CPD Questions (Aortic Stenosis - Avoiding Common Pitfalls)

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1. Which combination is most consistent with severe aortic stenosis?:: A. Vmax 3.2 m/s, mean PG 25 mmHg, AVA 1.4 cm²B. Vmax 4.2 m/s, mean PG 45 mmHg, AVA 0.8 cm²C. Vmax 2.8 m/s, mean PG 18 mmHg, AVA 1.2 cm²D. Vmax 3.5 m/s, mean PG 28 mmHg, AVA 1.3 cm²
2. What is the most common source of error leading to underestimation of AVA by the continuity equation?:: A. Overestimation of AV VTIB. Underestimation of LVOT diameterC. Measuring the LVOT VTI too close to the valveD. Incorrect tracing of the modal velocityE. Poor alignment of ultrasound beam with AS jet
3. Which visual clue in a parasternal long-axis (PLAX) view suggests that the LVOT diameter may be underestimated due to an oblique imaging plane?:: A. The right coronary cusp (RCC) is well-visualized.B. The mitral-aortic curtain is in fibrous continuity.C. The non-coronary cusp (NCC) of the aortic valve is NOT seen.D. Both the right coronary cusp (RCC) and non-coronary cusp (NCC) are well-visualized.E. Simultaneous biplane imaging shows the LVOT is appropriately centred.
4. Which of the following findings would suggest that the pulsed-wave sample volume for the LVOT VTI is placed incorrectly (too low or too far from the valve)?:: A. A VTI of 20 cmB. Presence of a clear closing clickC. A VTI of 12 cm in a patient with normal LV systolic functionD. Flow acceleration is noted immediately after the sample volumeE. Sample volume size is set to 4 mm
5. How is a Low Flow State defined when assessing for potential discordance in AS severity?:: A. Indexed Stroke Volume ≥ 58 mL/m²B. Indexed Stroke Volume between 36 and 57 mL/m²C. LVEF < 40% regardless of stroke volumeD. Indexed Stroke Volume ≤ 35 mL/m²E. Mean Pressure Gradient < 20 mmHg
6. Classical low-flow, low-gradient AS is characterised by::: A. Preserved LV systolic function with EF ≥50%B. Depressed LV systolic function with EF <50%C. Coexistent severe mitral regurgitationD. Low stroke volume stateE. B or C
7. In a very small or very large patient, the best next step when AVA seems discordant is to::: A. Ignore AVA and get a CT calcium score as the primary diagnostic toolB. Index AVA to body surface area and use the indexed AVA for gradingC. Use the velocity ratio (dimensionless severity index) for gradingD. Recalculate AVA using a ‘normalised’ LVOT diameterE. Use peak and mean pressure gradients only for grading
8. If a patient has a reversible high flow state (e.g., due to a temporary condition), what is the recommended clinical step for accurate AS assessment?:: A. Base the severity strictly on the current mean pressure gradientB. Perform a low-dose dobutamine stress echo immediatelyC. Treat the underlying cause and repeat the echocardiogram once flow is normalizedD. Perform CT calcium scoring to determine the true severityE. Use the dimensionless severity index as the sole diagnostic tool
9. Following the stepwise algorithm for Paradoxical Low-Flow, Low-Gradient AS, what is the first action to take when measurements suggest severe AS by AVA but moderate by gradients?:: A. Proceed immediately to a surgical consult.B. Perform a CT calcium score to confirm the degree of calcification.C. Check the accuracy of the measurements, specifically the LVOT diameter and VTI.D. Diagnose the patient with "Severe AS" based solely on the valve area.E. Administer high-dose dobutamine to increase the stroke volume.
10. In the context of the continuity equation, what does the Dimensionless Severity Index (also known as the Velocity Ratio) represent?:: A. The ratio of the LVOT diameter to the aortic valve diameter.B. The ratio of the LVOT VTI to the Aortic Valve VTI.C. The product of the LVOT area and the peak velocity.D. The difference between the peak velocity and the mean gradient.E. The ratio of the patient's BSA to the Aortic Valve Area.

CPD Questions (Aortic Stenosis - Avoiding Common Pitfalls)

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CPD Questions (Aortic Stenosis - Avoiding Common Pitfalls)

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