beam.

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Is located within the far field of an ultrasound beam. Therefore, one should focus when imaging the structures in far field but not those in near field

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Provides best lateral resolution because it is the narrowest part of the ultrasound beam.

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Dilatation of pulmonary artery is seen all the following except

Ostium primum ASD

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Valvular Pulmonary stenosis

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Pulmonary Hypertension

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Aortic stenosis

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Ostium secondum ASD

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In the trans gastric right ventricle inflow view, the following structures are usually seen except.

Anterior leaflet of tricuspid valve

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Posterior leaflet of tricuspid valve

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Septal leaflet of tricuspid valve

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Inferior/posterior wall of RV

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Anterior wall of RV

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In a patient having LVAD insertion, which of the following potential Prebypass TEE findings would be least likely to affect his intraoperative management?

Moderate to severe (3+) mitral stenosis

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Moderate (2+) AI

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Moderate to severe (3+) MR

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Small (2 mm), secundum ASD

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PFO

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Which feature is consistent with severe MR.

Vena contracta > 0.3 cm

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VTI Mitral/VTI Aortic < 1

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Effective regurgitant orifice area of 45 mm2

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Regurgitant volume 30 mls

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None of the above

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Using TOE, the rate of ventricular pressure rise (dP/dT) may be calculated from a

CWD profile of Aortic stenosis

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PWD profile of Aortic regurgitation

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PWD profile of Left ventricular flow

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CWD profile of mitral regurgitation

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None of the above

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Thrombus in the LA appendage is best seen in which view ?

ME bicaval

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ME 4 chamber

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ME 2 chamber

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TG 2 chamber

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ME aortic short axis

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One of the following statements regarding hemodynamic calculations is false

PA systolic pressure = (4VTR)2 + RAP

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PA diastolic pressure = (4Vlate PR)2 + RA

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LVEDP = DBP – (4Vend MR)2

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PA mean pressure = (4Vearly PR)2 + RA

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None of the above

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The following data were obtained from a 72-year-old man with a calcified aortic valve: left ventricular outflow tract (LVOT) velocity (V1) 0.8m/s, transaortic velocity (V2) 4 m/s, LVOT diameter 2 cm then (AVA) is:

0.45 cm2

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0.65 cm2

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0.85 cm2

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1.0 cm2

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1.2 cm2

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A 52-year-old patient with a 31mm St.Jude mitral valve has severe shortness of breath. Left ventricular function and aortic valve are normal. The disc motion of the prosthetic valve is normal. Analysis of transmitral flow with continuous wave Doppler revealed an E-wave velocity of 2.6 m/s, A-wave velocity of 0.6 m/s, E-wave pressure half-time 40ms, diastolic mean gradient of 6mmHg at a heart rate of 60/min, isovolumic relaxation time (IVRT) 30 ms. This patient is likely to have:

Prosthetic valve regurgitation

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Pannus growth into the prosthetic valve

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Prosthetic valve thrombosis

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Normal prosthetic valve function

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Stenosis of prosthetic valve

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A patient with a bileaflet mechanical aortic valve has shortness of breath on exertion. An echocardiogram revealed normal left ventricular systolic function and mitral valve function. The left ventricular outflow tract (LVOT) dimension was 2.2 cm, LVOT (V1) velocity was 1.5 m/s and aortic transvalvular velocity (V2) was 4.5 m/s, with no aortic regurgitation. Measurements obtained 2 years earlier when the patient was asymptomatic were: LVOT diameter 2.2 cm, V1 0.9 m/s and V2 2.7 m/s. Likely cause of this patient’s shortness of breath is:

Prosthetic valve stenosis

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Patient–prosthesis mismatch

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High cardiac output state

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Low cardiac output state

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None of the above

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All the following are True except

Fibroelastomas have a high potential for embolization

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Fibromas usually originate from intra-atrial septum

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Central calcification is a classical feature of fibroma

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Lambl’s excrescences are commonly seen on commisural edges of valve leaflets

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Increase gain settings on echo machines can mimic spontaneous echo contrast

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