NBE Transthoracic Echocardiography 2 — Questions and Answers
Question 1: Which TTE view best visualizes the left ventricular outflow tract (LVOT) for Doppler interrogation?
- Parasternal long-axis
- Apical five-chamber (Correct answer)
- Subcostal four-chamber
- Parasternal short-axis at mitral level
Correct answer: Apical five-chamber
The apical five-chamber view aligns the ultrasound beam parallel to flow through the LVOT, enabling accurate PW and CW Doppler measurements.
Question 2: A patient has a mitral valve area of 0.9 cm² by planimetry. This finding is consistent with which severity of mitral stenosis?
- Mild (MVA > 1.5 cm²)
- Moderate (MVA 1.0–1.5 cm²)
- Severe (MVA < 1.0 cm²) (Correct answer)
- Very severe (MVA < 0.6 cm²)
Correct answer: Severe (MVA < 1.0 cm²)
An MVA < 1.0 cm² meets the echocardiographic criterion for severe mitral stenosis per ASE/ACC/AHA guidelines.
Question 3: On M-mode echocardiography, an E-point septal separation (EPSS) of 15 mm most likely indicates:
- Normal left ventricular function
- Reduced left ventricular ejection fraction (Correct answer)
- Mitral valve prolapse
- Aortic regurgitation without LV dilation
Correct answer: Reduced left ventricular ejection fraction
EPSS > 7 mm correlates with reduced LVEF; an EPSS of 15 mm strongly suggests significant systolic dysfunction.
Question 4: Which of the following is the most reliable echocardiographic sign of cardiac tamponade?
- Left atrial dilation
- Right ventricular diastolic collapse (Correct answer)
- Elevated E/A ratio
- Increased aortic root diameter
Correct answer: Right ventricular diastolic collapse
Right ventricular free wall diastolic collapse occurs when pericardial pressure transiently exceeds RV diastolic pressure, signaling tamponade physiology.
Question 5: The proximal isovelocity surface area (PISA) method calculates regurgitant flow rate using which formula?
- 2π r² × aliasing velocity (Correct answer)
- π r² × peak velocity
- 4 × (peak velocity)²
- Stroke volume × heart rate
Correct answer: 2π r² × aliasing velocity
PISA flow rate = 2π r² × Va, where r is the PISA radius and Va is the aliasing (Nyquist) velocity.
Question 6: In a patient with suspected hypertrophic obstructive cardiomyopathy (HOCM), which echocardiographic finding is most characteristic?
- Symmetric left ventricular hypertrophy with dilated cavity
- Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve (Correct answer)
- Posterior wall hypertrophy with normal septum
- Dilated LV with reduced wall thickness
Correct answer: Asymmetric septal hypertrophy with systolic anterior motion of the mitral valve
HOCM classically shows asymmetric septal hypertrophy and SAM of the anterior mitral leaflet, which causes dynamic LVOT obstruction.
Question 7: Which Doppler parameter is used to estimate mean right atrial pressure when evaluating inferior vena cava (IVC) size and collapsibility?
- Tricuspid E/A ratio
- IVC diameter and respiratory variation (Correct answer)
- Pulmonary vein S/D ratio
- Hepatic vein systolic reversal
Correct answer: IVC diameter and respiratory variation
ASE guidelines use IVC diameter (< or ≥ 2.1 cm) combined with ≥ 50% inspiratory collapse to estimate RAP as 3 mmHg or ≥ 8 mmHg.
NBE Transthoracic Echocardiography 2
Which TTE view best visualizes the left ventricular outflow tract (LVOT) for Doppler interrogation?