Content Outline for the 2009 PTEeXAM

1. Principles of Ultrasound
   1. Nature of ultrasound: compression and rarefaction
   2. Frequency, wavelength, tissue propagation velocity
   3. Properties of ultrasound waves
   4. Ultrasound / tissue interactions
   5. Tissue characterization
2. Transducers
   1. Piezoelectric effect
   2. Crystal thickness and resonance
   3. Damping
   4. Sound beam formation
   5. Focusing
   6. Axial and lateral resolution
   7. Arrays
3. Equipment, Infection Control, and Safety
   1. Clinical dosimetry
   2. Biological effects of ultrasound
   3. Electrical and mechanical safety
   4. Infection control
   5. TEE probe insertion and manipulation
   6. Contraindications to transesophageal echocardiography
   7. Complications of transesophageal echocardiography
4. Imaging
   1. Instrumentation
   2. Displays
   3. B-mode, M-mode, and two-dimensional echocardiography
   4. Signal processing and related factors
5. Principles of Doppler Ultrasound
   1. Doppler effect
   2. Doppler equation
   3. Doppler shift frequencies and influencing factors
   4. Nyquist limit
   5. Spectral analysis and display characteristics
   6. Pulsed-wave Doppler
   7. High pulse repetition frequency pulsed-wave Doppler
   8. Continuous-wave Doppler
   9. Color flow Doppler
   10. Color M-mode
6. Quantitative M-Mode and Two-Dimensional Echocardiography
   1. Edge recognition
   2. Edge components
   3. Temporal resolution
   4. Referencing centroids, fixed and floating axis
   5. Center-line method
   6. Global function; measurements and calculations
   7. Geometric, spectral, and other methods
7. Quantitative Doppler
   1. Types of velocity measurements
   2. Volumetric measurements and calculations
   3. Valve gradients, areas, and other measurements
   4. Cardiac chamber and great vessel pressures
   5. Tissue Doppler
8. Doppler Profiles and Assessment of Diastolic Function
   1. Tricuspid valve and right ventricular inflow
   2. Pulmonary valve and right ventricular outflow
   3. Mitral valve and left ventricular inflow
   4. Aortic valve and left ventricular outflow
   5. Non-valvular flow profiles
9. Cardiac Anatomy
   1. Imaging planes
   2. Cardiac chambers and walls
   3. Cardiac valves
   4. Cardiac cycle and relation of events relative to ECG
10. Pericardium and Extracardiac Structures - Anatomy and Pathology
    1. Pericardium and pericardial space
    2. Pulmonary arteries
    3. Pulmonary veins
    4. Vena cavae and hepatic veins
    5. Coronary arteries
    6. Aorta and Great Vessels
       1. Anatomy
       2. Atherosclerosis
       3. Aneurysm
       4. Dissection and traumatic injury of the aorta
    7. Pleural space
11. Pathology of the Cardiac Valves
    1. Acquired valve diseases
       1. Endocarditis
       2. Rheumatic
       3. Myxomatous
       4. Calcific / degenerative
       5. Traumatic
    2. Tricuspid
    3. Pulmonary
    4. Mitral
       1. Mitral regurgitation
       2. Ischemic mitral valve dysfunction
       3. Mitral stenosis
       4. Systolic anterior motion of mitral valve (SAM)
    5. Aortic
       1. Aortic regurgitation
       2. Aortic stenosis
12. Intracardiac Masses and Devices
    1. Tumors
    2. Thrombi
    3. Devices and foreign bodies
13. Global Ventricular Systolic Function
    1. Normal left ventricular systolic function
    2. Abnormal left ventricular systolic function
       1. Etiologies including ischemia
       2. Assessment / ejection fraction
       3. Confounding factors
    3. Right ventricular systolic function
    4. Cardiomyopathies
       1. Hypertrophic
       2. Restrictive
       3. Dilated
14. Segmental Left Ventricular Systolic Function
    1. Myocardial segment identification
    2. Coronary artery distribution and flow
    3. Normal and abnormal segmental function
       1. Assessment and methods
       2. Differential diagnosis
       3. Confounding factors
    4. Left ventricular aneurysm
    5. Left ventricular rupture
15. Assessment of Perioperative Events and Problems
    1. Hypotension and causes of cardiovascular instability
    2. Cardiac surgery; techniques, and problems
       1. Assessment of bypass and cardioplegia
       2. Cannulae and devices commonly used during cardiac surgery
       3. Circulatory assist devices
       4. Intracavity air
       5. Minimally invasive cardiopulmonary bypass
       6. Off pump cardiac surgery
    3. Coronary surgery; techniques and assessment
    4. Valve surgery; techniques and assessment
       1. Valve replacement, mechanical, bioprosthetic, and other
       2. Valve repair
    5. Transplantation surgery
       1. Heart
       2. Lung
       3. Liver
16. Congenital Heart Disease
    1. Identification and situs of morphologically left and right structures
    2. Atrial septal defects
    3. Ventricular septal defects
    4. Pulmonary valve and infundibular stenosis
    5. Left atrial and mitral valve conditions
    6. Aortic valve and left ventricular outflow tract abnormalities
    7. Coronary artery anomalies
    8. Patent ductus arteriosus
    9. Coarctation of the aorta
    10. Ebstein's anomaly
    11. Persistent left superior vena cava
    12. Tetralogy of Fallot
    13. Transposition of great arteries
    14. Atrioventricular septal defect - "AV canal"
    15. Conditions with single ventricle physiology
17. Artifacts and Pitfalls
    1. Imaging artifacts
    2. Doppler artifacts and pitfalls
    3. Structures mimicking pathology
18. Related Diagnostic Modalities
    1. Stress echocardiography
    2. Myocardial perfusion imaging
    3. Epicardial scanning
    4. Contrast echocardiography
    5. Utility of TEE relative to other diagnostic modalities