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EACVI EACTA Transoesophageal Echocardiography
(TOE) Online Exam 202 6 Questions and Correct Answers
(Verified Answers) Plus Rationales | Instant Download Pdf
- Which view is most useful to visualize an atrial septal defect (ostium secundum) on transthoracic echo in a child? A. Parasternal long axis B. Subcostal short axis C. Apical four-chamber D. Subcostal four-chamber The subcostal four-chamber often provides the best perpendicular window for the atrial septum in children, improving ASD detection.
- In assessing ventricular septal defect (VSD) size and hemodynamic significance, which Doppler finding suggests a large, hemodynamically significant VSD? A. High velocity (>4 m/s) left-to-right jet B. Low velocity (<3 m/s) left-to-right jet with chamber enlargement C. No measurable flow across the defect D. Intermittent bidirectional flow with normal ventricles Low velocity across a VSD with chamber enlargement indicates low
resistance shunt and significant volume load, consistent with a large VSD.
- Which congenital lesion classically causes differential cyanosis with the lower extremities more cyanotic than the upper? A. Tetralogy of Fallot B. Transposition of the great arteries (TGA) with intact ventricular septum C. Patent ductus arteriosus with Eisenmenger physiology (right-to-left ductal shunt) D. Hypoplastic left heart syndrome When PDA shunts right-to-left after pulmonary vascular disease, lower body (post-ductal) desaturation is worse than upper, producing differential cyanosis.
- On color Doppler, aliasing of flow occurs when: A. Flow is laminar and slow B. Nyquist limit is very high C. Velocity exceeds the Nyquist limit D. Gain is too low Aliasing occurs when Doppler velocities exceed the Nyquist limit, causing wraparound of color/velocity display.
- The echocardiographic feature that best indicates right ventricular pressure
B. Pulmonary venous flow turbulence and elevated velocities with pulmonary venous congestion C. Normal pulmonary venous flow D. Large patent foramen ovale with right-to-left shunt Obstructed TAPVC shows abnormal pulmonary venous flow patterns with high velocities and pulmonary venous congestion.
- Which measurement is used to calculate Qp:Qs from echocardiography in shunt assessment? A. Mitral valve area and aortic area B. Pulmonary valve Doppler VTI × pulmonary annulus area and aortic valve Doppler VTI × aortic annulus area C. Tricuspid regurgitant jet velocity only D. Left ventricular outflow tract diameter only Qp:Qs uses stroke volumes across pulmonary and systemic outflow tracts (VTI × area) to estimate pulmonary vs systemic flow.
- A parachute mitral valve is best described as: A. Normal mitral leaflets with prolapse B. All chordae inserting into a single papillary muscle C. Multiple small mitral leaflets fused centrally
D. Bicuspid mitral valve with stenosis Parachute mitral valve has all chordae attached to one papillary muscle, causing mitral inflow obstruction.
- In repaired tetralogy of Fallot patients, the most common significant late finding on echo is: A. Left ventricular outflow obstruction B. Progressive tricuspid stenosis C. Pulmonary regurgitation leading to RV dilation D. Mitral valve prolapse Chronic pulmonary regurgitation after TOF repair commonly leads to RV volume overload and dilation.
B. DiGeorge syndrome (22q11 deletion) association; interruption often between left carotid and left subclavian (type B) C. Ebstein anomaly D. Tricuspid atresia Interrupted aortic arch type B is classically associated with 22q deletion/DiGeorge and conotruncal anomalies.
- Which echocardiographic view best shows the origin and proximal course of the coronary arteries in infants? A. Apical five-chamber B. Parasternal short-axis at the level of the aortic valve C. Subcostal four-chamber
D. Suprasternal notch view Parasternal short-axis at aortic valve level allows visualization of coronary ostia and proximal courses.
- In Ebstein anomaly, echocardiography characteristically demonstrates: A. Left ventricular hypertrophy B. Hypoplastic pulmonary arteries C. Apical displacement of the tricuspid valve leaflets with atrialized RV D. Absent tricuspid valve Ebstein anomaly shows apical displacement of septal and posterior tricuspid leaflets causing atrialization of proximal RV.
- Which congenital lesion frequently causes a “boot-shaped” heart on chest x-ray and severe RV outflow tract obstruction on echo? A. Transposition of the great arteries B. Coarctation of the aorta C. Tetralogy of Fallot D. Truncus arteriosus Tetralogy of Fallot includes RVOT obstruction and RV hypertrophy, producing the classic chest x-ray and echo features.
- For fetal echocardiography, when is the four-chamber view typically
D. Isolated RA enlargement Significant left-to-right shunts increase pulmonary return and LV preload, causing LV dilation and increased stroke volume.
- An absent pulmonary valve syndrome most commonly presents with: A. Severe aortic stenosis B. Massive aneurysmal pulmonary arteries with bronchial compression and pulmonary regurgitation C. Isolated ASD without other findings D. Left ventricular outflow tract obstruction Absent pulmonary valve leads to huge pulmonary arteries and severe PR; airway compression is common.
- In D-transposition of the great arteries (D-TGA), the echocardiographic hallmark is: A. Aorta arising from LV and pulmonary artery from RV (normal) B. Single arterial trunk overriding both ventricles C. Aorta arising from RV and pulmonary artery arising from LV (ventriculoarterial discordance) D. Interrupted aortic arch D-TGA shows ventriculoarterial discordance where the aorta connects to the RV and pulmonary artery to the LV.
- A peak tricuspid regurgitation velocity of 3.0 m/s with an estimated RA pressure of 5 mmHg yields an RVSP of approximately: A. 36 mmHg B. 40 mmHg C. 41 mmHg D. 55 mmHg RVSP ≈ 4v² + RA pressure = 4 (3.0)² + 5 = 4 9 + 5 = 36 + 5 = 41 mmHg.
- Which of the following best describes truncus arteriosus on echocardiography? A. Separate aortic and pulmonary valves with usual branching B. Interrupted aortic arch with PDA only
An interarterial course (between aorta and pulmonary artery) of an anomalous coronary can cause ischemia and sudden death.
- In assessing mitral stenosis in congenital disease, the mean transmitral gradient is most affected by: A. Heart rate only B. Left atrial size only C. Cardiac output and mitral valve area D. Aortic valve function Transmitral gradient depends on mitral valve area and flow (cardiac output), as well as heart rate.
- Which congenital lesion commonly results in a single S2 on auscultation and on echo shows absence of separate aortic and pulmonary semilunar valves?
A. Truncus arteriosus B. Tetralogy of Fallot C. Pulmonary atresia with VSD D. Double outlet right ventricle Pulmonary atresia with VSD may present with single audible S2; truncus also has single outflow but pulmonary atresia classically lacks a pulmonary valve—interpretation depends on context. On echo, absence of an anatomical pulmonary valve/arterial trunk in pulmonary atresia differentiates it.
- Which feature on echo suggests pulmonary vein stenosis in a child? A. Normal pulmonary venous flow pattern B. Increased left ventricular ejection fraction C. Turbulent, high-velocity pulmonary venous flow with LA enlargement D. Dilated inferior vena cava only Pulmonary vein stenosis causes turbulent high-velocity flow into LA and signs of pulmonary venous congestion and LA enlargement.
- In repaired congenitally corrected transposition (L-TGA), the systemic ventricle is: A. Morphologic left ventricle
CW Doppler gives accurate velocities and gradients across stenotic aortic valves.
- Which echocardiographic sign suggests significant mitral regurgitation in infancy? A. Small left atrium B. Left atrial enlargement and holosystolic color jet reaching the back wall C. Normal LA with tiny jet D. Isolated RV dilation Significant MR increases LA volume and often produces a large color jet; LA enlargement is an indirect sign of chronic significant MR.
- In McConnell’s sign (regional RV dysfunction), which clinical context is it most often associated with? A. Atrial septal defect B. Pulmonary embolism (acute RV strain) C. Hypertrophic cardiomyopathy D. Truncus arteriosus McConnell’s sign—akinesia of RV free wall with preserved apex—was described in acute PE causing RV strain.
- Which echo parameter is most reproducible for serial monitoring of RV size
and function in repaired TOF patients? A. Visual estimation only B. RV end-diastolic area and RV fractional area change (FAC) from apical or subcostal views C. Left atrial volume only D. Mitral E/A ratio RV FAC and indexed areas measured consistently are useful for serial assessment; 3D echo or MRI are even better but FAC is commonly used.
- Endocardial fibroelastosis is characterized on echo by: A. Thin ventricular walls with hypercontractility B. Echogenic, thickened endocardium with poor ventricular compliance and often dilatation
Duct-dependent systemic or pulmonary blood flow lesions need early diagnosis and PGE1 to maintain ductal patency and systemic/pulmonary circulation.
- A Chiari network on echocardiography is: A. Pathologic atrial thrombus B. A benign, mobile, netlike structure in the right atrium near the IVC/CS C. A form of atrial septal aneurysm D. Sign of endocarditis Chiari network is a benign embryologic remnant seen in right atrium and may be mistaken for pathologic masses.
- Which measurement is least reliable for estimating pulmonary artery pressures in a patient without measurable TR? A. TR velocity B. Pulmonary acceleration time (PAT) C. Left atrial volume D. Interventricular septal motion LA volume is unrelated to direct pulmonary artery pressure measurement; PAT, TR, and septal motion relate more directly to pulmonary pressures.
- For an infant with suspected double outlet right ventricle (DORV), the echo finding that confirms the diagnosis is: A. Aorta arising solely from LV B. Both aorta and pulmonary artery arising predominantly from the right ventricle C. Small VSD with normal outflow arrangement D. Interrupted aortic arch only DORV features both great arteries exiting predominantly from the RV; VSD location and relationship are important for physiology.
- Which of the following indicates restrictive ventricular physiology in a repaired congenital heart disease patient? A. Large, compliant ventricles
