CET Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A patient undergoing dobutamine stress echo develops new regional wall motion abnormalities at low dose (10 mcg/kg/min). This finding indicates:
- High-risk ischemia requiring immediate test termination and physician evaluation (Correct answer)
- Normal augmentation response
- The dose should be increased to confirm the finding
- The finding is artifact and imaging should continue
Correct answer: High-risk ischemia requiring immediate test termination and physician evaluation
New wall motion abnormalities at low dobutamine doses suggest severe underlying coronary artery disease and represent a high-risk endpoint requiring test termination.
Question 2: Before administering an ultrasound contrast agent, the sonographer verifies that resuscitation equipment is available. This is required because contrast agents carry a risk of:
- Anaphylactoid reactions including severe bronchospasm or cardiovascular collapse (Correct answer)
- Nephrotoxicity in patients with renal failure
- Permanent hearing loss from microbubble cavitation
- QT prolongation leading to torsades de pointes
Correct answer: Anaphylactoid reactions including severe bronchospasm or cardiovascular collapse
FDA labeling for ultrasound contrast agents mandates that resuscitation equipment be available due to the rare but serious risk of cardiopulmonary reactions.
Question 3: A patient on anticoagulation for atrial fibrillation is scheduled for TEE. The INR result returns at 4.8. The sonographer should:
- Notify the ordering physician before proceeding, as the INR exceeds the safe procedural threshold (Correct answer)
- Proceed with the study since TEE is non-invasive
- Request the procedure be converted to TTE only
- Administer vitamin K and proceed after 30 minutes
Correct answer: Notify the ordering physician before proceeding, as the INR exceeds the safe procedural threshold
An INR >3.5 is generally considered above the safe threshold for TEE; the physician must be informed to decide whether to proceed or correct coagulation first.
Question 4: During a TEE exam, the patient's oxygen saturation drops from 97% to 88% over two minutes. The MOST appropriate response is:
- Remove the probe, reposition the patient, provide supplemental oxygen, and notify the physician (Correct answer)
- Increase the bite block pressure to stabilize the probe and continue imaging
- Administer IV midazolam to reduce patient agitation
- Ask the patient to breathe more deeply and continue the study
Correct answer: Remove the probe, reposition the patient, provide supplemental oxygen, and notify the physician
A significant drop in SpO2 during TEE may indicate airway compromise or laryngospasm requiring immediate probe removal and airway management.
Question 5: In a patient with known latex allergy presenting for echocardiography, which item in the echo lab most commonly contains latex and must be substituted?
- Gloves used during probe handling and patient contact (Correct answer)
- Ultrasound gel
- ECG electrodes (modern disposable)
- Transducer covers for TTE
Correct answer: Gloves used during probe handling and patient contact
Latex gloves remain the most common source of latex exposure in the echo lab; latex-free gloves must be used for all contact with latex-allergic patients.
Question 6: A sonographer identifies a large intracardiac mass that appears highly mobile on a routine TTE. The correct risk-mitigation step is to:
- Immediately notify the interpreting cardiologist of the finding before the patient leaves the department (Correct answer)
- Complete the standard protocol and let the cardiologist review images at end of day
- Measure the mass dimensions and conclude the study without interruption
- Order a repeat study in one week to confirm the finding
Correct answer: Immediately notify the interpreting cardiologist of the finding before the patient leaves the department
A mobile intracardiac mass poses an immediate embolic risk and constitutes a critical finding requiring real-time physician notification before patient discharge.
Question 7: Which statement BEST describes the role of a sonographer in obtaining informed consent for TEE?
- The sonographer explains the procedure but the physician obtains and documents formal informed consent (Correct answer)
- The sonographer can obtain and legally document full informed consent independently
- Informed consent is not required for TEE as it is a diagnostic, not therapeutic, procedure
- Only an anesthesiologist can obtain consent when sedation is used
Correct answer: The sonographer explains the procedure but the physician obtains and documents formal informed consent
Informed consent for invasive procedures like TEE must be obtained by the supervising physician; sonographers may provide procedural education but not serve as the consenting provider.
CET Risk Assessment & Mitigation 3
A patient undergoing dobutamine stress echo develops new regional wall motion abnormalities at low dose (10 mcg/kg/min).
This finding indicates: