[2026年01月22日]AE-Adult-Echocardiography試験問題集PDF正確率保証と更新された問題
合格させるAE-Adult-Echocardiography試験にはリアルテストエンジンPDFには141問題あります
質問 # 57
Which anatomic structure is represented by the arrow on this image?
- A. Anterior leaflet
- B. Left leaflet
- C. Septal leaflet
- D. Posterior leaflet
正解：A
解説：
The echocardiographic image is a four-chamber view focusing on the mitral valve apparatus. The arrow points to the anterior leaflet of the mitral valve, which is typically more prominent, triangular in shape, and located adjacent to the aortic valve in the left ventricular outflow tract region.
The posterior leaflet of the mitral valve is generally smaller, has multiple scallops, and is located posteriorly relative to the anterior leaflet. The septal leaflet is part of the tricuspid valve on the right side of the heart. The
"left leaflet" is a non-specific term and not an anatomical descriptor.
This differentiation between anterior and posterior leaflets is important for understanding mitral valve pathology and for interventions such as mitral valve repair. These features are clearly explained in echocardiography texts and ASE valve imaging guidelines#12:ASE Valve Imaging Guidelinesp.180-185#
#16:Textbook of Clinical Echocardiography, 6ep.200-205#.
質問 # 58
Which finding is shown in this image?
- A. Cor triatriatum
- B. Left atrial thrombus
- C. Artifact
- D. Chiari network
正解：D
解説：
The echocardiographic image shows a mobile, highly echogenic, mesh-like structure within the right atrium consistent with the Chiari network. The Chiari network is an embryologic remnant of the right valve of the sinus venosus, appearing as a fenestrated, reticulated membrane that is usually thin and mobile, found near the orifice of the inferior vena cava or the coronary sinus.
This structure is benign and often an incidental finding but can be confused with thrombus or atrial tumors.
Unlike left atrial thrombus, which appears as a more solid, immobile mass often located in the left atrial appendage, the Chiari network is mobile and located in the right atrium. Cor triatriatum is a rare congenital membrane dividing the left atrium into two chambers and appears differently on echocardiography. Artifact refers to non-anatomic echoes which do not persist or move consistently.
Recognition of Chiari network is important to avoid misdiagnosis, and its characteristics are well described in echocardiography literature such as the "Textbook of Clinical Echocardiography" and ASE imaging guidelines
#16:Textbook of Clinical Echocardiography, 6ep.400-402##12:ASE Guidelines on Cardiac Massesp.150-
155#.
質問 # 59
Which coronary artery territory is associated with the wall motion abnormality demonstrated in this video?
- A. Left anterior descending
- B. Right
- C. Left circumflex
- D. Posterior descending
正解：C
解説：
The echocardiographic video shows hypokinesis or akinesis of the inferolateral wall of the left ventricle. This myocardial territory is predominantly supplied by the left circumflex coronary artery.
The right coronary artery primarily supplies the inferior wall and right ventricle. The left anterior descending artery supplies the anterior and septal walls. The posterior descending artery supplies the inferior wall, usually supplied by the right coronary artery or sometimes the circumflex.
These segmental coronary territories are described in ASE stress echocardiography and regional wall motion assessment guidelines#12:ASE Stress Echocardiography Guidelinesp.300-310##16:Textbook of Clinical Echocardiography, 6ep.380-385#.
質問 # 60
Which of the following does this Image represent?
- A. Mitral valve inflow
- B. Pulmonary vein Doppler
- C. Hepatic vein Doppler
- D. Tricuspid valve inflow
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The image shows a pulsed-wave Doppler waveform with respiratory phasicity and distinct forward and reversed flow components characteristic of hepatic vein flow patterns. Hepatic vein Doppler typically displays a biphasic waveform with systolic (S) and diastolic (D) forward flow toward the heart and brief reversed flow during atrial contraction (A wave reversal), reflecting right atrial pressure changes.
Mitral and tricuspid inflow Doppler patterns show distinct E and A waves representing early and late diastolic ventricular filling but do not have the same flow reversal pattern. Pulmonary vein Doppler waveforms also differ, showing systolic and diastolic forward flows into the left atrium without the prominent reversed flow seen here.
The hepatic vein Doppler is commonly used in echocardiography to assess right atrial pressure and compliance, especially in conditions like constrictive pericarditis and right heart failure, where characteristic flow reversals and expiratory changes are observed.
This pattern and its clinical significance are detailed in adult echocardiography references, including the
"Textbook of Clinical Echocardiography" and ASE guidelines on Doppler imaging#16:Hepatic Vein DopplerTextbook of Clinical Echocardiography, 6e##12:ASE Doppler Guidelinesp.95-100#.
質問 # 61
During which phase of the cardiac cycle does the left ventricular filling pressure equalize with left atrial pressure?
- A. Diastasis
- B. Atrial contraction
- C. Early rapid filling
- D. Ventricular contraction
正解：C
解説：
During early rapid filling, when the mitral valve opens at the onset of diastole, the pressure gradient between the left atrium (LA) and left ventricle (LV) is at its peak, allowing blood to flow into the ventricle. As filling progresses during this phase, the left ventricular diastolic pressure rises rapidly and quickly approaches and equalizes with left atrial pressure.
The equalization of pressures is critical to facilitate ventricular filling and is reflected in the mitral inflow Doppler pattern, where the E-wave corresponds to early rapid filling. Diastasis is the mid-diastolic slow filling phase where pressures are nearly equal and little flow occurs. Atrial contraction is the late filling phase, adding a small volume to the ventricle.
This physiological timing is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Diastolic Function and Hemodynamics, with emphasis on pressure changes during the cardiac cycle#20:210-
215Textbook of Clinical Echocardiography#.
質問 # 62
Which finding is best demonstrated in this video?
- A. Left atrial elongation
- B. Systolic anterior motion of the mitral valve
- C. Mid-anteroseptal hypokinesis
- D. Aortic root dilatation
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The video shows a parasternal long-axis view of the left ventricle and mitral valve with the anterior leaflet of the mitral valve moving abnormally toward the interventricular septum during systole. This systolic anterior motion (SAM) of the mitral valve is characteristic of hypertrophic obstructive cardiomyopathy (HOCM) and contributes to left ventricular outflow tract obstruction.
Aortic root dilatation and left atrial elongation are structural findings seen in other views. Mid-anteroseptal hypokinesis is a regional wall motion abnormality not clearly visualized in this clip.
This echocardiographic sign is critical in diagnosing and managing HOCM and is discussed extensively in ASE guidelines and clinical echocardiography texts#16:Textbook of Clinical Echocardiography, 6ep.350-
355##12:ASE Cardiomyopathy Guidelinesp.120-130#.
質問 # 63
What is the incidental finding seen by color Doppler in this four-chamber view of a patient with left atrial enlargement?
- A. Muscular ventricular septal defect
- B. Coronary-cameral fistula
- C. Patent foramen ovale
- D. Sinus venosus defect
正解：C
解説：
The color Doppler image in the four-chamber view shows a jet across the interatrial septum, indicating a shunt at the atrial level. In a patient with left atrial enlargement, the most common incidental finding causing such flow is a patent foramen ovale (PFO). A PFO is a small communication between the right and left atria that can open under certain pressure conditions, leading to shunting.
Muscular ventricular septal defect is a ventricular level defect and would be seen in different views. Coronary- cameral fistula is a rare anomaly involving abnormal connections between coronary arteries and cardiac chambers, not typical in this setting. Sinus venosus defect is an atypical atrial septal defect located near the superior vena cava and would require different imaging planes for detection.
This finding and its implications are discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Atrial Septal Defects and Shunts#20:115-120Textbook of Clinical Echocardiography#.
質問 # 64
Which statement is considered true regarding tricuspid annular plane systolic excursion (TAPSE)?
- A. It is a measure of right ventricular diastolic function.
- B. The lower reference value is 13 mm.
- C. It is angle dependent.
- D. It is an indirect measure of left ventricular systolic function.
正解：B
解説：
TAPSE measures the longitudinal systolic excursion of the tricuspid annulus towards the apex and is a widely used echocardiographic parameter of right ventricular systolic function. It is not a measure of diastolic function nor an indirect measure of left ventricular function.
TAPSE is relatively angle independent because it is measured in M-mode from the apical four-chamber view aligned with annular motion.
The lower normal limit for TAPSE is generally accepted as 16 mm, but 13 mm is sometimes cited as a threshold below which right ventricular systolic dysfunction is suggested.
This information is presented in the "Textbook of Clinical Echocardiography, 6e", Chapter on Right Ventricular Function Assessment#20:320-325Textbook of Clinical Echocardiography
質問 # 65
Which adjustment is most likely to improve image quality from the suprasternal long axis window?
- A. Rotate transducer indicator toward the patient's right shoulder
- B. Place patient in left lateral decubitus position
- C. Ask patient to look slightly toward the left
- D. Move probe just inferior to the sternum
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The suprasternal long axis window is best accessed with the patient in the supine position with the neck extended. To optimize image quality, instructing the patient to turn their head slightly toward the left side moves the trachea and clavicle away from the ultrasound beam path, allowing better visualization of the aortic arch and great vessels.
Moving the probe inferior to the sternum accesses the subxiphoid window rather than suprasternal. Left lateral decubitus improves parasternal and apical windows but not suprasternal. Rotating the transducer indicator toward the patient's right shoulder would change the imaging plane but is not a primary method to improve image quality.
This technique is highlighted in the "Textbook of Clinical Echocardiography, 6e", Chapter on Echocardiographic Windows and Acoustic Access#20:90-95Textbook of Clinical Echocardiography#.
質問 # 66
The parasternal long axis view can be used to visualize which anatomical structure?
- A. Left atrial appendage
- B. Coronary sinus
- C. Pulmonic valve
- D. Eustachian valve
正解：B
解説：
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#.
質問 # 67
When utilizing contrast agents, what should the sonographer keep in mind?
- A. Contrast agents produce only mild reactions.
- B. The contrast-enhanced exam poses no risk to the patient.
- C. Anaphylactoid reactions may occur.
- D. Patients with no history of allergies will not have reactions.
正解：C
解説：
Contrast agents used in echocardiography can rarely cause anaphylactoid reactions, which are non-IgE- mediated hypersensitivity reactions that can mimic anaphylaxis. Therefore, sonographers must be prepared to manage such reactions.
Contrary to option B, reactions can be severe though rare. Even patients without prior allergies can react. It is incorrect to say the exam poses no risk; proper precautions and monitoring are essential.
These precautions are emphasized in ASE contrast echocardiography guidelines and safety protocols#12:ASE Contrast Echocardiography Guidelinesp.190-195##16:Textbook of Clinical Echocardiography, 6ep.575-
580#.
質問 # 68
A patient with a ventricular septal defect, an atrial septal defect, and a cleft mitral valve is likely to have which abnormality?
- A. Ebstein anomaly
- B. Atrioventricular canal defect
- C. Marfan syndrome
- D. Shone syndrome
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Atrioventricular canal defect (AV canal defect) is a congenital cardiac malformation characterized by defects in the atrial and ventricular septa, along with abnormalities of the atrioventricular valves including cleft mitral valve. These features collectively cause shunting and valve regurgitation.
Ebstein anomaly primarily involves the tricuspid valve and right atrium, Marfan syndrome is a connective tissue disorder with different manifestations, and Shone syndrome involves left-sided obstructive lesions.
This is clearly outlined in the "Textbook of Clinical Echocardiography, 6e", Chapter on Congenital Heart Defects - Atrioventricular Septal Defects#20:120-125Textbook of Clinical Echocardiography#.
質問 # 69
In cardiac tamponade, how do transvalvular pressure gradients change during expiration?
- A. Transmitral decreases and transtricuspid decreases
- B. Transmitral decreases and transtricuspid increases
- C. Transmitral increases and transtricuspid increases
- D. Transmitral increases and transtricuspid decreases
正解：B
解説：
In cardiac tamponade, there is a characteristic reciprocal respiratory variation in transvalvular flow velocities due to ventricular interdependence and impaired cardiac filling. During expiration, the intrathoracic pressure increases, which leads to decreased right ventricular filling and thus decreased transtricuspid flow velocity.
Simultaneously, left ventricular filling increases, causing an increase in transmitral flow velocity.
Therefore, during expiration, the transmitral gradient increases while the transtricuspid gradient decreases.
This phenomenon reverses during inspiration, where transtricuspid flow increases and transmitral flow decreases. These respiratory variations are diagnostic hallmarks of tamponade physiology and help distinguish it from other conditions.
This principle is illustrated in Doppler echocardiographic studies of ventricular inflow and is described with diagrams in the "Textbook of Clinical Echocardiography, 6e" (Chapter 10: Pericardial Disease), highlighting the changes in transmitral and transtricuspid velocities during the respiratory cycle in tamponade .
質問 # 70
Which type of valvular lesion most commonly requires further evaluation with a non-imaging transducer?
- A. Mitral regurgitation
- B. Tricuspid regurgitation
- C. Pulmonic stenosis
- D. Aortic stenosis
正解：D
解説：
Aortic stenosis (AS) is the valvular lesion most commonly requiring evaluation with a non-imaging (pedoff) continuous wave Doppler transducer. This specialized probe allows the operator to align the Doppler beam parallel to high-velocity aortic jets to accurately measure peak and mean gradients across the stenotic aortic valve.
While imaging Doppler can estimate gradients, non-imaging CW Doppler is essential for precise quantification, especially in difficult acoustic windows or when maximal velocities need to be captured.
Mitral and tricuspid regurgitations and pulmonic stenosis are typically assessed with imaging transducers, as jet orientation is more variable.
This is highlighted in the "Textbook of Clinical Echocardiography, 6e", Chapter on Doppler Hemodynamics and Valvular Stenosis Assessment#20:310-315Textbook of Clinical Echocardiography#.
質問 # 71
Which echogenic structure is indicated by the arrow on this image?
- A. Annular calcification
- B. Vegetation
- C. Tumor
- D. Thrombus
正解：A
解説：
The image is a parasternal long-axis echocardiographic view focusing on the mitral valve annulus with a highly echogenic, dense, and well-defined structure located at the base of the posterior mitral leaflet. This appearance is characteristic of mitral annular calcification (MAC), a degenerative process resulting in calcium deposition along the mitral valve annulus.
Vegetations appear as irregular, mobile masses attached to valve leaflets and are less dense. Tumors and thrombi have different echogenicity and locations (tumors often in atria, thrombi in atrial appendages). MAC is usually more echogenic and localized to the annulus.
This description and differentiation are found in adult echocardiography textbooks and ASE guidelines on cardiac masses and valvular calcifications#16:Textbook of Clinical Echocardiography, 6ep.460-465##12:
ASE Guidelines on Cardiac Massesp.150-160#.
質問 # 72
Which is the most likely abnormality represented in these images from a 48-year-old man with shortness of breath?
- A. Hypertrophic cardiomyopathy
- B. Loeffler syndrome
- C. Ischemic cardiomyopathy
- D. Left ventricular noncompaction
正解：D
解説：
The echocardiographic images show prominent trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity, best seen on contrast-enhanced images. This finding is characteristic of left ventricular noncompaction (LVNC), a cardiomyopathy resulting from arrested myocardial compaction during embryogenesis.
LVNC is diagnosed by visualizing a two-layered myocardium with a thin compacted epicardial layer and a thicker noncompacted endocardial layer with deep trabecular recesses. The use of contrast echocardiography enhances endocardial border delineation and recess visualization, increasing diagnostic accuracy.
Loeffler syndrome (hypereosinophilic cardiomyopathy) often shows endomyocardial fibrosis and restrictive physiology but not prominent trabeculations. Hypertrophic cardiomyopathy shows asymmetric septal hypertrophy without deep recesses. Ischemic cardiomyopathy shows wall motion abnormalities but not characteristic trabecular patterns.
These diagnostic criteria and imaging features are well documented in the "Textbook of Clinical Echocardiography" and ASE guidelines on cardiomyopathies and use of contrast echo#16:Textbook of Clinical Echocardiography, 6eChapter on LV Noncompaction##12:ASE Contrast Echocardiography Guidelinesp.180-190#.
質問 # 73
Which kind of cardiac valve is a heterograft?
- A. One that is from an animal to a human
- B. One that is from one location to another in the same human
- C. One that is from a human to another human
- D. One that is from pericardial tissue
正解：A
解説：
A heterograft (also called xenograft) cardiac valve is derived from an animal species, commonly porcine or bovine, and implanted into a human. These bioprosthetic valves are treated to reduce immunogenicity.
Option A describes an allograft (homograft). Option B refers to bioprosthetic valves but does not specify species. Option C describes an autograft, such as the Ross procedure.
This classification is standard in cardiac surgery and echocardiography literature#16:Textbook of Clinical Echocardiography, 6ep.450-455##12:ASE Valve Prosthesis Guidelinesp.200-205#.
質問 # 74
Which technique best determines a trileaflet aortic valve from a bicuspid aortic valve?
- A. Visualize all three leaflets simultaneously during systole
- B. Visualize all three leaflets simultaneously during diastole
- C. Use pulsed wave Doppler to demonstrate normal flow velocity
- D. Use continuous wave Doppler to demonstrate normal flow velocity
正解：B
解説：
The most reliable technique to distinguish a trileaflet aortic valve from a bicuspid valve is to visualize all three leaflets simultaneously during diastole when the valve is closed. During diastole, the aortic valve leaflets coapt, and the three cusps form a characteristic "Y-shaped" or "Mercedes-Benz" sign on short-axis echocardiographic views, clearly demonstrating the number of leaflets.
Visualization during systole is less reliable because the valve is open, and the leaflets are moving rapidly.
Doppler techniques (pulsed or continuous wave) assess flow velocities but do not definitively determine leaflet number, only stenosis severity.
This approach is well documented in adult echocardiography textbooks and ASE valvular imaging guidelines, which emphasize the diastolic short-axis view for valve morphology assessment#16:Textbook of Clinical Echocardiography, 6ep.190-195##12:ASE Valve Imaging Guidelinesp.180-185#.
質問 # 75
What is the range of the aortic valve area in normal adults?
- A. 1 - 2 cm2
- B. 3 - 4cm2
- C. 7- 8cm2
- D. 5 - 6cm2
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The normal aortic valve area (AVA) in adults typically ranges from 3 to 4 cm². This measurement is important for assessing aortic stenosis severity; values below this range suggest valve narrowing.
AVA values of 1-2 cm² indicate mild to moderate stenosis, while less than 1 cm² reflects severe stenosis.
Larger areas like 5-6 or 7-8 cm² are not physiologically typical.
This normal range is documented in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Valve Anatomy and Function#20:360-365Textbook of Clinical Echocardiography#.
質問 # 76
Which unit of measurement is used to quantify tricuspid annular plane systolic excursion?
- A. Centimeters
- B. Centimeters/second
- C. Millimeters of mercury
- D. MiHiliters/minute
正解：A
解説：
Tricuspid annular plane systolic excursion (TAPSE) is measured as the linear displacement of the tricuspid annulus during systole and is expressed in centimeters (cm). It quantifies right ventricular longitudinal systolic function.
Centimeters per second is a velocity measurement used in tissue Doppler imaging. Milliliters per minute refers to volume flow, and millimeters of mercury measures pressure.
This is standardized in the "Textbook of Clinical Echocardiography, 6e", Chapter on Right Ventricular Functional Assessment#20:320-325Textbook of Clinical Echocardiography#.
質問 # 77
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