Echocardiogram Echocardiograms Anatomy and Physiology 3 — Questions and Answers
Question 1: Which layer of the pericardium is in direct contact with the epicardial surface of the heart?
- Fibrous pericardium
- Parietal pericardium
- Visceral pericardium (Correct answer)
- Mediastinal pleura
Correct answer: Visceral pericardium
The visceral pericardium (epicardium) is the innermost serosal layer that adheres directly to the myocardium and epicardial fat.
Question 2: In a normal adult, the right ventricular free wall thickness should be less than:
- 2 mm
- 3 mm
- 5 mm (Correct answer)
- 7 mm
Correct answer: 5 mm
Normal RV free wall thickness is less than 5 mm; values ≥5 mm suggest RV hypertrophy.
Question 3: The crista terminalis is an anatomical ridge found in which cardiac chamber?
- Left ventricle
- Right ventricle
- Left atrium
- Right atrium (Correct answer)
Correct answer: Right atrium
The crista terminalis is a smooth muscular ridge on the internal posterior wall of the right atrium, separating the smooth and trabeculated portions.
Question 4: During ventricular systole, which event occurs FIRST?
- Semilunar valve opening
- AV valve closure (Correct answer)
- Peak ventricular pressure
- Ejection of blood
Correct answer: AV valve closure
As ventricular pressure rises at the start of systole, it exceeds atrial pressure, causing AV valve closure before semilunar valves open.
Question 5: The left atrial appendage (LAA) is most commonly visualized in which echocardiographic view?
- Parasternal long axis
- Apical four-chamber
- Subcostal four-chamber
- Transesophageal midesophageal commissural view (Correct answer)
Correct answer: Transesophageal midesophageal commissural view
The LAA is best visualized on transesophageal echocardiography, particularly in the midesophageal commissural and LAA views.
Question 6: Which structure forms the posterior wall of the left atrium?
- Atrial septum
- Pulmonary veins (Correct answer)
- Coronary sinus
- Superior vena cava
Correct answer: Pulmonary veins
The pulmonary veins drain into and form the posterior wall of the left atrium, typically two on each side.
Question 7: What term describes the heart's intrinsic ability to increase contractile force in response to increased diastolic volume?
- Chronotropy
- Starling's Law (Correct answer)
- Afterload reserve
- Lusitropy
Correct answer: Starling's Law
Starling's Law (Frank-Starling mechanism) states that stroke volume increases in response to greater ventricular filling (preload), up to a physiological limit.
Echocardiogram Echocardiograms Anatomy and Physiology 3
Which layer of the pericardium is in direct contact with the epicardial surface of the heart?