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EACVI EACTA TRANSOESOPHAGEAL
ECHOCARDIOGRAPHY (TOE) ONLINE
EXAM 2025 ACCURATE
ANSWERS|UPDATED VERSION 2025 Q&A
|WITH RATIONALE
EACVI EACTA TRANSOESOPHAGEAL
ECHOCARDIOGRAPHY (TOE) ONLINE
EXAM 2025 ACCURATE
ANSWERS|UPDATED VERSION 2025
Q&A |WITH RATIONALE
EACVI EACTA TRANSOESOPHAGEAL ECHOCARDIOGRAPHY (TOE)
ONLINE EXAM 2025 ACCURATE ANSWERS|UPDATED VERSION 2025
Q&A |WITH RATIONALE
The focus is on core principles: anatomy, physics, image acquisition, clinical interpretation, and perioperative TOE applications.
- What is the recommended mid-esophageal view to assess the interatrial septum for a patent foramen ovale (PFO)? A) Mid-esophageal bicaval view B) Mid-esophageal four-chamber view C) Transgastric short-axis view D) Deep transgastric long-axis view Rationale: The mid-esophageal four-chamber view aligns well with the interatrial septum and is commonly used to identify PFO or atrial septal defects.
- Which structure is visualized at approximately 120 – 150° in the mid- esophageal long-axis view? A) Right atrial appendage B) Left ventricular outflow tract and aortic valve C) Superior vena cava D) Coronary sinus
C)Mid-esophageal two-chamber view D) Transgastric short-axis view Rationale: The mid-esophageal two-chamber view provides a clear window to visualize the LAA for thrombus or spontaneous echo contrast.
- Which of these is a contraindication to TOE? A) Previous myocardial infarction B) Hypertension C) Mild dysphagia D) Esophageal perforation Rationale: An esophageal perforation is an absolute contraindication due to the risk of worsening the injury.
- Which frequency range is typical for adult TOE probes? A) 1 – 2 MHz B) 5 – 7 MHz C) 10 – 15 MHz D) >20 MHz Rationale: Adult TOE probes typically operate at 5 – 7 MHz, balancing resolution and penetration depth.
- Which cardiac structure is NOT usually assessed in the transgastric short- axis view?
A) Left ventricular walls B) Papillary muscles C)Coronary sinus D) Right ventricle Rationale: The coronary sinus is located posteriorly and is not visualized in the transgastric short-axis view.
- What does a high E/e’ ratio on TOE suggest? A) Mitral stenosis B) Elevated left ventricular filling pressures C) Aortic insufficiency D) Right heart failure Rationale: A high E/e’ ratio indicates increased left ventricular filling pressures and diastolic dysfunction.
- Which manoeuvre can enhance detection of a PFO during TOE? A) Coughing B) Valsalva maneuver C) Inspiration D) Trendelenburg position Rationale: The Valsalva maneuver transiently increases right atrial pressure, promoting right-to-left shunt through a PFO.
- What is the best approach to assess aortic regurgitation severity? A) Continuous-wave Doppler at the tricuspid valve B) Vena contracta width C) Planimetry of LVOT D) LVOT pressure half-time Rationale: Vena contracta width is a reliable and reproducible method for grading aortic regurgitation severity.
- Which view is essential for assessing vegetations in infective endocarditis? A) Transgastric basal short-axis B) Mid-esophageal four-chamber C) Upper esophageal descending aorta view D) Deep transgastric long-axis Rationale: Mid-esophageal views are best for visualizing valves for vegetations.
- Which measurement should be obtained in systole when assessing the aortic root? A) Left atrial volume B) Aortic valve area C)Sinuses of Valsalva diameter D) E/e’ ratio
Rationale: The sinuses of Valsalva are measured in mid-systole for consistency and standardization.
- What is the function of the Bernoulli equation in TOE? A) Calculate stroke volume B) Measure chamber size C)Estimate pressure gradients D) Optimize probe frequency Rationale: The modified Bernoulli equation converts flow velocities to pressure gradients across valves.
- Which structure is imaged at approximately 90° in the mid-esophageal four- chamber view? A) Aortic valve B) Tricuspid valve only C)Both mitral and tricuspid valves D) Right pulmonary artery Rationale: The mid-esophageal four-chamber view shows the mitral and tricuspid valves in one plane.
- What does spontaneous echo contrast in the left atrium suggest? A) Normal flow B) Septal defect
A) Mid-esophageal two-chamber B) Mid-esophageal four-chamber C) Upper esophageal short-axis D) Transgastric basal short-axis Rationale: The mid-esophageal four-chamber view allows for good visualization of the right ventricle and its free wall motion.
- Which valve is most commonly affected in rheumatic heart disease? A) Aortic valve B) Mitral valve C) Pulmonary valve D) Tricuspid valve Rationale: The mitral valve is the most frequently involved valve in rheumatic fever.
- What is the advantage of harmonic imaging in TOE? A) Reduces penetration B) Improves image resolution C) Requires more gain D) Increases noise Rationale: Harmonic imaging enhances resolution and reduces artifacts, improving endocardial border definition.
- Which view helps detect aortic dissection? A) Transgastric mid-short-axis B) Upper esophageal aortic arch long-axis C) Mid-esophageal bicaval view D) Deep transgastric short-axis Rationale: The upper esophageal aortic arch long-axis view allows assessment of the aortic arch for intimal flaps.
- Which TOE finding suggests severe tricuspid regurgitation? A) Small vena contracta B) Laminar flow in hepatic veins C)Systolic flow reversal in hepatic veins D) E wave < A wave on tricuspid inflow Rationale: Systolic flow reversal in hepatic veins indicates significant backflow from the right atrium due to severe TR.
- Which probe manipulation moves the image plane more superiorly in the heart? A) Withdraw the probe slightly B) Advance the probe further C) Rotate to the right D) Increase gain
C) Screening for hypertension D) Systolic function only Rationale: TOE is more sensitive for detecting prosthetic valve dysfunction, vegetations, and thrombus than TTE.
- What is a typical sign of pericardial tamponade on TOE? A) Dilated left ventricle B) Small inferior vena cava C)Right atrial or RV diastolic collapse D) Hyperdynamic LVOT flow Rationale: Right atrial or RV diastolic collapse indicates elevated intrapericardial pressure exceeding intracardiac pressure.
- Which component of the mitral valve is visualized in the mid-esophageal commissural view? A) Only A2 segment B) Both commissures and all scallops C) LVOT only D) Coronary sinus Rationale: The commissural view shows the lateral and medial commissures, helping to localize pathology.
- Which is a normal TOE finding?
A) Large left atrial thrombus B) Severe mitral regurgitation C)Small physiologic tricuspid regurgitation D) Mobile aortic valve vegetation Rationale: Small physiologic TR is common and normal in healthy individuals.
- What is the best acoustic window for viewing the left atrial appendage thrombus? A) Deep transgastric B) Upper esophageal aortic arch C)Mid-esophageal two-chamber view D) Transgastric basal short-axis Rationale: The mid-esophageal two-chamber view aligns well with the LAA for detecting thrombus.
- Which Doppler modality assesses high velocities best? A) Pulsed-wave Doppler B) Continuous-wave Doppler C) M-mode only D) Color M-mode Rationale: Continuous-wave Doppler measures high velocities without being limited by aliasing, unlike pulsed-wave Doppler.
Rationale: Spontaneous echo contrast indicates blood stasis, often due to AF, increasing thrombus risk.
- Which TOE view is used to assess the superior vena cava (SVC)? A) Mid-esophageal bicaval view B) Transgastric mid-short-axis C) Upper esophageal descending aorta D) Deep transgastric long-axis Rationale: The mid-esophageal bicaval view visualizes both the IVC and SVC draining into the right atrium.
- Which finding suggests severe aortic stenosis? A) Aortic valve area >2 cm² B) Peak gradient <20 mmHg C)Peak velocity >4 m/s D) Mild calcification only Rationale: Severe AS is defined by a peak velocity >4 m/s or mean gradient > mmHg.
- What does the ‘vena contracta’ measure? A) Valve area B) Narrowest part of a regurgitant jet C) LV wall thickness
D) RV size Rationale: Vena contracta measures the narrowest region of the regurgitant jet, helping to quantify severity.
- What is the optimal frequency to achieve deep penetration in obese patients? A) Lower frequency (e.g., 2 – 4 MHz) B) Higher frequency (10– 15 MHz) C) Increase gain only D) Use harmonic mode only Rationale: Lower frequencies penetrate deeper but with less resolution, helpful in technically challenging patients.
- What artifact appears as multiple parallel lines? A) Acoustic shadowing B) Mirror artifact C)Reverberation D) Side lobe artifact Rationale: Reverberations create multiple equally spaced echoes, typical with prosthetic valves or metallic structures.
- Which TOE view best demonstrates the left ventricular apex?
- What is the correct probe position for the transgastric short-axis view? A) Mid-esophagus, 0° B) Stomach, 0 – 20°, anteflexion C) Upper esophagus, 90° D) Stomach, retroflexion Rationale: The transgastric short-axis view is obtained by advancing into the stomach, flexing anteriorly.
- Which TOE view shows all three cusps of the aortic valve? A) Mid-esophageal four-chamber B) Deep transgastric C)Mid-esophageal aortic valve short-axis D) Upper esophageal descending aorta Rationale: The mid-esophageal aortic valve short-axis view displays all three cusps simultaneously.
- What is the advantage of using M-mode? A) Color flow visualization B) High temporal resolution for motion analysis C) Multiplane scanning D) 3D reconstruction Rationale: M-mode provides high temporal resolution for analyzing rapid motion, e.g., valve leaflets.
- Which condition contraindicates TOE probe insertion? A) Known GERD B) Esophageal stricture C) Hiatal hernia D) Mild coagulopathy Rationale: An esophageal stricture is an absolute contraindication due to risk of perforation.
- What is the primary advantage of continuous-wave (CW) Doppler over pulsed-wave (PW) Doppler? A) Better for low velocities B) Measures flow direction C)Measures high velocities without aliasing D) Visualizes flow area Rationale: CW Doppler can record high velocities along the entire ultrasound beam without being limited by the Nyquist limit, making it ideal for high-velocity jets.
- Which TOE view is optimal for measuring left atrial volume? A) Transgastric short-axis B) Upper esophageal aorta C)Mid-esophageal four-chamber D) Deep transgastric long-axis
