CET Risk Assessment & Mitigation 2 — Questions and Answers
Question 1: A patient with a mechanical mitral valve prosthesis is referred for TEE. Which risk factor requires the most urgent pre-procedure evaluation?
- Known esophageal varices (Correct answer)
- Mild hypertension
- History of seasonal allergies
- Recent dental cleaning
Correct answer: Known esophageal varices
Esophageal varices are a contraindication to TEE due to risk of rupture and life-threatening hemorrhage during probe insertion.
Question 2: During a stress echocardiogram, a patient develops sustained ventricular tachycardia at peak exercise. The FIRST action the sonographer should take is:
- Stop the test and notify the supervising physician immediately (Correct answer)
- Continue imaging to capture the arrhythmia
- Administer IV beta-blocker
- Apply defibrillator pads and wait for further deterioration
Correct answer: Stop the test and notify the supervising physician immediately
Sustained VT during stress echo is a class I indication to terminate the test; the physician must be notified immediately to manage the arrhythmia.
Question 3: Which hemodynamic parameter during TEE monitoring most reliably signals impending hemodynamic collapse?
- Progressive hypotension with rising heart rate (Correct answer)
- Isolated sinus bradycardia
- Mild oxygen desaturation to 94%
- Occasional premature atrial contractions
Correct answer: Progressive hypotension with rising heart rate
Falling blood pressure accompanied by compensatory tachycardia indicates cardiovascular decompensation requiring immediate intervention.
Question 4: A patient being prepared for TEE discloses they took clopidogrel this morning. The PRIMARY concern this raises is:
- Increased bleeding risk if esophageal injury occurs (Correct answer)
- Reduced image quality due to altered cardiac contractility
- Risk of probe malfunction
- Higher likelihood of vasovagal reaction
Correct answer: Increased bleeding risk if esophageal injury occurs
Clopidogrel inhibits platelet aggregation, meaning any mucosal trauma from TEE probe insertion carries heightened hemorrhage risk.
Question 5: When performing echocardiography on a patient with suspected cardiac tamponade, which finding should prompt the operator to alert the team for possible emergent pericardiocentesis?
- Right ventricular diastolic collapse with respiratory variation in mitral inflow >25% (Correct answer)
- Mild pericardial effusion without chamber compression
- Left atrial enlargement
- Mild tricuspid regurgitation
Correct answer: Right ventricular diastolic collapse with respiratory variation in mitral inflow >25%
RV diastolic collapse combined with significant respiratory variation in Doppler inflow velocities indicates hemodynamically significant tamponade physiology.
Question 6: A sonographer notes that the transducer has a small crack in its housing after an exam. The appropriate action is to:
- Remove it from service, tag it, and report it to biomedical engineering (Correct answer)
- Cover the crack with tape and continue using it until a replacement arrives
- Only use it for TTE exams, not TEE
- Disinfect it thoroughly and return it to the probe storage
Correct answer: Remove it from service, tag it, and report it to biomedical engineering
A cracked transducer housing poses electrical safety and infection control hazards and must be immediately removed from service per accreditation standards.
Question 7: Which patient condition represents a RELATIVE contraindication (rather than absolute) to performing a standard transthoracic echocardiogram?
- Severe chest wall deformity limiting acoustic windows (Correct answer)
- Active cardiac arrest
- Uncooperative pediatric patient requiring sedation risk assessment
- Current ventricular fibrillation
Correct answer: Severe chest wall deformity limiting acoustic windows
Severe chest deformity makes imaging difficult and suboptimal but does not absolutely prohibit TTE, whereas active life-threatening arrhythmias require immediate resuscitation first.
CET Risk Assessment & Mitigation 2
A patient with a mechanical mitral valve prosthesis is referred for TEE.
Which risk factor requires the most urgent pre-procedure evaluation?