CET Case Analysis & Practical Application 2

Question 1

A 65-year-old patient with dyspnea shows a parasternal long-axis view with a dilated left ventricle, reduced wall motion, and an EF of 25%. The mitral valve appears to have incomplete leaflet coaptation. Which condition best explains these findings?

Accepted Answer

Functional mitral regurgitation due to dilated cardiomyopathy

Answer

Dilated cardiomyopathy causes annular dilation and papillary muscle displacement, leading to functional (secondary) mitral regurgitation with incomplete leaflet coaptation.

Question 2

During a stress echo, a patient develops new regional wall motion abnormality in the mid-anterior and anteroseptal segments at peak stress that was absent at rest. Which coronary artery territory is most likely ischemic?

Accepted Answer

Left anterior descending artery

Answer

The mid-anterior and anteroseptal walls are supplied by the LAD; new WMA in these segments at stress indicates LAD territory ischemia.

Question 3

A neonate presents with cyanosis. Echo shows a large VSD, an overriding aorta, right ventricular hypertrophy, and pulmonary stenosis. Which diagnosis does this constellation represent?

Accepted Answer

Tetralogy of Fallot

Answer

The four components described—VSD, overriding aorta, RVH, and pulmonary stenosis—are the classic tetrad of Tetralogy of Fallot.

Question 4

A patient recovering from a large anterior MI is found to have a thin, akinetic apical segment that bulges outward during systole. Color Doppler shows slow swirling flow within this segment. What complication has developed?

Accepted Answer

True left ventricular aneurysm with thrombus risk

Answer

A dyskinetic, thin-walled apical segment post-MI represents a true LV aneurysm; slow swirling flow indicates stagnant blood with high thrombus risk.

Question 5

On TEE, a patient with atrial fibrillation scheduled for cardioversion shows a spontaneous echo contrast ('smoke') in the left atrial appendage but no discrete thrombus. What is the most appropriate next step based on echocardiographic findings?

Accepted Answer

Defer cardioversion and extend anticoagulation, as smoke indicates stasis and elevated thrombus risk

Answer

Spontaneous echo contrast represents red cell aggregation due to stasis and is associated with thromboembolic risk, indicating the need for extended anticoagulation before cardioversion.

(CET) Certified Echocardiography Technician Practice Test

(CET) Certified Echocardiography Technician Practice Test

CET Case Analysis & Practical Application 2