CET CET Cardiac Pathology & Disease Recognition 2 — Questions and Answers
Question 1: Which echocardiographic feature best differentiates a bicuspid aortic valve from a tricuspid aortic valve?
- Aortic regurgitation jet direction
- Elliptical or fish-mouth orifice in systole on short-axis view (Correct answer)
- Calcification of leaflet tips
- Dilated aortic root diameter
Correct answer: Elliptical or fish-mouth orifice in systole on short-axis view
A bicuspid aortic valve appears as an elliptical or fish-mouth shaped orifice in systole on parasternal short-axis view, unlike the triangular orifice of a tricuspid valve.
Question 2: Echocardiographic 'smoke' or spontaneous echo contrast in the left atrium is most associated with which condition?
- Hypertrophic cardiomyopathy
- Atrial fibrillation with mitral stenosis (Correct answer)
- Pulmonary hypertension
- Tricuspid regurgitation
Correct answer: Atrial fibrillation with mitral stenosis
Spontaneous echo contrast ('smoke') in the left atrium indicates slow blood flow and is most common in atrial fibrillation combined with mitral stenosis, signaling high thromboembolic risk.
Question 3: Which echocardiographic sign is characteristic of acute pulmonary embolism on transthoracic echo?
- Left ventricular diastolic dysfunction with elevated filling pressures
- McConnell sign — RV free wall hypokinesis with preserved apex (Correct answer)
- Dilated left atrium with reduced mitral valve area
- Increased aortic root diameter with AR
Correct answer: McConnell sign — RV free wall hypokinesis with preserved apex
McConnell sign (regional right ventricular free wall hypokinesis with preserved apical function) is a specific echo finding in acute massive pulmonary embolism.
Question 4: On echocardiography, which finding most strongly suggests non-compaction cardiomyopathy?
- Diffuse LV hypokinesis with dilated chambers
- Prominent trabeculations with deep intertrabecular recesses in the LV apex (Correct answer)
- Asymmetric septal hypertrophy with LVOT gradient
- Restrictive filling pattern with preserved LV size
Correct answer: Prominent trabeculations with deep intertrabecular recesses in the LV apex
Non-compaction cardiomyopathy is identified by a two-layered myocardium with non-compacted to compacted ratio >2:1 and deep intertrabecular recesses, typically in the LV apex.
Question 5: Which type of ventricular septal defect is most commonly associated with aortic regurgitation?
- Muscular VSD in the trabecular septum
- Inlet VSD beneath the tricuspid valve
- Supracristal (outlet) VSD in the perimembranous position (Correct answer)
- Apical trabecular VSD
Correct answer: Supracristal (outlet) VSD in the perimembranous position
Supracristal (subpulmonary/outlet) VSDs are associated with aortic regurgitation because the right coronary cusp lacks subvalvular support and prolapses into the defect.
Question 6: A 'dagger-shaped' continuous wave Doppler profile from the tricuspid regurgitation jet is most characteristic of which condition?
- Severe pulmonary hypertension (Correct answer)
- Ebstein's anomaly
- Hypertrophic obstructive cardiomyopathy
- Constrictive pericarditis
Correct answer: Severe pulmonary hypertension
Severe pulmonary hypertension produces a 'dagger-shaped' or early-peaking TR jet with a rapid rise and fall in CW Doppler due to rapid RV pressure equalization.
CET CET Cardiac Pathology & Disease Recognition 2
Which echocardiographic feature best differentiates a bicuspid aortic valve from a tricuspid aortic valve?