CME Self-Assessment Examination

Self-Assessment Examination

See answer key link at bottom of page

1. Which of the following statements about echocardiography is correct?

a.Transthoracic echocardiography can confirm the diagnosis of pulmonary hypertension (PH) in approximately 50% of the cases.
b. Identification of a tricuspid regurgitation jet is necessary in order to estimate the right ventricular systolic pressure.
c. The presence of pericardial effusion in a patient with pulmonary arterial hypertension (PAH) simply reflects the need to adjust the diuretic regimen and does not carry a worse prognosis.
d. The major hemodynamic predictors of survival in PAH are directly related to the severity of the pulmonary arterial pressures.
e. Accurate assessment of right ventricular (RV) function is easily done with transthoracic echocardiography.

2. All of the following statements about echocardiography in PH and PAH are true, except:

a. Right ventricular systolic pressure (representing pulmonary arterial systolic pressure) is estimated by using the modified Bernoulli's equation: 4v2 + right atrial pressure where v = tricuspid regurgitation jet velocity.
b. Calculation of pulmonary vascular resistance (PVR) by echocardiography has a strong correlation with PVR measured during right heart catheterization.
c. Finding an enlarged left atrium in a patient with PH may suggest the presence of nonsystolic dysfunction of the left ventricle (also known as diastolic dysfunction).
d. An increase in the size of the right atrial area confers a worse prognosis in PAH.
e. A tricuspid annular plane systolic excursion (TAPSE) measurement of less than 1.8 cm appears to significantly increase the mortality risk in patients with PAH.

3. All of the following statements about right heart catheterization are true, except:

a. Presence of distinct A and V waves suggests that the catheter tip is properly placed and that the pulmonary capillary wedge pressure (PCWP) measurement is likely accurate.
b. PCWP should be measured at end exhalation.
c. Pulmonary arterial pressure should be measured at end exhalation.
d. To measure the PCWP, one must measure top and bottom of the V wave (during exhalation, before pressure decline) and then average the values.
e. A blood oxygen saturation-obtained from the catheter while wedged-that is close to the systemic arterial oxygen saturation, suggests the catheter tip is well placed and that the wedge tracing and measurement is likely adequate.

4. All of the following statements about right heart catheterization in PH and PAH are true, except:

a. The 2 most common methods to assess cardiac output/cardiac index (CO/CI) are thermodilution (TD) and the Fick method.
b. A low CI has been shown to carry a poor prognostic for patients with PAH.
c. When obtaining CO by the thermodilution method, there is no need to obtain more than 1 measurement if the first measurement shows a good wave form.
d. Stroke volume index is an important value since it takes heart rate into consideration; it might be a better assessment of ventricular performance.
e. Potential limitations to CO measurement by TD include severe tricuspid regurgitation and the presence of a congenital heart defect.

5. Which of the following statements about right heart catheterization is correct?

a. A low mixed venous oxygen saturation (eg, 50%) at rest suggests an adequate cardiac output.
b. A high arteriovenous oxygen difference (eg, 7) at rest suggests an adequate cardiac output.
c. A prominent V wave form at rest suggests severe mitral valve stenosis.
d. A significant increase in PCWP during a pulmonary vasodilator challenge may suggest the presence of left ventricular (LV) diastolic dysfunction.
e. Assumption of basal oxygen consumption is not a limitation to the CO/CI calculation by the Fick method.

6. Compared to echocardiography and right cardiac catheterization, which of the following statements about cardiac magnetic resonance imaging (MRI) is correct?

a. MRI provides the best assessment of the RV stroke volume, RV ejection fraction, and RV mass.
b. MRI provides the best estimate of RV pressure.
c. MRI provides the best measurement of the right atrial pressure.
d. MRI provides the best measurement of tricuspid regurgitation.
e. All of the above.

7. Which of the following statements about cardiac MRI is correct?

a. Cardiac MRI can be used in patients who have a pacemaker.
b. Cardiac MRI is very well tolerated even by patients who are claustrophobic.
c. Cardiac MRI requires the ability to perform breath holds.
d. Cardiac MRI can be performed in all patients who have had aneurysm clips.
e. None of the above.

8. All of the following statements about cardiac MRI are true except:

a. MRI assessment of distensibility in the main pulmonary artery was highly correlated with pulmonary vasodilator response.
b. Improvement in RV stroke volume is observed during the first 4 months of PAH treatment and is closely correlated with increase in the 6-minute-walk distance.
c. Increased RV volume and decreased stroke volume and LV volume are strong predictors of mortality and treatment failure in PAH.
d. MRI has been used to show restoration of the RV structure and function after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension.
e. None of the above.

The answer key is linked below