CET CET Cardiac Pathology & Disease Recognition 1 — Questions and Answers
Question 1: Which echocardiographic finding is most characteristic of hypertrophic obstructive cardiomyopathy (HOCM)?
- Dilated left ventricle with reduced ejection fraction
- Systolic anterior motion (SAM) of the mitral valve (Correct answer)
- Pericardial effusion with right ventricular collapse
- Flail mitral valve leaflet with severe regurgitation
Correct answer: Systolic anterior motion (SAM) of the mitral valve
SAM of the mitral valve is the hallmark echocardiographic finding of HOCM, causing dynamic left ventricular outflow tract obstruction.
Question 2: On echocardiography, which pattern of ventricular filling is most consistent with constrictive pericarditis?
- Decreased E/A ratio with prolonged deceleration time
- Respiratory variation in mitral inflow velocities >25% (Correct answer)
- Elevated E/e' ratio with reduced tissue Doppler velocities
- Reduced peak E velocity with normal deceleration time
Correct answer: Respiratory variation in mitral inflow velocities >25%
Constrictive pericarditis characteristically shows >25% respiratory variation in mitral inflow E velocity due to ventricular interdependence.
Question 3: Which echocardiographic feature best distinguishes cardiac tamponade from constrictive pericarditis?
- Presence of pericardial effusion only in tamponade
- Right ventricular diastolic collapse in tamponade (Correct answer)
- Septal bounce present only in constriction
- Elevated right atrial pressure in both conditions
Correct answer: Right ventricular diastolic collapse in tamponade
Right ventricular diastolic collapse (free wall) is a sensitive echocardiographic sign specific to cardiac tamponade physiology.
Question 4: A patient with rheumatic heart disease most commonly shows which mitral valve echocardiographic pattern?
- Mitral valve prolapse with posterior leaflet displacement
- Thickened leaflets with diastolic doming and commissural fusion (Correct answer)
- Flail anterior leaflet with ruptured chordae tendineae
- Calcified mitral annulus with normal leaflet mobility
Correct answer: Thickened leaflets with diastolic doming and commissural fusion
Rheumatic mitral stenosis classically shows thickened, immobile leaflets with a hockey-stick doming pattern and commissural fusion on 2D echo.
Question 5: Which echocardiographic finding is pathognomonic for Ebstein's anomaly?
- Apical displacement of the tricuspid valve >8mm/m² BSA (Correct answer)
- Tricuspid regurgitation with flail posterior leaflet
- Right ventricular hypertrophy with suprasystemic pressures
- Dilated coronary sinus with persistent left SVC
Correct answer: Apical displacement of the tricuspid valve >8mm/m² BSA
Apical displacement of the septal tricuspid leaflet insertion >8mm/m² BSA is the defining echocardiographic criterion for Ebstein's anomaly.
Question 6: In a patient with Marfan syndrome, which echocardiographic measurement is most critical for surgical planning?
- Left ventricular ejection fraction
- Aortic root diameter at the sinuses of Valsalva (Correct answer)
- Mitral valve prolapse degree
- Pulmonary artery systolic pressure
Correct answer: Aortic root diameter at the sinuses of Valsalva
Aortic root diameter at the sinuses of Valsalva is the key measurement guiding surgical intervention in Marfan syndrome, with >4.5cm typically indicating surgery.
CET CET Cardiac Pathology & Disease Recognition 1
Which echocardiographic finding is most characteristic of hypertrophic obstructive cardiomyopathy (HOCM)?