Quiz: Cardiology Series with Dr. Peter Modler – 20-900054

20-900054

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(Use the following profession codes for this board: Veterinarian=V; Veterinarian Technician=VT) SELECT FROM DROPDOWN!

Quiz

Cardiology is simple and logical

1.Severe mitral valve insufficiency due to Degenerative Mitral Valve Disease causes:(Required)

Left ventricular volume overload

Left ventricular pressure overload

Right ventricular volume overload

Right ventricular pressure overload

2.Severe subaortic stenosis causes(Required)

Left ventricular volume overload

Left ventricular pressure overload

Right ventricular volume overload

Right ventricular pressure overload

3.Severe pulmonic stenosis causes:(Required)

Left ventricular volume overload

Left ventricular pressure overload

Right ventricular volume overload

Right ventricular pressure overload

4.Severe tricuspid regurgitation causes:(Required)

Left ventricular volume overload

Left ventricular pressure overload

Right ventricular volume overload

Right ventricular pressure overload

5.Compensatory mechanisms for severe mitral regurgitation are(Required)

Left ventricular eccentric hypertrophy

Increased heart rate

Increased sympathetic tone

Right ventricular concentric hypertrophy

6.Typical signs of decompensation of severe Degenerative Mitral Valve Disease are:(Required)

Pulmonary edema

Increased respiratory rate

Lameness

Ascites

7.Typical clinical signs of decompensated severe tricuspid dysplasia are(Required)

Ascites

Enlarged abdomen

Pulmonary edema

Blindness

8.A PDA with a large Left to Right shunting volume causes(Required)

Left-sided volume overload

Increased left ventricular outflow velocities

Differential cyanosis

Anemia

9.Dogs with pericardial effusion causing cardiac tamponade(Required)

Always need urgent treatment with Furosemide

Shall never be treated with furosemide

Need urgent pericardiocentesis

Always have a bad prognosis

10.Mild left ventricular concentric hypertrophy due to subaortic stenosis can be best seen(Required)

On radiographs

On ECG

On ultrasound

Doppler, how to adjust and how to interpret

11.The PW Doppler can be used for(Required)

Estimating maximal velocities along the LVOT and aortic root

Determining the flow pattern (laminar vs. turbulent)

Assessment of diastolic function without a concominant ECG recording

12.The CW-Doppler(Required)

Is used to find areas of turbulent flow

Achieves usually lower Nquist limits than the PW-Doppler

Is used to determine maximal flow velocities

13.Adjustments of PW-Doppler influencing the achieved information do not include(Required)

Baseline-Filter

Grayscale

Pulse repetition frequency

14.Adjustments of CW-Doppler influencing the achieved information do not include(Required)

Size and sample volume

Frequency of transducer

Setting of Zero baseline

15.The typical velocity of a mitral regurgitant jet in a patient that is not in CHF is(Required)

2 m/s

3 m/s

5-6 m/s

16.The typical velocity of a tricuspid regurgitant jet in a patient without pulmonary hypertension is(Required)

0.5 m/s

Around 2.2 m/s

7 m/s

17.Which sentence applies to aortic regurgitations(Required)

Is a normal finding in a dog

Has a typical maximal velocity of 3 m/s

The slope refers to the severity of the insufficiency

18.Pulmonic regurgitant jets are typically accelerated in cases of(Required)

Pulmonary hypertension

Pulmonic stenosis

Presence of erythrocyte casts

Mitral valve dysplasia

19.Comparing left aortic and pulmonary artery flow profiles, which statement is correct?(Required)

The aortic profile is symmetric

The pulmonary artery flow profile is symmetric

The aortic profile as 3 times as large as the pulmonary artery profile

20.The gain should be set so that(Required)

There are no speckles around the profiles

There are some speckles around the profiles

The profiles vanish

21.The position of the baseline can be changed to(Required)

Increase the resolution of the Doppler signal

Avoid signal aliasing

Should never be changed

Degenerative Mitral Valve Disease – Getting the Right Data for the Right Decisions

22.Degenerative Mitral Valve Disease (DMVD) is(Required)

A congenital disorder that occurs frequently in giant breeds

An acquired disease affecting mainly small breed dogs

An inflammatory disease secondary to periodontitis

23.Stage B2 DMVD means that(Required)

There is minimal mitral regurgitation and no cardiac enlargement

There is left atrial and ventricular enlargement secondary to DMVD that is severe enough to meet the criteria used to identify dogs that profit from initiation of medical therapy that can delay the onset of congestive heart failure

End stage DMVD

24.Stage C DMVD includes(Required)

Patients with past or present clinical signs of heart failure due to DMVD

Patients at risk for developing DMVD but without present structural or functional cardiac abnormalities

Patient with DMVD and mitral regurgitation but without evidence of cardiac enlargement

25.Hemodynamically significant mitral regurgitation causes(Required)

Left sided volume overload

Left sided pressure overload

Right sided volume overload

26.Risk factors in dogs with DMVD for the development of CHF are(Required)

Progressing left ventricular and left atrial volume overload

E-waves < 0.8 m/s

Severe valvular changes

27.An inverse E/A-ratio on mitral inflow profiles (E wave smaller than A wave)(Required)

Means that the patient is very likely not in CHF

Means that the patient is very likely in CHF

Does not exist in dogs

28.Left ventricular dimensions can be normalized by body weight using the(Required)

Cornell-Index

Kittleson-Index

Atkins-Index

29. Mitral valve prolapse(Required)

Means that the free edges of mitral valve leaflet overtop the mitral annular plane

Can be caused by chordal elongation or chordal rupture

Occurs frequently in dogs with DCM

30.Correct echocardiographic assessment of morphology, dimensions, and function in dogs with DMVD(Required)

Does not make a difference and is therefore not necessary

Does not have any influence on treatment decisions

Is very important to guide appropriate treatment and monitoring

31.Surgical treatment of DMVD(Required)

Is today a realistic option for patient suffering from advanced disease

is a purely experimental procedure and not a realistic option for patients suffering from DMVD

requires a trained and skilled team consisting of surgeons, anesthesiologists, and perfusionists

Congenital Heart Disease – Differentiating the Dangerous from the Harmless

32.Aortic stenosis in dogs causes a heart murmur with a point of maximum intensity over(Required)

The left apex

The left heart base

The right apex

33.Severe pulmonic stenosis causes(Required)

Right ventricular concentric hypertrophy

Left ventricular concentric hypertrophy

Left atrial enlargement

34.A large left to right shunting PDA in a dog causes(Required)

Left ventricular volume overload

An increase in left ventricular outflow velocity

Right ventricular concentric hypertrophy

35.A pulmonic stenosis with a pressure gradient of 150 mmHg across the right ventricular outflow tract is(Required)

Mild

Moderate

Severe

36.A ventricular septal defect in a dog without pulmonic stenosis or significant pulmonary hypertension usually causes(Required)

left to right blood flow

right to left blood flow

bidirectional blood flow

37.Severe aortic stenosis in dogs(Required)

Is usually associated with moderate to severe left ventricular concentric hypertrophy

Can cause sudden cardiac death

Can cause ascites

38.A left-to-right shunting and hemodynamically significant PDA in a dog usually causes(Required)

A left basal machinery murmur

A right apical systolic murmur

A right basal systolic murmur

39.Mild pulmonic stenosis can be identified(Required)

On radiographs

On echo

Cannot be identified

40.Mild aortic stenosis(Required)

Can cause sudden cardiac death

Can cause left-sided congestive heart failure

Does usually not affect the patient’s prognosis

41.An atrial septal defect as a single congenital heart defect usually causes(Required)

Left to right shunting of blood because the right ventricle has a higher compliance than the left ventricle (fills easier with blood in diastole)

Right to left shunting of blood because all pulmonary veins enter the right atrium

Does never cause any shunting of blood

DCM (dilated cardiomyopathy) – What Ultrasound Can Tell Us

42.Which of these statements is correct(Required)

There exist different types of primary DCM (Type I, Type II, Mixed type)

DCM can be primary (genetic) or secondary

DCM does not exist in dogs

43.Which of the following breeds is predisposed to DCM?(Required)

Doberman Pinscher

Great Dane

Chihuahua

44.DCM is characterized by(Required)

Decreased systolic function and increased sphericity of the left ventricle

Increased left ventricular wall thickness

Increased right ventricular wall thickness

45.Possible causes of secondary DCM are(Required)

Hypothyroidism

Long episodes of severe tachycardia (Tachycardia induced cardiomyopathy)

Addison’s

46.If 5 VPCs are identified on a routine echocardiogram in a Doberman Pinscher(Required)

It is strongly recommended to perform a Holter-ECG-recording

They can be considered completely harmless, no further workup is required

Doberman Cardiomyopathy (DCM) has to be taken into consideration

Pulmonary Hypertension – How Not to Miss It

47.Pulmonary hypertension(Required)

Is a syndrome defined by increased pulmonary arterial pressures caused by a variety of diseases

Means that oxygen partial pressure is increased within the lungs

Means that the chest has been compressed by a trauma

48.Which statement is correct?(Required)

It is important to detect pulmonary hypertension because it can cause significant morbidity

Pulmonary hypertension is always a harmless condition that never affects quality of life

Pulmonary hypertension can only identified with cardiac catheterization

49.A useful tool to determine pulmonary hypertension in dogs is(Required)

Doppler ultrasonography

CBC

Auscultation

50.Pulmonary arterial pressures can be estimated(Required)

using the maximum velocity to a tricuspid regurgitation jet in the absence of pulmonic stenosis

using the maximum velocity of a mitral regurgitation jet in the absence of aortic stenosis

using the maximum velocity of portal vein flow

51.Possible causes of pulmonary hypertension are(Required)

Left sided congestive heart failure due to mitral valve disease

Heart worms

Intestinal foreign body

51.Possible causes of pulmonary hypertension are(Required)

Left sided congestive heart failure due to mitral valve disease

Heart worms

Intestinal foreign body

52.2D-echocardiographic signs of severe pulmonary hypertension are:(Required)

Widening of the main pulmonary artery

Widening of the aortic root

Reduced fractional shortening of the left ventricle

53.Typical 2D-echocardiographic signs of severe pulmonary hypertension are:(Required)

Septal flattening

Reduced motion of the mitral valve

An apical aneurysm of the right ventricle

54.A calculated systolic pulmonary arterial pressure of 120 mm Hg means(Required)

Mild pulmonary hypertension

Moderate pulmonary hypertension

Severe pulmonary hypertension

55.Increased left atrial pressures due to severe degenerative mitral valve disease(Required)

Can cause postcapillary pulmonary hypertension

Can cause Precapillary pulmonary hypertension

Cannot cause pulmonary hypertension because the left atrium is not connected to the pulmonary veins

56.Typical Clinical signs of severe pulmonary hypertension can be(Required)

Ascites

Syncope

Lameness

Help! I Can’t Get That View!

57.If the ventricle appears too short on a right parasternal 4-chamber view, the transducer usually needs a(Required)

Twist

Slide

Tilt

58.If no right ventricle is seen on a right parasternal short-axis view at the level oft he papillary muscles, the transducer is usually positioned too close to the(Required)

Ventricular apex

Elbow

Hip

59.If the heart appears tilted on a right parasternal 4-chamber view and the apex is too close to the top oft he image, the transducer has to be(Required)

Slide towards the spine

Slide towards the apex

Tilted

60.In order, to obtain accurate M-Mode and 2D-measurements(Required)

The imaging planes have to be perfect

The imaging planes are not important

We just need Doppler measurements, M-mode and 2D-measurements are not necessary

61.When doing M-Mode measurements from a right parasternal 4-Chamber view, the M-Mode cursor hast o be positioned(Required)

Perpendicular to the ventricular septum

Angled at about 30° to the ventricular septum

It’s not possible to do an M-Mode from a right parasternal 4-chamber view)

Cats: a Different World – Feline Heart Disease

62.Systolic anterior motion of the mitral valve can be best identified using (Please check all that apply)(Required)

radiographs

Tissue Doppler

M-Mode of across the mitral valve leaflets from a right parasternal view

2-D imaging

63.Feline patients with left-sided congestive heart failure (Please check all that apply)(Required)

Must be forced into left lateral recumbency in order to perform a thorough echocardiogram

Have to be stabilized before a detailed echocardiogram can be performed

Have to be handled with care to avoid unnecessary stress

64.Left-sided congestive heart failure in cats (Please check all that apply)(Required)

Appears only as pulmonary edema

Can appear as pulmonary edema or pleural effusion

can be identified using bedside ultrasound by identification of B-Lines and/or pleural effusion in combination with left atrial enlargement

65.Which statement about pericardial effusion in cats is correct?(Required)

Pericardial effusion can be seen in cats with left sided congestive heart failure

Pericardial effusion always causes cardiac tamponade and ascites

Pericardial effusion always requires pericardiocentesis

Furosemide is always contraindicated in cats with pericardial effusion

66.Feline Hypertrophic Cardiomyopathy (Please check all that apply)(Required)

Occurs only in pure bred cats

Has to be differentiated from other causes of concentric hypertrophy

Can have different phenotypes

Is never associated with diastolic dysfunction

Cliff Notes on ECG

67.The p-wave in an ECG stands for(Required)

Atrial depolarization

Ventricular depolarization

Ventricular repolarization

68.In a normal ECG, the QRS complex is?(Required)

Narrow

Bizarre and wide

Third There is no QRS complex in a normal canine ECG

69.AV-Block III means(Required)

The electrical conduction from the atria to the ventricles is completely blocked. P-waves and QRS-complexes appear in a completely independent way, P-waves are not followed by associated QRS-complexes any more

a tachycardic arrhythmia with wide QRS-complexes

No p-waves are visible on the ECG

70.Sinus tachycardia(Required)

Is always an indication for beta blockers

occurs frequently secondary to fever, pain, anemia, excitement…

Is a sinus rhythm at a high heart rate

71.Ventricular premature complexes are usually(Required)

Wide and bizarre

Narrow

Extremely narrow

72.Supraventricular premature complexes are usually(Required)

Narrow

Wide and bizarre

Extremely wide and bizarre

73.Atrial fibrillation(Required)

Is characterized by a irregularly irregular sequence of beats

Does not exist in dogs

Does not exist in cats

74.A sick sinus syndrome(Required)

Is a bradyarrhythmia, sometimes associated with tachycardic episodes

is always an incidental finding and does never require therapy

cannot be detected by a surface ECG

75.One way to calculate the heart rate in an ECG recording is(Required)

Count the QRS complexes over 15 cm and take them times 20 if the paper speed is 50 mm/s

Count the QRS complexes over 15 cm and take them times 10 if the paper speed is 25 mm/s

Count the QRS complexes over 7,2 cm and take them times 122344 if the paper speed is 100 mm /s

76.In a normal canine ECG(Required)

Every P-wave is followed by a QRS complex

There is a P-wave in front of every QRS complex

There is a z wave in front of every RTZ complex