CET Case Analysis & Practical Application 3

Question 1

A patient with known hypertension has concentric LV hypertrophy (relative wall thickness 0.52) with normal cavity size and an EF of 65%. Diastolic assessment shows E/e' ratio of 16 and LAVi of 38 mL/m². What grade of diastolic dysfunction is present?

Accepted Answer

Grade II (pseudonormal)

Answer

E/e' >14 combined with enlarged LAVi in a patient with LVH and normal EF meets criteria for Grade II (pseudonormal/moderate) diastolic dysfunction.

Question 2

During examination of a premature infant, you identify a continuous 'machinery' murmur and echo demonstrates a tubular connection between the descending aorta and the pulmonary artery with left-to-right shunting. What structure has failed to close?

Accepted Answer

Patent ductus arteriosus

Answer

Persistence of the ductus arteriosus after birth creates the classic continuous murmur and aorta-to-pulmonary artery shunt seen in PDA.

Question 3

A patient with systemic lupus erythematosus has small, irregular, non-mobile vegetations on both surfaces of the mitral and aortic valves. Cultures are negative. Which condition should be suspected?

Accepted Answer

Libman-Sacks endocarditis

Answer

Libman-Sacks endocarditis is the non-bacterial thrombotic endocarditis associated with SLE, characterized by small verrucous lesions on both valve surfaces.

Question 4

On 2D echo, a patient with chest pain has an aortic root measuring 5.2 cm at the sinuses of Valsalva with a Type A dissection flap visible on TEE extending into the ascending aorta. The aortic valve shows moderate AR. Which is the most critical immediate finding to report?

Accepted Answer

Dissection flap in the ascending aorta (Type A)

Answer

Type A aortic dissection involving the ascending aorta is a surgical emergency requiring immediate reporting as it carries high mortality without intervention.

Question 5

A 55-year-old with progressive dyspnea shows echo findings of right heart enlargement, RV pressure overload pattern (D-shaped septum in systole), tricuspid regurgitation with peak velocity 4.5 m/s, and no left-sided disease. What condition should be the primary consideration?

Accepted Answer

Pulmonary arterial hypertension

Answer

TR jet velocity of 4.5 m/s yields an estimated RVSP of >80 mmHg, and the septal flattening with RV enlargement without left-sided cause points to pulmonary arterial hypertension.

(CET) Certified Echocardiography Technician Practice Test

(CET) Certified Echocardiography Technician Practice Test

CET Case Analysis & Practical Application 3