Echocardiography CME + Self-Assessment Question Bank

30 CME Credits

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Echocardiography Sample Questions:

Question 1

The structure denoted by the arrow is:

A) Left atrial appendage
B) Left lower pulmonary vein
C) Left upper pulmonary vein
D) Right lower pulmonary vein

A) Left atrial appendage

Correct: (A) Left atrial appendage. Explanation: The structure denoted by the arrow is the left atrial appendage. This is separated from the left upper pulmonary vein, which is to the posterior with a ridge popularly known as the ''coumadin ridge'' because of the potential to be misinterpreted as a thrombus. Because this ridge is echoreflective, sometimes one can see thrombus-like artifacts in the appendage as mirror image artifacts. Though the appendage is clearly visualized here, this view alone is not sufficient to rule out a thrombus. Multiple tomographic views have to be obtained through the appendage in its entirety as the appendagemay have multiple lobes.

2012 Wiley Publisher

Question 2

Saline contrast echocardiography is suggestive of:

A) Patent foramen ovale (PFO)
B) Pulmonary AV fistula
C) Patent foramen or pulmonary A-V fistula
D) No right to left shunting

C) Patent foramen or pulmonary A-V fistula

Correct: (C) Patent foramen or pulmonary A-V fistula. Explanation: There are bubbles in the left atrium indicative of a right to left shunt. However, from a single frame the level of shunting cannot be determined. Hence the timing of appearance of bubbles in LA in relation to appearance in the RA is important. It is important to record at least 8-10 beats after the appearance of contrast in the RA. If the bubbles in the LA appear within 2-3 beats of its appearance in the RA the shunt probably is at the atrial level: if it appears later it is likely to be transpulmonary shunting due to pulmonary A-V fistulae. Examples of the latter include end stage liver disease and Rendu-Weber-Osler disease. In our laboratory we perform saline contrast echo without and with Valsalva's maneuver. The shunt in PFO is conditional to the transient rise in RA pressure and is produced by Valsalva, coughing and pressure over the abdomen. Movement of the atrial septum to the left ascertains a higher RA pressure. PFO diagnosis rate is higher by TEE and with lower limb contrast injection, as the direction of the PFO channel is directly in line with the inferior vena cava (IVC). Hence injection from the upper limb may be washed away by IVC flow and prevented from entering the PFO channel.

2012 Wiley Publisher

Questions taken from the BoardVitals Echocardiography CME + Self-Assessment Question Bank

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