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AE-Adult-Echocardiography Exam Review | New AE-Adult-Echocardiography Test Voucher

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ARDMS AE-Adult-Echocardiography Exam Syllabus Topics:

Topic
Details

Topic 1

Pathology: This section of the exam measures skills of adult echocardiography technicians and focuses on identifying and evaluating abnormal physiology and perfusion and postoperative conditions. It includes assessment of ventricular aneurysms, aortic and valve abnormalities, arrhythmias, cardiac masses, diastolic dysfunction, endocarditis, ischemic diseases, cardiomyopathies, congenital anomalies, and postoperative valve repair or replacement and intracardiac devices. Candidates must demonstrate ability to recognize abnormal Doppler signals, EKG changes, wall motion abnormalities, and a wide range of cardiac pathologies including pulmonary hypertension and septal defects.

Topic 2

Anatomy and Physiology: This section of the exam measures skills of adult echocardiography technicians and covers knowledge and abilities related to normal cardiac anatomy and physiology. It includes assessing great vessels like the aorta and pulmonary arteries, recognizing anatomic variants of the heart, and evaluating cardiac chambers, pericardium, valve structures, and vessels of arterial and venous return. Candidates must document normal systolic and diastolic function, normal valve function and measurements, the phases of the cardiac cycle, normal Doppler changes with respiration, and appearance of arterial and venous waveforms. This also involves assessing the normal hemodynamic response to stress testing and maneuvers such as Valsalva, respiratory, handgrip, and postural changes.

Topic 3

Clinical Care and Safety: This section of the exam measures skills of adult echocardiography technicians in applying clinical care principles and safety protocols. It includes evaluating patient history and external data, preparing patients including fasting state and intravenous line management, proper patient positioning, EKG lead placement, blood pressure measurement, and ergonomic techniques. Candidates are expected to identify critical echocardiographic findings, know contraindications for procedures, and be able to respond and manage medical emergencies that may arise during echocardiographic exams.

Topic 4

Measurement Techniques, Maneuvers, and Sonographic Views: This section of the exam measures skills of adult echocardiography technicians in performing accurate cardiac measurements, conducting provocative maneuvers, and obtaining optimized sonographic imaging views. It involves applying 2D, 3D, M-mode, and Doppler techniques to measure heart valves, chambers, and vessels, including the aortic valve, mitral valve, left and right ventricles, atria, pulmonary artery, and shunt ratios. Candidates must instruct patients in maneuvers such as Valsalva, cough, sniff, and squat. They should also be proficient in acquiring standard echocardiographic views including apical, parasternal, subcostal, and suprasternal notch views.

Topic 5

Instrumentation, Optimization, and Contrast: This section of the exam measures skills of adult echocardiography technicians related to use and optimization of ultrasound instrumentation and the application of contrast agents. Candidates should recognize imaging artifacts, utilize non-imaging transducers, and adjust ultrasound console settings for optimal imaging and Doppler recordings. Knowledge of harmonic imaging, principles of contrast agents, and the safe and effective use of saline and echo-enhancing contrast agents is essential. Candidates must also be able to optimize images when using contrast agents to ensure diagnostic quality.

ARDMS AE Adult Echocardiography Examination Sample Questions (Q46-Q51):

NEW QUESTION # 46
Which mitral valve filling pattern is characterized by a long deceleration time and an E/A ratio of 0.6?

A. Normal
B. Restrictive
C. Pseudonormal
D. Impaired relaxation

Answer: D

Explanation:
The mitral valve filling pattern characterized by a long deceleration time and a reduced E/A ratio (less than 1, such as 0.6) is consistent with impaired relaxation. This pattern is typically seen in early diastolic dysfunction, where there is slowed ventricular relaxation, resulting in reduced early diastolic filling (E wave) and a compensatory increase in atrial contraction contribution (A wave).
Impaired relaxation pattern shows:
E/A ratio < 1 (e.g., 0.6)
Prolonged deceleration time (>200 ms)
Prolonged isovolumic relaxation time (IVRT)
This pattern differs from restrictive filling, which has a high E/A ratio (>2), shortened deceleration time (<150 ms), and elevated left atrial pressures. Pseudonormal filling has a normal or near-normal E/A ratio but elevated filling pressures that mask underlying dysfunction and requires further evaluation with tissue Doppler or pulmonary venous flow for diagnosis. Normal filling has a typical E/A ratio around 1 to 1.5 with normal deceleration times.
The textbook details that impaired relaxation is the earliest sign of diastolic dysfunction and describes the prolongation of the deceleration time and reduced E/A ratio as hallmark findings of this stage.

NEW QUESTION # 47
Which of the following are key features of an unrepaired tetralogy of Fallot?

A. Inlet ventricular septal defect, common atrioventricular valve, atrioventricular valve regurgitation, and primum atrial septal defect
B. Outlet ventricular septal defect, overriding aorta, right ventricular outflow tract obstruction, and right ventricular hypertrophy
C. Supravalvular mitral valvular ring, subaortic membrane, bicuspid aortic valve, and aortic coarctation
D. Displaced tricuspid valve, atrialization of the right ventricle, severe tricuspid regurgitation, and a secundum atrial septal defect

Answer: B

Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four key anatomical abnormalities: an outlet (malalignment) ventricular septal defect (VSD), an overriding aorta that receives blood from both ventricles, right ventricular outflow tract (RVOT) obstruction (commonly infundibular stenosis), and resultant right ventricular hypertrophy. These defects cause cyanosis due to right-to-left shunting and impaired pulmonary blood flow.
Option A describes Ebstein anomaly, characterized by a displaced tricuspid valve and atrialization of the right ventricle.
Option B describes features more consistent with Shone complex or other left heart obstructive lesions.
Option C describes atrioventricular septal defect (AVSD), seen in conditions like Down syndrome.
In unrepaired TOF, echocardiography demonstrates the large malalignment VSD, overriding aorta, RVOT obstruction, and hypertrophied right ventricle. These are classic textbook findings described in adult and pediatric echocardiography literature, including "Textbook of Clinical Echocardiography" (Chapter on Congenital Heart Disease) and ASE guidelines#16:Textbook of Clinical Echocardiography, 6ep.560-565#
#12:ASE Adult Congenital Guidelinesp.400-410#.

NEW QUESTION # 48
In cardiac tamponade, how do transvalvular pressure gradients change during expiration?

A. Transmitral decreases and transtricuspid decreases
B. Transmitral decreases and transtricuspid increases
C. Transmitral increases and transtricuspid increases
D. Transmitral increases and transtricuspid decreases

Answer: B

Explanation:
In cardiac tamponade, there is a characteristic reciprocal respiratory variation in transvalvular flow velocities due to ventricular interdependence and impaired cardiac filling. During expiration, the intrathoracic pressure increases, which leads to decreased right ventricular filling and thus decreased transtricuspid flow velocity.
Simultaneously, left ventricular filling increases, causing an increase in transmitral flow velocity.
Therefore, during expiration, the transmitral gradient increases while the transtricuspid gradient decreases.
This phenomenon reverses during inspiration, where transtricuspid flow increases and transmitral flow decreases. These respiratory variations are diagnostic hallmarks of tamponade physiology and help distinguish it from other conditions.
This principle is illustrated in Doppler echocardiographic studies of ventricular inflow and is described with diagrams in the "Textbook of Clinical Echocardiography, 6e" (Chapter 10: Pericardial Disease), highlighting the changes in transmitral and transtricuspid velocities during the respiratory cycle in tamponade .

NEW QUESTION # 49
Which hepatic vein flow pattern signals severe tricuspid regurgitation?

A. Flow reversal in systole
B. Flow reversal in diastole
C. Atrial flow reversal in systole
D. Biphasic flow reversal in diastole

Answer: A

Explanation:
In severe tricuspid regurgitation (TR), the regurgitant jet flows back from the right ventricle into the right atrium during systole, causing reversal of flow in the hepatic veins during the same phase. On Doppler echocardiography, this manifests as systolic flow reversal in the hepatic veins, which is a hallmark sign of severe TR.
Normally, hepatic vein flow consists of a predominant systolic forward flow into the right atrium. However, in severe TR, the high pressure in the right atrium during systole causes retrograde flow in the hepatic veins.
This pattern is diagnostic and aids in severity assessment.
Diastolic flow reversal is uncommon in TR and more associated with other pathologies. Atrial flow reversal in systole or biphasic flow reversal in diastole are not recognized patterns for severe TR.
This is described in detail in the "Textbook of Clinical Echocardiography, 6e", Chapter on Right Heart and Tricuspid Valve Disease, with Doppler patterns illustrated for hepatic vein flow in tricuspid regurgitation#20:
330-335Textbook of Clinical Echocardiography#.

NEW QUESTION # 50
Which pathology is consistent with the left ventricular strain pattern shown in this image?

A. Apical hypertrophy
B. Right coronary artery infarct
C. Non-ischemic cardiomyopathy
D. Amyloidosis

Answer: D

Explanation:
The strain imaging shown is a classic example of the "apical sparing" pattern, highly characteristic of cardiac amyloidosis. In cardiac amyloidosis, the basal and mid segments of the left ventricle show markedly reduced longitudinal strain (represented here by more positive or less negative strain values), while the apical segments retain relatively preserved strain (more negative strain values). This "cherry on top" or "bull's eye" pattern with apical strain preserved distinguishes amyloidosis from other causes of LV dysfunction.
This pattern is not typical of apical hypertrophy, which would show focal thickening and abnormal strain limited to the apex. Non-ischemic cardiomyopathy generally has a more diffuse and uniform reduction in strain without the apical sparing. Right coronary artery infarcts affect the inferior and posterior walls and would have segmental strain abnormalities corresponding to the infarct distribution, not the typical apical sparing.
The left ventricular global longitudinal strain (GLS) in amyloidosis is typically severely reduced, but the relative preservation of apical strain is a hallmark useful for diagnosis, as described in the "Textbook of Clinical Echocardiography, 6e" (Chapter on strain imaging and infiltrative cardiomyopathies) .

NEW QUESTION # 51
......

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