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ARDMS AE-Adult-Echocardiography Exam Syllabus Topics:| Topic | Details | | Topic 1 | - Pathology: This section of the exam measures skills of adult echocardiography technicians and focuses on identifying and evaluating abnormal physiology and perfusion and postoperative conditions. It includes assessment of ventricular aneurysms, aortic and valve abnormalities, arrhythmias, cardiac masses, diastolic dysfunction, endocarditis, ischemic diseases, cardiomyopathies, congenital anomalies, and postoperative valve repair or replacement and intracardiac devices. Candidates must demonstrate ability to recognize abnormal Doppler signals, EKG changes, wall motion abnormalities, and a wide range of cardiac pathologies including pulmonary hypertension and septal defects.
| | Topic 2 | - Clinical Care and Safety: This section of the exam measures skills of adult echocardiography technicians in applying clinical care principles and safety protocols. It includes evaluating patient history and external data, preparing patients including fasting state and intravenous line management, proper patient positioning, EKG lead placement, blood pressure measurement, and ergonomic techniques. Candidates are expected to identify critical echocardiographic findings, know contraindications for procedures, and be able to respond and manage medical emergencies that may arise during echocardiographic exams.
| | Topic 3 | - Anatomy and Physiology: This section of the exam measures skills of adult echocardiography technicians and covers knowledge and abilities related to normal cardiac anatomy and physiology. It includes assessing great vessels like the aorta and pulmonary arteries, recognizing anatomic variants of the heart, and evaluating cardiac chambers, pericardium, valve structures, and vessels of arterial and venous return. Candidates must document normal systolic and diastolic function, normal valve function and measurements, the phases of the cardiac cycle, normal Doppler changes with respiration, and appearance of arterial and venous waveforms. This also involves assessing the normal hemodynamic response to stress testing and maneuvers such as Valsalva, respiratory, handgrip, and postural changes.
| | Topic 4 | - Instrumentation, Optimization, and Contrast: This section of the exam measures skills of adult echocardiography technicians related to use and optimization of ultrasound instrumentation and the application of contrast agents. Candidates should recognize imaging artifacts, utilize non-imaging transducers, and adjust ultrasound console settings for optimal imaging and Doppler recordings. Knowledge of harmonic imaging, principles of contrast agents, and the safe and effective use of saline and echo-enhancing contrast agents is essential. Candidates must also be able to optimize images when using contrast agents to ensure diagnostic quality.
| | Topic 5 | - Measurement Techniques, Maneuvers, and Sonographic Views: This section of the exam measures skills of adult echocardiography technicians in performing accurate cardiac measurements, conducting provocative maneuvers, and obtaining optimized sonographic imaging views. It involves applying 2D, 3D, M-mode, and Doppler techniques to measure heart valves, chambers, and vessels, including the aortic valve, mitral valve, left and right ventricles, atria, pulmonary artery, and shunt ratios. Candidates must instruct patients in maneuvers such as Valsalva, cough, sniff, and squat. They should also be proficient in acquiring standard echocardiographic views including apical, parasternal, subcostal, and suprasternal notch views.
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ARDMS AE Adult Echocardiography Examination Sample Questions (Q123-Q128):NEW QUESTION # 123
Which of the following is a feature of constrictive pericarditis?
- A. Normal hepatic vein size
- B. Dilated inferior vena cava with inspiratory collapse during sniff test
- C. Interventricular septal bounce
- D. Mitral inflow pattern has a large E-wave and a small A-wave without respiratory changes
Answer: C
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
Constrictive pericarditis is characterized by thickening and fibrosis of the pericardium which restricts diastolic filling of the ventricles. Key echocardiographic features include a characteristic interventricular septal
"bounce" or shift during early diastole due to the abrupt cessation of ventricular filling imposed by the rigid pericardium. This septal bounce reflects rapid early diastolic filling followed by a sudden halt as filling pressures equalize, a hallmark of constriction physiology.
Additionally, Doppler studies show marked respiratory variation in mitral and tricuspid inflow velocities (>25%), with an inspiratory increase in tricuspid inflow and a decrease in mitral inflow velocity, reflecting ventricular interdependence caused by the noncompliant pericardium. The mitral inflow typically shows a large E-wave with a small or absent A-wave and a steep deceleration slope, but importantly these velocities vary significantly with respiration, which is not the case in restrictive cardiomyopathy.
Hepatic vein Doppler often reveals a prominent a-wave and a deep y-descent with increased diastolic flow reversal during expiration, indicating elevated right atrial pressures and constrictive physiology.
The inferior vena cava (IVC) is usually dilated and shows no inspiratory collapse (i.e., no normal collapse with sniff test) because of elevated right atrial pressure and impaired venous return.
Therefore:
* Option A is incorrect because mitral inflow in constrictive pericarditis shows significant respiratory variation, not absence of it.
* Option B is incorrect because the hepatic vein is typically dilated with abnormal flow patterns, not normal size.
* Option C is incorrect because the IVC is dilated and does NOT collapse normally with inspiration/sniff in constrictive pericarditis.
* Option D is correct because the interventricular septal bounce is a classic feature reflecting ventricular interdependence and constrictive physiology.
These findings are summarized in the "Textbook of Clinical Echocardiography, 6e" (Catherine M. Otto, MD), Chapter 10 (Pericardial Disease), pages 280-285, with key illustrations showing septal bounce, Doppler inflow variations, hepatic vein flow patterns, and IVC findings in constrictive pericarditis. The "Mayo Clinic criteria" for echocardiographic diagnosis also emphasize ventricular septal shift as a critical feature, often combined with tissue Doppler annular velocity patterns and hepatic vein diastolic flow reversal for high diagnostic accuracy.
NEW QUESTION # 124
Which of the following measurements is required for calculating the Qp/Qs ratio?
- A. Mitral valve velocity time integral (VTI)
- B. Aortic valve VTI
- C. Right ventricular outflow tract (RVOT) VTI
- D. Tricuspid valve VTI
Answer: C
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
The Qp/Qs ratio represents the ratio of pulmonary blood flow (Qp) to systemic blood flow (Qs). It is commonly calculated to quantify the magnitude of a left-to-right shunt in congenital heart disease.
To calculate Qp/Qs using echocardiography, stroke volumes across both the pulmonary and systemic outflow tracts are measured by combining the cross-sectional area of the outflow tract and the velocity time integral (VTI) of flow through it.
Pulmonary blood flow (Qp) is calculated using the right ventricular outflow tract (RVOT) diameter and RVOT VTI. Systemic blood flow (Qs) is calculated using the left ventricular outflow tract (LVOT) diameter and aortic valve VTI.
Thus, RVOT VTI is essential for Qp calculation, making option D correct.
This method is explained in detail in the "Textbook of Clinical Echocardiography, 6e", Chapter on Congenital Shunts and Quantification of Flow#20:360-365Textbook of Clinical Echocardiography#.
NEW QUESTION # 125
The parasternal long axis view can be used to visualize which anatomical structure?
- A. Left atrial appendage
- B. Pulmonic valve
- C. Coronary sinus
- D. Eustachian valve
Answer: C
Explanation:
The parasternal long axis (PLAX) view provides visualization of the left ventricle, left atrium, mitral and aortic valves, and importantly, the coronary sinus located posteriorly between the left atrium and left ventricle.
The pulmonic valve is best visualized in the parasternal short axis or suprasternal views. The eustachian valve is in the right atrium and visualized best in subcostal or apical views. The left atrial appendage is usually seen in transesophageal echocardiography.
This anatomical visualization is discussed in standard echocardiography textbooks and ASE imaging protocols
#12:ASE Imaging Guidelinesp.70-75##16:Textbook of Clinical Echocardiography, 6ep.100-105#.
NEW QUESTION # 126
Which method is useful for obtaining a good quality pulmonary vein spectral Doppler waveform for evaluation of diastolic function?
- A. Use of non-imaging transducer
- B. Doppler wall filter settings changed to allow for low frequency signals
- C. Use of continuous wave Doppler
- D. Doppler wall filter settings changed to filter out low frequency signals
Answer: B
Explanation:
Comprehensive and Detailed Explanation From Exact Extract:
Pulmonary vein Doppler signals have low velocity and low frequency components that can be filtered out by standard Doppler wall filters. To obtain a good quality spectral Doppler waveform for diastolic function evaluation, the wall filter settings should be lowered or adjusted to allow low frequency signals to be detected and displayed clearly.
Non-imaging transducers and continuous wave Doppler are not appropriate for pulmonary vein Doppler because spatial resolution and site localization are required. Filtering out low frequency signals would degrade the quality of the pulmonary vein waveform.
This is detailed in ASE Doppler imaging and diastolic function assessment protocols#12:ASE Diastolic Function Guidelinesp.85-90##16:Textbook of Clinical Echocardiography, 6ep.125-130#.
NEW QUESTION # 127
The variables necessary to calculate mitral regurgitant (MR) effective orifice area by the proximal isovelocity surface area (PISA) equation include MR aliasing hemispheric radius, the aliasing velocity, and which other parameter?
- A. Time velocity integral of pulsed wave at mitral annulus
- B. Maximum mitral regurgitant velocity
- C. Left ventricular outflow tract diameter
- D. Mitral annular diameter
Answer: B
Explanation:
The proximal isovelocity surface area (PISA) method estimates the effective regurgitant orifice area (EROA) in mitral regurgitation by measuring the radius of the hemispheric flow convergence region (aliasing radius) and incorporating the aliasing velocity and the peak velocity of the MR jet.
The equation for EROA is:
EROA = (2# × r² × Va) / Vmax
Where:
r = radius of the PISA hemisphere (aliasing radius)
Va = aliasing velocity (the velocity at which color aliasing occurs)
Vmax = peak MR velocity obtained by continuous wave Doppler
This calculation does not involve the mitral annular diameter, time velocity integral of mitral annulus, or left ventricular outflow tract diameter.
Thus, the third necessary parameter after aliasing radius and velocity is the maximum MR velocity measured by continuous wave Doppler, which allows determination of flow rate through the regurgitant orifice.
This formula and its clinical application are well established in adult echocardiography literature and ASE valvular regurgitation guidelines#12:ASE Valvular Regurgitation Guidelinesp.210-220##16:Textbook of Clinical Echocardiography, 6eChapter on Mitral Regurgitation Assessment#.
NEW QUESTION # 128
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