ARDMS AE Adult Echocardiography Examination AE-Adult-Echocardiography Exam Questions
Question #1 (Topic: demo questions)
Which of the following is a feature of constrictive pericarditis?
Correct Answer: D
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
Answer: D
Constrictive pericarditis is characterized by thickening and fibrosis of the pericardium which restricts
diastolic filling of the ventricles. Key echocardiographic features include a characteristic
interventricular septal "bounce" or shift during early diastole due to the abrupt cessation of
ventricular filling imposed by the rigid pericardium. This septal bounce reflects rapid early diastolic
filling followed by a sudden halt as filling pressures equalize, a hallmark of constriction physiology.
Additionally, Doppler studies show marked respiratory variation in mitral and tricuspid inflow
velocities (>25%), with an inspiratory increase in tricuspid inflow and a decrease in mitral inflow
velocity, reflecting ventricular interdependence caused by the noncompliant pericardium. The mitral
inflow typically shows a large E-wave with a small or absent A-wave and a steep deceleration slope,
but importantly these velocities vary significantly with respiration, which is not the case in restrictive
cardiomyopathy.
Hepatic vein Doppler often reveals a prominent a-wave and a deep y-descent with increased diastolic
flow reversal during expiration, indicating elevated right atrial pressures and constrictive physiology.
The inferior vena cava (IVC) is usually dilated and shows no inspiratory collapse (i.e., no normal
collapse with sniff test) because of elevated right atrial pressure and impaired venous return.
Therefore:
Option A is incorrect because mitral inflow in constrictive pericarditis shows significant respiratory
variation, not absence of it.
Option B is incorrect because the hepatic vein is typically dilated with abnormal flow patterns, not
normal size.
Comprehensive and Detailed Explanation From Exact Extract:
Answer: D
Constrictive pericarditis is characterized by thickening and fibrosis of the pericardium which restricts
diastolic filling of the ventricles. Key echocardiographic features include a characteristic
interventricular septal "bounce" or shift during early diastole due to the abrupt cessation of
ventricular filling imposed by the rigid pericardium. This septal bounce reflects rapid early diastolic
filling followed by a sudden halt as filling pressures equalize, a hallmark of constriction physiology.
Additionally, Doppler studies show marked respiratory variation in mitral and tricuspid inflow
velocities (>25%), with an inspiratory increase in tricuspid inflow and a decrease in mitral inflow
velocity, reflecting ventricular interdependence caused by the noncompliant pericardium. The mitral
inflow typically shows a large E-wave with a small or absent A-wave and a steep deceleration slope,
but importantly these velocities vary significantly with respiration, which is not the case in restrictive
cardiomyopathy.
Hepatic vein Doppler often reveals a prominent a-wave and a deep y-descent with increased diastolic
flow reversal during expiration, indicating elevated right atrial pressures and constrictive physiology.
The inferior vena cava (IVC) is usually dilated and shows no inspiratory collapse (i.e., no normal
collapse with sniff test) because of elevated right atrial pressure and impaired venous return.
Therefore:
Option A is incorrect because mitral inflow in constrictive pericarditis shows significant respiratory
variation, not absence of it.
Option B is incorrect because the hepatic vein is typically dilated with abnormal flow patterns, not
normal size.
Option C is incorrect because the IVC is dilated and does NOT collapse normally with inspiration/sniff
in constrictive pericarditis.
Option D is correct because the interventricular septal bounce is a classic feature reflecting
ventricular interdependence and constrictive physiology.
These findings are summarized in the "Textbook of Clinical Echocardiography, 6e" (Catherine M. Otto,
MD), Chapter 10 (Pericardial Disease), pages 280–285, with key illustrations showing septal bounce,
Doppler inflow variations, hepatic vein flow patterns, and IVC findings in constrictive pericarditis. The
"Mayo Clinic criteria" for echocardiographic diagnosis also emphasize ventricular septal shift as a
critical feature, often combined with tissue Doppler annular velocity patterns and hepatic vein
diastolic flow reversal for high diagnostic accuracy.
Question #2 (Topic: demo questions)
Which syndrome is associated with pulmonic stenosis?
Correct Answer: C
Explanation:
Pulmonic stenosis is a congenital valve abnormality often seen in genetic syndromes with cardiac manifestations. Among these, Noonan syndrome is the most frequently associated with pulmonic stenosis. Noonan syndrome is a genetic disorder characterized by distinctive facial features, short stature, and congenital heart defects, with pulmonic valve stenosis being the predominant cardiac lesion. The stenosis is usually valvular and caused by dysplastic pulmonary valve leaflets, leading to obstruction of right ventricular outflow. Other syndromes listed do not typically present with pulmonic stenosis: Turner syndrome is more commonly linked with bicuspid aortic valve and coarctation of the aorta, not pulmonic stenosis. Eisenmenger syndrome refers to the advanced phase of congenital heart defects with significant pulmonary hypertension and is not a genetic syndrome. Marfan syndrome is predominantly associated with aortic root dilation and mitral valve prolapse, but not with pulmonic stenosis. This association is well documented in adult echocardiography guidelines and texts, such as the "Textbook of Clinical Echocardiography" by Catherine Otto, which clearly identifies Noonan syndrome as the syndrome most commonly associated with pulmonic stenosis among congenital heart defects 【 16:Chapter on Congenital Heart Disease†Textbook of Clinical Echocardiography, 6e 】 .
Question #3 (Topic: demo questions)
Which view is most appropriate for measuring right ventricular dimensions?
Correct Answer: C
Explanation: