Download PrepIQ EACVI AEPC Congenital Heart Disease Echocardiography Echo CHD Online Ultimate Exam and more Exams Technology in PDF only on Docsity!
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Question 1. Which ultrasound property determines axial resolution in echocardiography? A) Frequency B) Amplitude C) Pulse duration D) Beam width Answer: A Explanation: Higher frequency yields shorter wavelength, improving axial resolution, though at the cost of penetration. Question 2. In a parasternal long-axis view, the aortic valve is best visualized at which depth setting? A) 2 cm B) 4 cm C) 6 cm D) 8 cm Answer: C Explanation: The aortic valve lies approximately 5–7 cm deep in most children; setting depth to 6 cm ensures inclusion of the valve and left ventricular outflow tract. Question 3. The piezoelectric crystal in an ultrasound transducer converts electrical energy into: A) Heat B) Light C) Mechanical vibration D) Magnetic field Answer: C
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Explanation: Piezoelectric materials deform when voltage is applied, generating acoustic waves; the reverse occurs for receiving echoes. Question 4. Which of the following adjustments primarily reduces blooming artifact on grayscale images? A) Increase gain B) Decrease dynamic range C) Increase TGC at the apex D) Decrease sector width Answer: B Explanation: Reducing dynamic range compresses the grayscale, limiting excess brightness that causes blooming. Question 5. In color Doppler, aliasing occurs when the measured velocity exceeds: A) The Nyquist limit B) The Doppler shift frequency C) The pulse repetition frequency (PRF) D) Both A and C Answer: D Explanation: Aliasing appears when velocity exceeds the Nyquist limit, which is half the PRF; both terms describe the same threshold. Question 6. The mechanical index (MI) is most directly related to which potential bioeffect? A) Thermal heating B) Cavitation C) Electrical stimulation
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B) Left atrium directly C) Inferior vena cava D) Pulmonary veins Answer: A Explanation: In >90 % of cases the LSVC empties into the coronary sinus, producing a dilated coronary sinus on echo. Question 10. The normal origin of the left coronary artery is from which sinus? A) Right sinus of Valsalva B) Non-coronary sinus C) Left sinus of Valsalva D) Posterior sinus Answer: C Explanation: The left coronary artery arises from the left (anterior) sinus of Valsalva. Question 11. Which type of atrial septal defect is most commonly associated with a deficient superior rim? A) Ostium secundum ASD B) Ostium primum ASD C) Sinus venosus ASD (superior) D) Sinus venosus ASD (inferior) Answer: C Explanation: Superior sinus venosus ASD occurs near the entry of the superior vena cava and often lacks a superior rim. Question 12. The “scooped” appearance of the interventricular septum on M-mode is characteristic of:
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A) Ventricular septal defect B) Tetralogy of Fallot C) Pulmonary hypertension D) Hypertrophic cardiomyopathy Answer: C Explanation: Elevated right-ventricular pressure in pulmonary hypertension causes septal flattening and systolic “scooping”. Question 13. In a patient with a large VSD, the most reliable echocardiographic measurement of shunt size is: A) Color Doppler jet width B) VSD diameter measured in the parasternal short-axis view C) PW Doppler peak velocity across the defect D) Qp:Qs ratio calculation Answer: B Explanation: Direct measurement of the defect diameter in a short-axis view provides the anatomical size; jet width and velocity are flow-dependent. Question 14. Atrioventricular septal defect (complete) is best identified by which echo finding? A) Single common AV valve with separate leaflets B) Two separate mitral and tricuspid valves with a large VSD C) Atrioventricular valve regurgitation only D) Presence of a primum ASD only Answer: A Explanation: Complete AVSD features a common atrioventricular valve (single annulus) and a combined atrial and ventricular septal defect.
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Explanation: In neonates with valvar aortic stenosis, the leaflets appear domed during systole due to restricted opening. Question 18. The most common cause of coarctation of the aorta in infants is: A) Discrete juxtaductal narrowing B) Long segment arch hypoplasia C) Post-ductal narrowing D) Intracardiac obstruction Answer: A Explanation: A discrete, shelf-like narrowing just distal to the ductus arteriosus is typical in neonates. Question 19. The “boot-shaped” heart on a chest X-ray correlates with which echocardiographic finding? A) Right ventricular hypertrophy in Tetralogy of Fallot B. Left ventricular hypertrophy in aortic stenosis C. Dilated pulmonary arteries in PDA D. Enlarged left atrium in ASD Answer: A Explanation: The boot shape reflects a prominent right ventricular outflow tract and overriding aorta seen in TOF. Question 20. In transposition of the great arteries (d-TGA), the most reliable echo sign of parallel great arteries is: A) The aorta arising anteriorly to the pulmonary artery B) The aorta and pulmonary artery arising from opposite ventricles in the short-axis view C) Aortic arch looping over the pulmonary artery
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D) Presence of a VSD Answer: B Explanation: In the short-axis view, the aorta and pulmonary artery arise side-by-side from different ventricles, indicating transposition. Question 21. Which surgical repair is indicated for d-TGA with intact ventricular septum in the neonatal period? A) Atrial switch (Mustard) B) Arterial switch operation (ASO) C) Rastelli procedure D) Norwood procedure Answer: B Explanation: The arterial switch corrects the ventriculo-arterial connections and restores normal coronary anatomy. Question 22. A double-outlet right ventricle (DORV) with a subaortic VSD is best described as which physiologic lesion? A) Tetralogy of Fallot variant B. Truncus arteriosus C) Pulmonary atresia with VSD D. Simple VSD Answer: A Explanation: DORV with a subaortic VSD and pulmonary stenosis mimics the hemodynamics of TOF. Question 23. In a patient after the Blalock-Taussig-Thomas (BTT) shunt, which Doppler finding indicates adequate shunt flow? A) Low-velocity continuous-wave signal (<1 m/s)
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A) A homograft conduit B) The patient’s pulmonary valve C) A mechanical prosthesis D) A bovine pericardial valve Answer: B Explanation: In the Ross, the native pulmonary valve is harvested and implanted in the aortic position; a conduit then replaces the pulmonary valve. Question 27. Which echo finding suggests conduit stenosis in a patient with a right-ventricle to pulmonary-artery (RV-PA) conduit? A) Peak gradient <10 mmHg across the conduit B) Continuous-wave Doppler velocity >3 m/s in the conduit C) Color Doppler aliasing within the RV cavity D. No flow in the conduit on color Answer: B Explanation: A peak velocity >3 m/s corresponds to a gradient >36 mmHg, indicating significant conduit obstruction. Question 28. A device-occluder seen on echo after ASD closure appears as: A) A hyperechoic linear structure across the septum B) A hypoechoic cystic area within the atrium C. An anechoic shadow extending into the left atrium D. A mobile echodense mass attached to the mitral valve Answer: A Explanation: Most occluders are metal mesh devices that appear as bright echogenic structures spanning the defect.
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Question 29. The simplified Bernoulli equation is ΔP = 4v². What pressure gradient results from a peak velocity of 2.5 m/s? A) 10 mmHg B) 20 mmHg C) 25 mmHg D) 40 mmHg Answer: D Explanation: ΔP = 4 × (2.5)² = 4 × 6.25 = 25 mmHg; however the correct calculation is 4 × (2.5)² = 25 mmHg. (Correction: the correct answer is C, 25 mmHg). Question 30. In calculating Qp:Qs, which of the following measurements is NOT required? A) Stroke volume across the pulmonary valve B) Stroke volume across the aortic valve C) Right-ventricular end-diastolic area D) Valve diameter for continuity equation Answer: C Explanation: Qp:Qs uses stroke volumes derived from the pulmonary and aortic outflow; RV end-diastolic area is unrelated. Question 31. The continuity equation for calculating aortic valve area uses which three measurements? A) LVOT diameter, LVOT VTI, and aortic valve VTI B) Mitral annular diameter, mitral VTI, and aortic VTI C) LVOT diameter, mitral VTI, and aortic VTI D) Aortic root diameter, aortic VTI, and LVOT VTI Answer: A
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C) Pseudonormalization D) Restrictive filling Answer: B Explanation: In infants, lateral e′ <10 cm/s indicates reduced early diastolic relaxation. Question 35. Which echocardiographic sign indicates a restrictive VSD? A) Small jet width with high velocity (>4 m/s) B) Large jet width with low velocity (<2 m/s) C) Bidirectional shunt on color Doppler D) Absence of a jet on color imaging Answer: A Explanation: A restrictive VSD allows only a narrow, high-velocity jet due to the small orifice. Question 36. In neonates with hypoplastic left heart syndrome (HLHS), the most critical pre-operative echo measurement is: A) Ascending aorta diameter B) Mitral valve annulus size C) Pulmonary artery branch diameters D) Right-ventricular outflow tract gradient Answer: B Explanation: The mitral valve size determines the suitability for staged palliation; a severely hypoplastic valve may preclude reconstruction. Question 37. Which of the following is the hallmark echo feature of a persistent truncus arteriosus?
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A) Single arterial trunk overriding a VSD with a common valve B) Two separate semilunar valves with a VSD C) Aortic arch discontinuity D) Absence of pulmonary arteries Answer: A Explanation: Truncus arteriosus presents as one arterial trunk giving rise to systemic, pulmonary, and coronary flow, with a single semilunar valve. Question 38. In a patient after Mustard atrial switch, the systemic ventricle is: A) Morphologic left ventricle B) Morphologic right ventricle C) Both ventricles share systemic load equally D) A biventricular conduit Answer: B Explanation: The Mustard redirects systemic venous return to the morphologic right ventricle, making it the systemic pump. Question 39. Which imaging plane is optimal for measuring the diameter of a ductus arteriosus in a pre-term infant? A) Parasternal short-axis at the level of the aortic valve B) Suprasternal longitudinal view C) Subcostal sagittal view D) Apical five-chamber view Answer: B Explanation: The suprasternal longitudinal view aligns the ductus in its long axis, allowing accurate diameter measurement.
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Explanation: Prior esophageal surgery (e.g., repair of atresia) raises risk of perforation; it is a contraindication. Question 43. When is cardiac MRI preferred over echo in congenital heart disease? A) To assess valve morphology in neonates B) For quantifying right-ventricular volumes after Fontan C) To measure pulmonary artery pressure non-invasively D) For routine screening of ASD in school-age children Answer: B Explanation: MRI provides accurate RV volumetrics and flow quantification, essential after Fontan completion. Question 44. In 3-D echocardiography, the term “volumetric dataset” refers to: A) A single 2-D slice captured over time B) A series of sequential 2-D images reconstructed into a cube C) Real-time color Doppler flow map D) Tissue Doppler velocity map Answer: B Explanation: 3-D echo acquires a pyramidal or full-volume set of 2-D frames that are reconstructed into a three-dimensional dataset. Question 45. Speckle tracking strain analysis of the systemic right ventricle after an atrial switch is most useful for detecting: A) Outflow tract obstruction B) Early systolic dysfunction before EF falls C) Valve regurgitation severity
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D) Pulmonary artery stenosis Answer: B Explanation: Strain detects subtle myocardial dysfunction earlier than conventional ejection fraction measurements. Question 46. In the parasternal short-axis view at the level of the papillary muscles, the “C-shaped” interventricular septum is typical of: A) Tetralogy of Fallot B) Pulmonary hypertension C) Hypertrophic cardiomyopathy D) D-transposition of the great arteries Answer: B Explanation: Elevated RV pressure flattens the septum, producing a C-shape during systole. Question 47. The optimal frame rate for color flow mapping of the mitral inflow in a newborn is: A) 10–20 Hz B) 30–40 Hz C) 60–80 Hz D) >100 Hz Answer: C Explanation: A frame rate of 60–80 Hz balances temporal resolution with adequate color fill for rapid fetal/infant inflow. Question 48. A “ring-like” echo density at the aortic valve in the newborn suggests: A) Bicuspid aortic valve with raphe
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Question 51. The “double-bubble” sign on fetal ultrasound is indicative of: A) Double-outlet right ventricle B) Persistent left superior vena cava C) Bile duct cysts D) Two separate aortic arches (right and left) Answer: D Explanation: Two parallel tubular structures representing right and left aortic arches produce the double-bubble appearance. Question 52. In a neonate with an obstructed total anomalous pulmonary venous return (TAPVR), the most reliable echocardiographic indicator of obstruction is: A) Dilated coronary sinus B) High-velocity flow (>1.5 m/s) in the pulmonary venous confluence C) Small left atrium D) Presence of a VSD Answer: B Explanation: Elevated velocity across the obstructed pulmonary venous pathway signals significant obstruction. Question 53. Which of the following is a typical finding in a patient with a sinus venosus ASD (inferior) on echo? A) Superior vena cava overriding the atrial septum B) Partial anomalous pulmonary venous return from the right lower lobe C) Deficient inferior rim of the atrial septum D) Dilated coronary sinus Answer: B
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Explanation: Inferior sinus venosus ASD is frequently associated with anomalous drainage of right lower pulmonary veins into the SVC or right atrium. Question 54. During a post-operative assessment of a Ross procedure, which measurement is critical to evaluate pulmonary autograft dilation? A) Ascending aortic root diameter at the sinotubular junction B) Pulmonary artery branch diameters C) Mitral annular diameter D) Left ventricular outflow tract velocity Answer: A Explanation: The autograft (pulmonary valve) becomes the new aortic root; dilation at the sinotubular junction may indicate failure. Question 55. The “saw-tooth” pattern on the Doppler spectral trace of the tricuspid valve is characteristic of: A) Tricuspid regurgitation B) Ebstein’s anomaly C) Right-ventricular outflow tract obstruction D) Normal tricuspid inflow Answer: B Explanation: Ebstein’s anomaly produces a delayed, irregular tricuspid inflow pattern resembling a saw-tooth. Question 56. In a patient with a large atrial septal defect, the presence of paradoxical embolism is most likely due to: A) Right-to-left shunt during Valsalva maneuver B) Left-to-right shunt increasing pulmonary flow C) Bidirectional shunting at rest
