ARDMS AE Adult Echocardiography Examination AE-Adult-Echocardiography Exam Practice Test

Answer : D

The echocardiographic video shows a defect in the ventricular septum with left-to-right shunting consistent with an ischemic ventricular septal defect (VSD), a mechanical complication of myocardial infarction. The defect allows blood flow between the left and right ventricles.

Coronary artery aneurysm appears as dilated coronary vessels, not a septal defect. Tricuspid regurgitation involves the right atrioventricular valve and is identified differently. Pseudoaneurysm of the apex is a contained myocardial rupture with narrow neck and does not involve septal communication.

This complication and its echocardiographic features are described in the 'Textbook of Clinical Echocardiography, 6e', Chapter on Post-Infarction Mechanical Complications20:430-435Textbook of Clinical Echocardiography.

Answer : D

Osler nodes are tender, erythematous nodules typically located on the fingers and toes, and are a classic sign of infective endocarditis (IE). They represent immune complex deposition and microemboli causing localized vasculitis.

Carcinoid heart disease presents with right-sided valve fibrosis and not with Osler nodes. Lambl excrescences are small filiform valvular strands without clinical manifestations such as Osler nodes. Papillary fibroelastomas are benign cardiac tumors that may cause emboli but not immune-mediated skin lesions.

This classic clinical sign and its echocardiographic correlation in IE are discussed in the 'Textbook of Clinical Echocardiography, 6e', Chapter on Infective Endocarditis20:400-405Textbook of Clinical Echocardiography.

Answer : D

Comprehensive and Detailed Explanation From Exact Extract:

Biplane disk summation (Simpson's method) of left atrial (LA) volume, indexed to body surface area, is the most accurate and recommended method for assessing LA size. This method accounts for the asymmetrical shape of the LA and provides reproducible volume measurements.

3D imaging can provide even more precise volume data but is less widely available and less standardized. Linear dimension and planimetry are less accurate because they do not fully represent LA size.

ASE chamber quantification guidelines strongly recommend biplane volume measurement for LA size assessment in clinical practice12:ASE Chamber Quantification Guidelinesp.90-9516:Textbook of Clinical Echocardiography, 6ep.120-125.

Answer : C

The proximal isovelocity surface area (PISA) method estimates the effective regurgitant orifice area (EROA) in mitral regurgitation by measuring the radius of the hemispheric flow convergence region (aliasing radius) and incorporating the aliasing velocity and the peak velocity of the MR jet.

The equation for EROA is:

EROA = (2 r Va) / Vmax

Where:

r = radius of the PISA hemisphere (aliasing radius)

Va = aliasing velocity (the velocity at which color aliasing occurs)

Vmax = peak MR velocity obtained by continuous wave Doppler

This calculation does not involve the mitral annular diameter, time velocity integral of mitral annulus, or left ventricular outflow tract diameter.

Thus, the third necessary parameter after aliasing radius and velocity is the maximum MR velocity measured by continuous wave Doppler, which allows determination of flow rate through the regurgitant orifice.

This formula and its clinical application are well established in adult echocardiography literature and ASE valvular regurgitation guidelines12:ASE Valvular Regurgitation Guidelinesp.210-22016:Textbook of Clinical Echocardiography, 6eChapter on Mitral Regurgitation Assessment.

Answer : B

Comprehensive and Detailed Explanation From Exact Extract:

In hypertrophic obstructive cardiomyopathy (HOCM), systolic anterior motion (SAM) of the anterior mitral leaflet causes posteriorly directed mitral regurgitation (MR) jets. The abnormal anterior leaflet motion leads to incomplete leaflet coaptation and regurgitant flow directed toward the posterior left atrium.

Anterior jets are seen with posterior leaflet abnormalities. Central jets are seen in functional MR. Medial jets are less common and depend on leaflet pathology.

This jet direction is an important echocardiographic feature distinguishing HOCM-related MR and is outlined in ASE valvular heart disease and cardiomyopathy guidelines12:ASE Valvular Regurgitation Guidelinesp.220-22516:Textbook of Clinical Echocardiography, 6ep.350-355.

Answer : C

Pulmonic stenosis is a congenital valve abnormality often seen in genetic syndromes with cardiac manifestations. Among these, Noonan syndrome is the most frequently associated with pulmonic stenosis. Noonan syndrome is a genetic disorder characterized by distinctive facial features, short stature, and congenital heart defects, with pulmonic valve stenosis being the predominant cardiac lesion. The stenosis is usually valvular and caused by dysplastic pulmonary valve leaflets, leading to obstruction of right ventricular outflow.

Other syndromes listed do not typically present with pulmonic stenosis:

Turner syndrome is more commonly linked with bicuspid aortic valve and coarctation of the aorta, not pulmonic stenosis.

Eisenmenger syndrome refers to the advanced phase of congenital heart defects with significant pulmonary hypertension and is not a genetic syndrome.

Marfan syndrome is predominantly associated with aortic root dilation and mitral valve prolapse, but not with pulmonic stenosis.

This association is well documented in adult echocardiography guidelines and texts, such as the 'Textbook of Clinical Echocardiography' by Catherine Otto, which clearly identifies Noonan syndrome as the syndrome most commonly associated with pulmonic stenosis among congenital heart defects16:Chapter on Congenital Heart DiseaseTextbook of Clinical Echocardiography, 6e.

Answer : A

The subcostal view is the preferred transthoracic echocardiographic window to assess atrial situs, especially in congenital heart disease. This view provides a cross-sectional look at the abdominal organs and atrial chambers, helping determine the relative position of the inferior vena cava and aorta, which aids in defining atrial situs (solitus, inversus, or ambiguous).

Short axis and long axis views provide excellent cardiac anatomy but are less informative for visceral situs. The suprasternal notch window is mainly used to visualize the great vessels but does not provide adequate assessment of atrial situs.

The subcostal view's ability to demonstrate abdominal situs and systemic venous return makes it essential in congenital cardiac evaluations and is recommended in echocardiography protocols for congenital heart disease assessment .