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True/False: Tricuspid valve hemodynamics occur approximately 50 milliseconds prior to mitral valve hemodynamics.
True
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True/False: The M-mode criteria for tricuspid stenosis includes the following
dense, thick leaflets
reduced E-F slope
reduced A wave
increased E wave
T, T, T, F
M-mode criteria of TS are similiar to the pattern seen in MS
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True/False: The 2D echo views that allow visualization of at least two tricuspid leaflets include
PLAX (right heart)
PSAX
Apical 4c
Apical
All True
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Which condition is most indicative of tricuspid stenosis?
right ventricular enlargement
right venticular hypertrophy
right atrial enlargement
pulmonary insufficiency
right atrial enlargement
right atrial enlargement is direct physiological consequence of tricuspid stenosis
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Which tricuspid M-mode criterion clearly indicates tricuspid regurgitation?
reduced E-F slope
mid to late prolapse
notching
none of the above
None of the criteria are directly related
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Which of the following 2D echo criteria may be most useful in defining tricuspid regurgitation?
reduced tricuspid E-F slope
right ventricular enlargement
right ventricular hypertrophy
right atrial enlargement
right atrial enlargement
right atrial enlargement is a direct physiological consequence of tricuspid regurgitation, as it is of tricuspid stenosis
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Bacterial endocarditis most commonly occurs in the
mitral valve
tricuspid valve
aortic valve
pulmonic valve
tricuspid valve
is the first valve contacted by returning blood flow to the heart and is therefore the valve where bacterial endocarditis most commonly occurs
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True/False: Echo features of carcinoid heart disease involving the tricuspid valve are:
tricuspid regurgitation
tricuspid prolapse
thickened, immobile leaflets
increased pressure 1/2 time
T, F, T, F
echo features of carcinoid heart disease in the tricuspid valve are thickening, rigid leaflets that do not close during systole, leaving wide-open tricuspid regurgitation
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True/False: When performing a Doppler examination of the IVC and/or hepatic veins for evidence of tricuspid regurgitation, one would expect to find.
flow toward the transducer in systole
flow away from the transducer in systole
flow towards the transducer in diastole
flow away from the transducer in systole
T, F, F, T
subcostal position, presence of flow toward the transducer in systole when flow in the IVC/hepatic vein is being insonated is evidence for tricuspid regurgitation. Normal flow is always away from the transducer in diastole, with or without TR
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Tricuspid regurgitation can be recognized on an M-mode study of the IVC in which contrast medium is injected into an arm vein by the appearance of contrast medium:
following atrial systole
during ventricular systole
following atrial diastole
during ventricular diastole
during ventricular systole
contrast appears in the IVC on the M-mode during ventricular systole with TR. It appears following atrial systole in normal subjects and there is no contrast effect in diastole
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True/False: Tricuspid inflow velocity normally resembles mitral flow EXCEPT:
tricuspid flow is at a higher velocity
tricuspid inflow is at a lower velocity
tricuspid inflow increases with inspiration
tricuspid inflow decreases with inspiration
F, T, T, F
mitral valve inflow velocity is normal subjects is higher than tricuspid valve inflow velocity. Also tricuspid inflow increases with inspiration
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True/False: Significant tricuspid regurgitation is present on the Doppler 2D exam when.
localized tricuspid regurgitation signals are noted
right atrial dimensions is increased
systolic flow into the hepatic veins is observed in the subcostal approach
tricuspid regurgitation jet jugs the interatrial septum
F, T, T, F
localized signals means mild TR. RA dimensions are increased in significant insufficiency. When doppler shows systolic flow into the hepatic veins, TR is siginificant. TR jets frequently hug the IAS, and this is not a sign of severity
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True/False: Doppler features of tricuspid stenosis include:
an increase in peak velocity
slow rate of descent of the velocity curve following peak velocity
a decrease in velocity with inspiration
diastolic dispersion
T, T, F, T
velocity increase with inspiration in TS. Other answers are all typical of TS-increase in velocity that is mild compared with mitral stenosis, slow rate of descent of velocity curve following peak velocity, and diastolic dispersion
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Tricuspid regurgitation peak velocity is proportional to the:
diastolic pressure gradient between the RV & RA
systolic pressure gradient between the RV & RA
diastolic pressure gradient between the RV & PA
systolic pressure gradient betwween the RV & RA
systolic pressure gradient between the RV & RA
RVSP can be estimated by taking the peak velocity of TR jet(systole), using Bernoulli's equation to predict peak RV minus RA pressure gradient. By estimating mean RA pressure as 10 mmHg and adding that to the above finding, RVSP is estimated
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During a contrast study, contrast appearing in the IVC and hepatic veins during right ventricular systole indicates:
tricuspid stenosis
tricuspid insufficiency
pulmonary hypertension
pulmonary insufficiency
tricuspid insufficiency
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True/False: The differences in timing of the opening and closing of the mitral valve and tricuspid valves are
tricuspid valve closure occurs prior to mitral valve closure
tricuspid valve closure occurs after mitral valve closure
tricuspid valve opening occurs prior to mitral valve opening
tricuspid valve opening occurs after the mitral valve opening
F, T, T, F
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The PLAX right ventricular inflow view demostrates which tricuspid valve leaflets?
anterior and septal
anterior and posterior
septal and posterior
inferior and posterior
anterior and posterior
3 TV valve are the anterior, posterior and septal. In the parasternal RVIT veiw, anterior & posterior are imaged. PSAX all 3 leaflets are imaged optimally. A4 veiw demonstrates the anterior and septal leaflets
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True/False: To distinguish the tricuspid valve from the mitral valve when attempting to identify the morphologyof the right ventricle, one looks for
* more apical insertion of the septal leaflet of the tricuspid valve(in relation to the anterior mitral leaflet)
* more basil insertion of the septal leaflet of the tricuspid valve(in relation to the anterior mitral leaflet)
* the trileaflet configuration of the tricuspid valve
* presence of four distinct papillary muscles
T, F, T, F
the apical insertion of the tricuspid setal leaflet relative to the mitral anterior leaflet distinguishes the RV when there is any doubt. TV has 3 leaflets and also papillary muscles, not four.
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True/False: Tricuspid valve echo finding in patients with such acquired diseases as endomyocardial fibrosis, endocardial fibroelastosis, and malignant carcinoid include:
increased E to A ratio
thickened leaflets and chordae
diastolic leaflet doming
restriction of leaflet motion
F, F, T, T
group of acquired disorders presents on the echo with findings of TS: thickened cordae, distolic leaflet doming, and restriction of leaflet motion. E:A ration would be either decreased or, owing to lact of an A wave, nonsxistent
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True/False: The most reliable views for demostrating doming of the stenotic tricuspid valve are
PLAX, right ventricular inflow
PSAX
Apical 4C
all of the above
T, F, T, F
PLAX RVIT and the A4 view are the most reliable for veiwing doming in TS. PSAX is less reliable, although it may at times be domed
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True/False: Signs of right ventricular volume overload in tricuspid regurgitation include.
dilatation of the right ventricle
dilatation fo the right atrium
flattening of the septum during diastole
anterior motion of the IVS during isovolumetri contraction
T, F, T, T
dilatation of RA occurs in TR but is not a sign of RVVO. The other signs are all true of RVVO
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