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ARDMS AE Adult Echocardiography Examination Sample Questions (Q43-Q48):
NEW QUESTION # 43
During which phase of the cardiac cycle does mitral valve prolapse occur?
- A. Ventricular contraction
- B. Atrial systole
- C. Diastasis
- D. Ventricular filling
Answer: A
Explanation:
Mitral valve prolapse (MVP) occurs during ventricular contraction (systole). Specifically, during systole, the increased pressure in the left ventricle causes the mitral valve leaflets to billow or prolapse back into the left atrium. This abnormal systolic displacement of the mitral leaflets beyond the annular plane leads to mitral regurgitation in many cases.
The echocardiographic hallmark of MVP is systolic bowing or displacement of the mitral leaflets into the left atrium, best visualized in parasternal long-axis or apical views during ventricular contraction. MVP is not seen during ventricular filling phases such as early filling, atrial systole, or diastasis because the leaflets are normally open or positioned differently.
This is well-documented in the "Textbook of Clinical Echocardiography, 6e", Chapter on Mitral Valve Disease, explaining the pathophysiology of MVP and its timing during the cardiac cycle#20:390-
395Textbook of Clinical Echocardiography#.
NEW QUESTION # 44
Which condition is most likely demonstrated by this M-mode image?

- A. Dilated cardiomyopathy
- B. Mitral valve prolapse
- C. Hypertrophic cardiomyopathy
- D. Mitral stenosis
Answer: D
Explanation:
The M-mode image shows characteristic diastolic doming or "hockey stick" appearance of the anterior mitral leaflet with restricted leaflet motion. This is a classic sign of mitral stenosis, where leaflet thickening and fusion cause limited opening during diastole.
Dilated cardiomyopathy shows increased chamber sizes and decreased systolic function but not mitral leaflet doming. Hypertrophic cardiomyopathy is characterized by septal thickening and SAM of the mitral valve.
Mitral valve prolapse shows leaflet billowing into the left atrium during systole.
This pattern is well described in ASE valvular heart disease guidelines and echocardiography texts#12:ASE Valve Imaging Guidelinesp.180-185##16:Textbook of Clinical Echocardiography, 6ep.200-205#.
NEW QUESTION # 45
Which of the following measurements is required for calculating the Qp/Qs ratio?
- A. Right ventricular outflow tract (RVOT) VTI
- B. Aortic valve VTI
- C. Mitral valve velocity time integral (VTI)
- D. Tricuspid valve VTI
Answer: A
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
The Qp/Qs ratio represents the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). It is commonly calculated to quantify the magnitude of a left-to-right shunt in congenital heart disease.
To calculate Qp/Qs using echocardiography, stroke volumes across both the pulmonary and systemic outflow tracts are measured by combining the cross-sectional area of the outflow tract and the velocity time integral (VTI) of flow through it.
Pulmonary blood flow (Qp) is calculated using the right ventricular outflow tract (RVOT) diameter and RVOT VTI. Systemic blood flow (Qs) is calculated using the left ventricular outflow tract (LVOT) diameter and aortic valve VTI.
Thus, RVOT VTI is essential for Qp calculation, making option D correct.
This method is explained in detail in the "Textbook of Clinical Echocardiography, 6e", Chapter on Congenital Shunts and Quantification of Flow#20:360-365Textbook of Clinical Echocardiography#.
NEW QUESTION # 46
Which congenital abnormality is most consistent with the findings in this video?
- A. Eisenmenger syndrome
- B. Patent foramen ovale
- C. Ebstein anomaly
- D. Ventricular septal defect
Answer: C
Explanation:
The video shows an apical four-chamber or subcostal echocardiographic view demonstrating a markedly enlarged right atrium with atrialization of part of the right ventricle, displacement of the tricuspid valve septal leaflet downward into the RV cavity, and severe tricuspid regurgitation. These findings are hallmark features of Ebstein anomaly, a congenital malformation of the tricuspid valve causing apical displacement of the septal and posterior leaflets.
Patent foramen ovale and ventricular septal defects have different echocardiographic features without tricuspid leaflet displacement. Eisenmenger syndrome refers to advanced pulmonary hypertension due to shunts but is not a specific congenital structural abnormality.
These diagnostic criteria and echocardiographic hallmarks are described in adult congenital heart disease literature and echocardiography textbooks#16:Textbook of Clinical Echocardiography, 6ep.570-575##12:
ASE Adult Congenital Guidelinesp.400-405#.
NEW QUESTION # 47
What is the significance of a mitral B-bump seen on M-mode?
- A. Mitral stenosis
- B. Elevated left atrial systolic pressure
- C. Elevated left ventricular end-diastolic pressure
- D. Hypertrophic obstructive cardiomyopathy
Answer: B
Explanation:
The mitral B-bump on M-mode echocardiography represents a distinct anterior motion or thickening of the anterior mitral leaflet during atrial systole. It is associated with elevated left atrial systolic pressure.
The B-bump is a marker of increased left atrial pressure transmitted to the mitral valve, often seen in diastolic dysfunction and conditions causing elevated left atrial pressure.
It is not a direct indicator of left ventricular end-diastolic pressure, hypertrophic obstructive cardiomyopathy, or mitral stenosis.
This phenomenon is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Diastolic Function and Mitral Valve Motion#20:215-220Textbook of Clinical Echocardiography#.
NEW QUESTION # 48
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