Order Tricuspid and Pulmonic Pathology

Order Tricuspid and Pulmonic Pathology
Order 5936209
Order Tricuspid and Pulmonic Pathology
1. Which of the following is not true regarding tricuspid valve
involvement in carcinoid syndrome?
A. Occurs primarily in the presence of carcinoid hepatic
B. Valvular involvement in carcinoid disease
predominantly affects the tricuspid and pulmonic valves
as opposed to mitral and aortic involvement.
C. Carcinoid involvement of the tricuspid valve may
manifest as isolated tricuspid stenosis.
D. The typical appearance of a tricuspid valve in carcinoid
disease is a thickened, retracted valve with limited
mobility and incomplete coaptation.
2. Which of the following is true regarding the condition
present in Figure 17.1 and Video 17.1?
A. Is an abnormality, which affects the tricuspid valve only.
B. More than 50% of patients have a shunt at the atrial
level with either a patent foramen ovale or secundum
ASD, which results in varying degrees of cyanosis.
C. The posterior lea‚et of the tricuspid valve is usually
sail-like and larger than normal.
D. The most reliable echocardiographic indicator is
reduced apical displacement of the septal insertion of
the tricuspid valve.
E. A displacement index of 8 mm is invariably associated
with this abnormality.
3. Which of the following is inconsistent with the diagnosis of
chronic, severe tricuspid regurgitation?
A. Normal tricuspid regurgitation CW velocity jet of
2.0 m/s
B. Normal right atrial size
C. Systolic reversal of hepatic vein ‚ow on subcostal
D. A regurgitation vena contracta width of 0.8 cm
E. Triangular, early peaking of tricuspid regurgitation
4. Which of the following represents the best method to grade
the severity of pulmonary stenosis?
A. Planimetry of the pulmonic valve area
B. Calculation of the pulmonary valve area via the
continuity equation
C. Proximal isovelocity surface area method
D. Measurement of systolic pressure gradient via
pulsed-wave spectral Doppler measurement from the
parasternal short-axis view
Order Tricuspid and Pulmonic Pathology
E. Measurement of the maximal systolic pressure gradient
via continuous-wave spectral Doppler measurement
from the subcostal view
5. A patient with Noonan syndrome presents for transthoracic
echocardiographic evaluation. She has excellent-quality
echo images and is noted to have right ventricular hypertrophy with a dilated right ventricle. She has moderate
tricuspid regurgitation, with a TR systolic velocity of 4.2
m/s. The IVC is enlarged. The pulmonary valve appears
dysplastic with ‚ow acceleration through the valve, post–
stenotic dilation, and moderate pulmonary regurgitation.
The maximal measured systolic transvalvular velocity is
2.7 m/s from several views. What is the most likely explanation for the difference in pulmonic and tricuspid valve
A. Increased right ventricular lling pressure from
pulmonary regurgitation.
B. A left-to-right shunt from an undetected atrial septal
Order Tricuspid and Pulmonic Pathology
C. A serial, distal pulmonary branch artery stenosis is
present in addition to the PV stenosis.
D. The pulmonary transvalvular velocities are severely
Chapter 17
Tricuspid and Pulmonic
Kwan S. Lee and Steven J. Lester
Figure 17.1
0c) 2015 Wolters Kluwer. All Rights Reserved.
Chapter 17 Tricuspid and Pulmonic Pathology 125
6. Which of the following is true regarding pulmonary and
tricuspid regurgitation
ow signal evaluation?
A. Mean pulmonary artery pressure can be estimated from
the pulmonary RVOT systolic continuous-wave signal.
B. Pulmonary diastolic pressure can be estimated from the
peak-diastolic regurgitation velocity.
C. Pulmonary vascular resistance can be evaluated by
dividing the peak tricuspid regurgitation velocity by the
RVOT time–velocity integral.
D. When augmenting the tricuspid regurgitation
ow signal
with agitated saline, the addition of blood or plasma to
the air–saline concentration degrades the signal.
7. A 57-year-old patient presents to clinic with a history of isolated severe tricuspid regurgitation and normal pulmonary
pressures, associated with moderate RV dilation and normal
function. Except for mild peripheral edema controlled with
diuretics, she has had no interval change in her symptoms.
Her last echocardiogram was 14 months ago. You decide to
order a repeat surveillance transthoracic echo. Which is the
most correct answer considering the current Appropriate
Use Criteria for Transthoracic Echocardiography guidelines?
A. Appropriate (score 7 to 9).
B. Inappropriate (score 4 to 6).
C. Uncertain (score 1 to 3).
D. This topic is unclassied (score 0)
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