CCI RCS QUESTIONS AND CORRECT
ANSWERS
When should you not make the diagnosis of MVP ANSW✅✅do not diagnose in the 4 chamber and
do not diagnose in the presence of a large pericardial effusion
Is it always abnormal to find regurgitation with prosthetic valves ANSW✅✅no
Pannus ANSW✅✅tissue overgrowth
EKG of apical hypertrophy ANSW✅✅large inverted T-waves
What is the typical spectral doppler finding for apical hypertrophy ANSW✅✅flow acceleration in
the mid LV cavity
Asymmetrical hypertrophy ratio ANSW✅✅septal to posterior wall >1.3:1
LVOT obstruction causes the aortic valve to ANSW✅✅close in mid systole
What is the normal strain pattern for HOCM patients ANSW✅✅-10%
What is seen in chagas disease ANSW✅✅posterior and apical thinning
What is the EKG finding for dilated cardiomyopathy ANSW✅✅pulsus alterans, alternating strong
and weak pulse due to poor LV systolic dysfunction
Why might you see a B-notch on M-mode ANSW✅✅increased LVEDP
What are the diastolic phases ANSW✅✅isovolumic relaxation, early filling, diastasis and atrial
contraction
,What are the 4 mitral inflow filling patterns ANSW✅✅normal, abnormal relaxation, normalization
(pseudo normal) and restrictive
If a patient has a normal MV inflow but the pulmonary veins show a decreased S and D wave, the
may have a ANSW✅✅pseudonormal pattern
How may the normal doppler waveform at the mitral annulus differ from the waveform at the leaflet
tip ANSW✅✅E and A are reversed at these sites
How can you differentiate from constrictive pericarditis and restrictive physiology
ANSW✅✅respiratory changes with mitral inflow if there is constrictive pericarditis
In constrictive pericaridits will the E wave increase or decrease with inspiration
ANSW✅✅decrease
Name the 3 layers of the pericardium ANSW✅✅fibrous pericardium, serous pericardium, serous
visceral
A pericardial effusion is often seen in patients with ANSW✅✅renal failure
What is becks triad ANSW✅✅sign of tamponade- elevated venous pressure, hypotension, quiet
heart
The most sensitive way to diagnose cardiac tamponade is ANSW✅✅respiratory variation
What condition would prevent RV diastolic collapse in cardiac tamponade ANSW✅✅pulmonary
hypertension
Difference between PSAX LV in PHTN vs volume overload ANSW✅✅with PHTN, the septum
remains flat throughout the cardiac cycle while volume overload is rounded during systole and flat in
diastole
The size of aneurysms during systole ANSW✅✅increase
,What is the most common mechanical complication of an MI ANSW✅✅aneurysm formation
What type of MI will cause a papillary muscle rupture ANSW✅✅inferior MI
Characteristics of a true aneurysm ANSW✅✅wide base, walls composed of myocardium, low risk
of free rupture
Characteristics of a pseudoaneurysm ANSW✅✅narrow base, walls composed of thrombus and
pericardium, high risk of free rupture
Where is the most common location for a pseudoaneurysm ANSW✅✅inferior basal segment
Does the wall of a pseudoaneurysm contain endocardium ANSW✅✅no
What walls does the left anterior descending supply ANSW✅✅anterior wall, anteroseptal wall, LV
apex
What walls does the left circumflex supply ANSW✅✅anterolateral wall, inferolateral wall
What walls does the right coronary artery supply ANSW✅✅inferior, inferoseptal, RV apex, RV free
wall
How to calculate RVSP with a VSD ANSW✅✅SBP-VSD
How far does the insertion of the TV have to be from the MV to confirm the diagnosis of ebsteins
anomaly ANSW✅✅10mm
What might be the first indication of a metastatic cardiac disease ANSW✅✅pericardial effusion
Which cardiac chamber is most likely involved with metastatic tumors ANSW✅✅right atrium
, What may placing the transducer too high on the chest cause ANSW✅✅pseudo bicuspid aortic
valve
How does switching to a lower frequency transducer affect aliasing ANSW✅✅aliasing will occur at
higher velocities
Which pericardial leyer is the serous ANSW✅✅visceral or epicardial
Cardiac tamponade is rapid filling of fluid ANSW✅✅causing restrictive diastolic filling
What is the difference between a pacer wire and a catheter ANSW✅✅pacer wires go to the RV
apex, venous lines stay in the RA and Swan-Ganz dont go to the apex
With what disease should you not rely on M mode for quantifying LVEF ANSW✅✅apical infarction
What may cause pre systolic opening of the aortic valve leaflets ANSW✅✅LVEDP
Are right sided pressures elevated with a valsalva manuever ANSW✅✅during the strain phase no
but during release yes
Frequency for TTE vs TEE ANSW✅✅TTE probes are 2-7MHz while TEE are 5-7MHz
What causes an S4 ANSW✅✅atrial contraction
Which of the following choices would not be used to correct for pulsed wave doppler aliasing
ANSW✅✅using a higher frequency probe. you could shift the baseline, use CW, or decrease
sample volume depth?
Preload is best described as ANSW✅✅LV filling
Afterload is best described as ANSW✅✅aortic pressure
ANSWERS
When should you not make the diagnosis of MVP ANSW✅✅do not diagnose in the 4 chamber and
do not diagnose in the presence of a large pericardial effusion
Is it always abnormal to find regurgitation with prosthetic valves ANSW✅✅no
Pannus ANSW✅✅tissue overgrowth
EKG of apical hypertrophy ANSW✅✅large inverted T-waves
What is the typical spectral doppler finding for apical hypertrophy ANSW✅✅flow acceleration in
the mid LV cavity
Asymmetrical hypertrophy ratio ANSW✅✅septal to posterior wall >1.3:1
LVOT obstruction causes the aortic valve to ANSW✅✅close in mid systole
What is the normal strain pattern for HOCM patients ANSW✅✅-10%
What is seen in chagas disease ANSW✅✅posterior and apical thinning
What is the EKG finding for dilated cardiomyopathy ANSW✅✅pulsus alterans, alternating strong
and weak pulse due to poor LV systolic dysfunction
Why might you see a B-notch on M-mode ANSW✅✅increased LVEDP
What are the diastolic phases ANSW✅✅isovolumic relaxation, early filling, diastasis and atrial
contraction
,What are the 4 mitral inflow filling patterns ANSW✅✅normal, abnormal relaxation, normalization
(pseudo normal) and restrictive
If a patient has a normal MV inflow but the pulmonary veins show a decreased S and D wave, the
may have a ANSW✅✅pseudonormal pattern
How may the normal doppler waveform at the mitral annulus differ from the waveform at the leaflet
tip ANSW✅✅E and A are reversed at these sites
How can you differentiate from constrictive pericarditis and restrictive physiology
ANSW✅✅respiratory changes with mitral inflow if there is constrictive pericarditis
In constrictive pericaridits will the E wave increase or decrease with inspiration
ANSW✅✅decrease
Name the 3 layers of the pericardium ANSW✅✅fibrous pericardium, serous pericardium, serous
visceral
A pericardial effusion is often seen in patients with ANSW✅✅renal failure
What is becks triad ANSW✅✅sign of tamponade- elevated venous pressure, hypotension, quiet
heart
The most sensitive way to diagnose cardiac tamponade is ANSW✅✅respiratory variation
What condition would prevent RV diastolic collapse in cardiac tamponade ANSW✅✅pulmonary
hypertension
Difference between PSAX LV in PHTN vs volume overload ANSW✅✅with PHTN, the septum
remains flat throughout the cardiac cycle while volume overload is rounded during systole and flat in
diastole
The size of aneurysms during systole ANSW✅✅increase
,What is the most common mechanical complication of an MI ANSW✅✅aneurysm formation
What type of MI will cause a papillary muscle rupture ANSW✅✅inferior MI
Characteristics of a true aneurysm ANSW✅✅wide base, walls composed of myocardium, low risk
of free rupture
Characteristics of a pseudoaneurysm ANSW✅✅narrow base, walls composed of thrombus and
pericardium, high risk of free rupture
Where is the most common location for a pseudoaneurysm ANSW✅✅inferior basal segment
Does the wall of a pseudoaneurysm contain endocardium ANSW✅✅no
What walls does the left anterior descending supply ANSW✅✅anterior wall, anteroseptal wall, LV
apex
What walls does the left circumflex supply ANSW✅✅anterolateral wall, inferolateral wall
What walls does the right coronary artery supply ANSW✅✅inferior, inferoseptal, RV apex, RV free
wall
How to calculate RVSP with a VSD ANSW✅✅SBP-VSD
How far does the insertion of the TV have to be from the MV to confirm the diagnosis of ebsteins
anomaly ANSW✅✅10mm
What might be the first indication of a metastatic cardiac disease ANSW✅✅pericardial effusion
Which cardiac chamber is most likely involved with metastatic tumors ANSW✅✅right atrium
, What may placing the transducer too high on the chest cause ANSW✅✅pseudo bicuspid aortic
valve
How does switching to a lower frequency transducer affect aliasing ANSW✅✅aliasing will occur at
higher velocities
Which pericardial leyer is the serous ANSW✅✅visceral or epicardial
Cardiac tamponade is rapid filling of fluid ANSW✅✅causing restrictive diastolic filling
What is the difference between a pacer wire and a catheter ANSW✅✅pacer wires go to the RV
apex, venous lines stay in the RA and Swan-Ganz dont go to the apex
With what disease should you not rely on M mode for quantifying LVEF ANSW✅✅apical infarction
What may cause pre systolic opening of the aortic valve leaflets ANSW✅✅LVEDP
Are right sided pressures elevated with a valsalva manuever ANSW✅✅during the strain phase no
but during release yes
Frequency for TTE vs TEE ANSW✅✅TTE probes are 2-7MHz while TEE are 5-7MHz
What causes an S4 ANSW✅✅atrial contraction
Which of the following choices would not be used to correct for pulsed wave doppler aliasing
ANSW✅✅using a higher frequency probe. you could shift the baseline, use CW, or decrease
sample volume depth?
Preload is best described as ANSW✅✅LV filling
Afterload is best described as ANSW✅✅aortic pressure
