AE-Adult-EchocardiographyのPDF問題集リアル2026最近更新された問題
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ARDMS AE-Adult-Echocardiography 認定試験の出題範囲：
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質問 # 11
What is a normal response to dobutamine stress testing?
- A. A decrease in left ventricular cavity size and a decrease in systolic blood pressure
- B. A decrease in left ventricular cavity size and an increase in systolic blood pressure
- C. An increase in left ventricular cavity size and a decrease in systolic blood pressure
- D. An increase in left ventricular cavity size and an increase in systolic blood pressure
正解：B
解説：
During dobutamine stress testing, a normal physiological response includes increased myocardial contractility leading to a decrease in left ventricular (LV) cavity size during systole due to more effective ejection.
Concurrently, systolic blood pressure increases due to the inotropic and chronotropic effects of dobutamine.
An increase in LV cavity size during stress would suggest impaired contractility or ischemia, which is abnormal.
This normal response is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Stress Echocardiography and Hemodynamic Responses#20:400-405Textbook of Clinical Echocardiography#.
質問 # 12
Which of the following occurs during the strain phase of the Valsalva maneuver?
- A. Increased afterload
- B. Decreased preload
- C. Decreased afterload
- D. Increased preload
正解：B
解説：
During the strain phase of the Valsalva maneuver, intrathoracic pressure increases significantly due to forced expiration against a closed glottis. This elevated intrathoracic pressure compresses the thoracic veins, leading to decreased venous return to the heart, which causes a reduction in preload (the volume of blood filling the ventricles during diastole). This reduction in preload is transient and results in decreased stroke volume and cardiac output.
This physiologic response is exploited during echocardiographic evaluation to unmask pseudonormal filling patterns of the left ventricle and to assess diastolic function. For example, during the strain phase, the early mitral inflow velocity (E wave) decreases due to reduced preload, and the E/A ratio can normalize or reverse if diastolic dysfunction is present.
The strain phase does not decrease afterload; in fact, afterload can transiently increase during other phases, but the hallmark of the strain phase is decreased preload.
This explanation is detailed in the "Textbook of Clinical Echocardiography, 6e," which explains the hemodynamic changes during the Valsalva maneuver and its clinical application in echocardiographic assessment of diastolic function .
質問 # 13
Which parameter is necessary to calculate a 2D left atrial volume index?
- A. Cardiac output
- B. Age
- C. Height
- D. Blood pressure
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The left atrial volume index (LAVI) is the left atrial volume normalized to the patient's body surface area (BSA), which accounts for patient size. To calculate BSA, height and weight are required, most commonly using formulas such as the Mosteller formula.
Therefore, height is a necessary parameter to calculate the left atrial volume index. Age, blood pressure, and cardiac output are not used in the calculation of LAVI but may be clinically relevant for interpretation.
This approach standardizes LA size across patients of different body habitus, making LAVI a more accurate and reproducible measure of LA remodeling and a predictor of cardiovascular outcomes.
The echocardiography guidelines and textbooks emphasize the importance of indexing LA volume to BSA and highlight height as a required measurement for this purpose .
質問 # 14
Which view is best for assessing atrial situs in the presence of congenital heart disease?
- A. Short axis
- B. Long axis
- C. Subcostal
- D. Suprasternal notch
正解：C
解説：
The subcostal view is the preferred transthoracic echocardiographic window to assess atrial situs, especially in congenital heart disease. This view provides a cross-sectional look at the abdominal organs and atrial chambers, helping determine the relative position of the inferior vena cava and aorta, which aids in defining atrial situs (solitus, inversus, or ambiguous).
Short axis and long axis views provide excellent cardiac anatomy but are less informative for visceral situs.
The suprasternal notch window is mainly used to visualize the great vessels but does not provide adequate assessment of atrial situs.
The subcostal view's ability to demonstrate abdominal situs and systemic venous return makes it essential in congenital cardiac evaluations and is recommended in echocardiography protocols for congenital heart disease assessment .
質問 # 15
Which flow abnormality produces a continuous murmur?
- A. Aortic regurgitation
- B. Mitral stenosis
- C. Muscular ventricular septal defect
- D. Ruptured sinus of Valsalva aneurysm
正解：D
解説：
Comprehensive and Detailed Explanation From Exact Extract:
A continuous murmur is a heart murmur that occurs throughout both systole and diastole. Among the options, a ruptured sinus of Valsalva aneurysm produces a continuous murmur due to persistent flow between the aorta and a cardiac chamber (usually the right atrium or ventricle) during both systole and diastole.
Aortic regurgitation causes a diastolic murmur, mitral stenosis causes a diastolic murmur, and a muscular ventricular septal defect typically causes a holosystolic murmur but not continuous.
Ruptured sinus of Valsalva aneurysm causes a continuous shunting of blood, resulting in the characteristic continuous murmur, often described as "machinery-like." This clinical correlation is covered in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Root and Sinus of Valsalva Pathology#20:420-425Textbook of Clinical Echocardiography#.
質問 # 16
Which of the following are key features of an unrepaired tetralogy of Fallot?
- A. Displaced tricuspid valve, atrialization of the right ventricle, severe tricuspid regurgitation, and a secundum atrial septal defect
- B. Inlet ventricular septal defect, common atrioventricular valve, atrioventricular valve regurgitation, and primum atrial septal defect
- C. Outlet ventricular septal defect, overriding aorta, right ventricular outflow tract obstruction, and right ventricular hypertrophy
- D. Supravalvular mitral valvular ring, subaortic membrane, bicuspid aortic valve, and aortic coarctation
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Tetralogy of Fallot (TOF) is a congenital heart defect characterized by four key anatomical abnormalities: an outlet (malalignment) ventricular septal defect (VSD), an overriding aorta that receives blood from both ventricles, right ventricular outflow tract (RVOT) obstruction (commonly infundibular stenosis), and resultant right ventricular hypertrophy. These defects cause cyanosis due to right-to-left shunting and impaired pulmonary blood flow.
Option A describes Ebstein anomaly, characterized by a displaced tricuspid valve and atrialization of the right ventricle.
Option B describes features more consistent with Shone complex or other left heart obstructive lesions.
Option C describes atrioventricular septal defect (AVSD), seen in conditions like Down syndrome.
In unrepaired TOF, echocardiography demonstrates the large malalignment VSD, overriding aorta, RVOT obstruction, and hypertrophied right ventricle. These are classic textbook findings described in adult and pediatric echocardiography literature, including "Textbook of Clinical Echocardiography" (Chapter on Congenital Heart Disease) and ASE guidelines#16:Textbook of Clinical Echocardiography, 6ep.560-565#
#12:ASE Adult Congenital Guidelinesp.400-410#.
質問 # 17
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. Left ventricular outflow tract diameter
- C. Maximum mitral regurgitant velocity
- D. Mitral annular diameter
正解：C
解説：
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#.
質問 # 18
Which mitral valve filling pattern is characterized by a long deceleration time and an E/A ratio of 0.6?
- A. Restrictive
- B. Impaired relaxation
- C. Pseudonormal
- D. Normal
正解：B
解説：
The mitral valve filling pattern characterized by a long deceleration time and a reduced E/A ratio (less than 1, such as 0.6) is consistent with impaired relaxation. This pattern is typically seen in early diastolic dysfunction, where there is slowed ventricular relaxation, resulting in reduced early diastolic filling (E wave) and a compensatory increase in atrial contraction contribution (A wave).
Impaired relaxation pattern shows:
E/A ratio < 1 (e.g., 0.6)
Prolonged deceleration time (>200 ms)
Prolonged isovolumic relaxation time (IVRT)
This pattern differs from restrictive filling, which has a high E/A ratio (>2), shortened deceleration time (<150 ms), and elevated left atrial pressures. Pseudonormal filling has a normal or near-normal E/A ratio but elevated filling pressures that mask underlying dysfunction and requires further evaluation with tissue Doppler or pulmonary venous flow for diagnosis. Normal filling has a typical E/A ratio around 1 to 1.5 with normal deceleration times.
The textbook details that impaired relaxation is the earliest sign of diastolic dysfunction and describes the prolongation of the deceleration time and reduced E/A ratio as hallmark findings of this stage.
質問 # 19
Which finding is most consistent with this M-mode image?
- A. Systolic antenor motion of the mitral valve
- B. Mitral valve prolapse
- C. Mitral valve annuloplasty ring
- D. Rheumatic mitral stenosis
正解：D
解説：
Comprehensive and Detailed Explanation From Exact Extract:
This M-mode echocardiographic image shows thickened mitral valve leaflets with a characteristic "doming" or "hockey-stick" appearance during diastole, which is classic for rheumatic mitral stenosis. Rheumatic mitral stenosis leads to leaflet thickening, restricted opening, and calcification, which alters the normal mitral valve motion on M-mode.
Mitral valve prolapse would show systolic displacement of the leaflets into the left atrium, typically later in systole, not doming in diastole. Mitral valve annuloplasty ring would appear as a bright echogenic line around the annulus but is not seen in this image. Systolic anterior motion (SAM) of the mitral valve is usually seen in hypertrophic cardiomyopathy and presents as anterior motion during systole, not the diastolic pattern shown.
This classical M-mode appearance is described in "Textbook of Clinical Echocardiography, 6e", Chapter on Rheumatic Valve Disease#20:385-390Textbook of Clinical Echocardiography#.
質問 # 20
Which measurement is indicated by the arrow on this image?
- A. S', a measurement of right ventricular systolic function
- B. S', a measure of right ventricular diastolic function
- C. a', a measure of right atrial systolic function
- D. a', a measure of right atrial diastolic function
正解：A
解説：
The Doppler tissue imaging waveform shown indicates the systolic annular velocity of the tricuspid valve annulus, labeled as S'. This measurement reflects right ventricular systolic function by quantifying the velocity of longitudinal myocardial motion during systole.
The a' wave corresponds to atrial contraction, not systole. S' assesses systolic function, whereas e' and a' relate to diastolic phases.
This assessment method is detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Right Ventricular Function and Tissue Doppler Imaging#20:320-325Textbook of Clinical Echocardiography#.
質問 # 21
Which finding is demonstrated in this video?
- A. Mechanical valve replacement
- B. Annuloplasty ring repair
- C. Bioprosthetic valve replacement
- D. Native valve with extensive calcification
正解：B
解説：
The echocardiographic video shows a prosthetic ring-like structure attached to the mitral annulus with preserved native leaflet motion, consistent with an annuloplasty ring repair. Annuloplasty rings are used to reduce the mitral annulus size and improve leaflet coaptation in mitral regurgitation without replacing the valve.
Bioprosthetic or mechanical valve replacements would show distinctly different echogenic valve structures with leaflet or disc motion replacing the native valve. Extensive calcification of a native valve appears as echogenic, thickened leaflets without a discrete ring.
This is described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Mitral Valve Repair Techniques#20:400-405Textbook of Clinical Echocardiography#.
質問 # 22
Which view best demonstrates a wall thickening abnormality of the apical lateral segment?
- A. Two-chamber
- B. Four-chamber
- C. Mid-parastemal short axis
- D. Parasternal long axis
正解：A
解説：
The two-chamber apical view allows visualization of the left ventricle's anterior and inferior walls, including the apical lateral segment. It is ideal for assessing wall thickness and segmental wall motion abnormalities in this region.
The four-chamber view visualizes septal and lateral walls but does not optimally display the apical lateral segment. Parasternal long axis primarily visualizes the anterior septum and posterior wall but is limited for lateral apex. The mid-parasternal short axis focuses on mid-ventricular segments and does not visualize the apex.
This anatomical and echocardiographic detail is described in the "Textbook of Clinical Echocardiography,
6e", Chapter on Left Ventricular Segmental Analysis#20:120-125Textbook of Clinical Echocardiography#.
質問 # 23
A patient presents in the emergency room with a history of chronic high Wood pressure and new onset severe back pain. A physical exam reveals a new diastolic murmur. Which would be the most likely finding?
- A. Aortic aneurysm
- B. Ruptured papillary muscle
- C. Aortic dissection
- D. Left ventricular rupture
正解：C
解説：
The combination of chronic elevated Wood units (indicative of pulmonary hypertension), severe back pain, and a new diastolic murmur strongly suggests an acute aortic dissection involving the ascending aorta or aortic valve.
Aortic dissection can cause tearing of the intima and compromise the aortic valve, leading to acute aortic regurgitation manifesting as a new diastolic murmur. Back pain is a classic symptom due to the dissection extending along the aorta.
Aortic aneurysm may cause symptoms but usually not acute severe pain and murmur. Left ventricular rupture and ruptured papillary muscle are typically complications of myocardial infarction and present differently.
This clinical presentation and echocardiographic assessment are described in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Pathology and Emergencies#20:380-385Textbook of Clinical Echocardiography#.
質問 # 24
Which of the following is the most likely cause for the findings demonstrated in this video?
- A. Systemic lupus
- B. Drug-induced valvulopathy
- C. Rheumatic fever
- D. Infective endocarditis
正解：B
解説：
The video shows thickened, retracted, and possibly regurgitant valve leaflets with a characteristic appearance seen in drug-induced valvulopathy. Drugs such as ergot derivatives (e.g., methysergide) and appetite suppressants (e.g., fen-phen) can cause fibrotic thickening of valve leaflets mimicking carcinoid heart disease or rheumatic valve disease.
Infective endocarditis presents with vegetations and potentially valve destruction but typically not the diffuse thickening seen here. Rheumatic fever causes leaflet thickening but has a different chronic clinical course.
Systemic lupus may cause valve thickening but often involves Libman-Sacks vegetations rather than diffuse fibrosis.
This is discussed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Valvular Heart Disease - Drug Induced and Secondary Causes#20:400-405Textbook of Clinical Echocardiography#.
質問 # 25
Which region of the aorta is being measured to assess the critical finding in this image?
- A. Sinus of Valsalva
- B. Ascending aorta
- C. Descending aorta
- D. Aortic root
正解：B
解説：
The echocardiographic image shows measurement of the ascending aorta, identified by its position above the aortic valve and before the arch vessels. The ascending aorta is a critical region assessed for dilation or aneurysm.
The sinus of Valsalva refers to the dilated portion just above the aortic valve cusps, while the aortic root includes the annulus, sinuses, and sinotubular junction. The descending aorta is posterior and visualized in other windows.
This measurement and its importance are detailed in the "Textbook of Clinical Echocardiography, 6e", Chapter on Aortic Root and Ascending Aorta Evaluation#20:380-385Textbook of Clinical Echocardiography#.
質問 # 26
The parasternal long axis view can be used to visualize which anatomical structure?
- A. Pulmonic valve
- B. Coronary sinus
- C. Left atrial appendage
- 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 # 27
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AE-Adult-Echocardiography問題集と練習テスト（141試験問題)：https://www.passtest.jp/ARDMS/AE-Adult-Echocardiography-shiken.html
ガイド（2026年最新）実際のARDMS AE-Adult-Echocardiography試験問題：https://drive.google.com/open?id=1RGHB-_yZyOUjE2cMeKF-vrsz7kJ0PfWw