Physics, Hemodynamics, and Calculations
Congenital Abnormalities
Normal Cardiac Anatomy and Function
Valvular Pathology
Anesthesia History
100
The velocity of an ultrasound wave in soft tissue
1540 meters/second or 1.54 mm/microsecond
100
What is the most common type of ventricular septal defect?
Membranous, peri-, para-, infracristal, subaortic
100
A sixty-three-year-old female patient presents for a three-vessel coronary artery bypass graft. A comprehensive intraoperative transesophageal echocardiography study is performed and the following recommended view is obtained. Identify the correct view:
The midesophageal ascending aorta short axis view
100
Give 2 methods of calculating the area of this valve using Doppler derived data
Mitral valve Answer: 220/PHT, 760/DT, Continuity equation, PISA
100
Name one of the two anesthesiologists who developed the cuffed endotracheal tube.
Double points: How did they test this their new device
Arthur Ernest Guedel, Ralph Waters
200
The relationship between axial resolution and spatial pulse length?
Axial resolution = ½ SPL
200
This is the only VSD located above the crista supraventricularis
Type 1 (Outlet, subpulmonic, subvalvular, supracristal, conal, intraconal, doubly committed subarterial)
200
Which posterior leaflet scallop of the mitral valve is closest to the Left Atrial Appendage?
P1
200
The patient below presents with severe mitral stenosis. What is the most likely cause:
Rheumatic mitral stenosis (Hockey stick sign)
200
This German surgeon was the first to perform spinal anesthesia in 1898
August Karl Gustav Bier
300
When using PISA to determine orifice area in patient with mitral stenosis, in which direction should you shift the ultrasound baseline when obtaining aliasing velocity?
In the direction of blood flow, or down into the LV
300
In patients with this anomaly, which leaflet of the triscuspid valve is described as “large, sail-like”?
(CLIP: Ebstein’s Anomaly; answer: Anterior)
300
What is the physiologic mechanism responsible for this portion of the pulsed-wave doppler tracing shown here?
Normal pulmonary venous flow pointing at S1 Answer: Atrial relaxation; S2 is due to RV stroke volume and descent of MV annulus)
300
A Patient presents for AVR following a technically difficult TTE that demonstrated a high gradient across the valve. Following induction you obtain the following TEE images and the surgeon asks for guidance. What do you tell him?
Normal AV in short axis with planimetry showing normal values. CWD through LVOT with dynamic obstruction showing “dagger-appearance” Answer: Valve appears normal, pt. has HOCM
300
This New-Zealand born British anesthesiologist helped develop a popular laryngoscope. He was later knighted for making improvements on parachutes
Robert Macintosh
400
The piezoelectric crystal of most ultrasound probes is composed of what?
lead-zirconate-titonate
400
What additional anomaly is this defect associated with?
(CLIP: Sinus Venosus ASD; answer: Partial Anomalous Pulmonary Venous Return ( or Scimitar syndrome)
400
Disruption of this structure would lead to what EKG abnormality?
Image of moderator band. Answer: RBBB
400
Normal DVI values for this valve would be expected to be above what?
Clip: prosthetic mechanical aortic valve. Answer 0.3)
400
Good luck finding this IV anesthetic that ultimately was replaced by propofol. Exportation to the US has been limited by the EU since 2010 due to its use in lethal injections
sodium thiopental
500
Nearfield length is determined by what 2 variables?
Ln = radius of transducer ^2/ wavelength
500
What are the 2 surgical options to augment pulmonary blood flow during a Stage I Norwood procedure?
Sano shunt (RV to PA conduit) or BT shunt (SCA to PA)
500
Which cusp of this valve is closest to the aortic valve?
Which cusp of this valve is closest to the aortic valve? (Clip: pulmonic valve Answer: Left)
left
500
Shortly after coming off pump following valve replacement, the following clip is obtained. The surgeon asks if he needs to go back on pump to repair the valve, what do you tell him?
Normal washing jets in a mechanical mitral valve. Answer: No
500
Credited with developing the anesthetic applications of ketamine; this University of Michigan professor continued his research until his death at 96. He shares no relation with the international pizza chain headquartered in Ann Arbor.
Edward Domino