Download PrepIQ EACVI EACTAIC in Adult Transoesophageal Echocardiography TOE Ultimate Exam and more Exams Technology in PDF only on Docsity!
Transoesophageal
Echocardiography TOE Ultimate
Exam
Question 1. Which physical principle allows a piezoelectric crystal in an ultrasound transducer to generate sound waves when an electric voltage is applied? A) Magnetostriction B) Photoelectric effect C) Piezoelectric effect D) Thermoelastic expansion Answer: C Explanation: The piezoelectric effect converts electrical energy into mechanical vibrations (sound) and vice-versa, enabling ultrasound generation and reception. Question 2. In tissue, attenuation of ultrasound is primarily caused by which combination of phenomena? A) Reflection and refraction B) Scattering and absorption C) Diffraction and dispersion D) Refraction and Doppler shift Answer: B Explanation: Attenuation results from scattering of the beam and conversion of acoustic energy into heat (absorption). Question 3. What determines the axial resolution of an ultrasound image? A) Beam width B) Pulse length C) Transducer frequency D) Scan depth Answer: B Explanation: Axial resolution depends on the spatial pulse length; shorter pulses improve the ability to separate structures along the beam axis.
Transoesophageal
Echocardiography TOE Ultimate
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Question 4. Which Doppler mode provides the highest temporal resolution for measuring high-velocity flow across aortic stenosis? A) Pulsed-wave Doppler B) Continuous-wave Doppler C) Color flow mapping D) Tissue Doppler imaging Answer: B Explanation: Continuous-wave Doppler samples the entire line of sight continuously, allowing accurate measurement of very high velocities without aliasing. Question 5. The Nyquist limit in color flow mapping is directly proportional to: A) PRF divided by twice the Doppler frequency shift B) PRF divided by twice the transmitted frequency C) Transducer frequency divided by PRF D) Pulse repetition frequency (PRF) divided by 2 Answer: D Explanation: Nyquist limit = PRF/2; velocities exceeding this limit cause aliasing. Question 6. In Tissue Doppler Imaging (TDI), the measured velocity at the mitral annulus during early diastole (e′) primarily reflects: A) Left atrial pressure B) Myocardial relaxation C) Transmitral flow volume D) Aortic pressure gradient Answer: B
Transoesophageal
Echocardiography TOE Ultimate
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D) Probe sterility Answer: B Explanation: MI estimates the likelihood of acoustic cavitation, a safety parameter distinct from thermal indices. Question 10. Which of the following is an absolute contraindication to transesophageal echocardiography? A) Recent upper gastrointestinal bleed B) Controlled atrial fibrillation C) Prior esophageal varices that are banded D) Mild dysphagia Answer: A Explanation: Active or recent upper GI bleeding poses a high risk of aspiration or perforation, making TOE absolutely contraindicated. Question 11. The standard sedation regimen for TOE often includes midazolam for anxiolysis and which opioid for analgesia? A) Morphine B) Fentanyl C) Hydromorphone D) Meperidine Answer: B Explanation: Fentanyl provides rapid, short-acting analgesia commonly combined with midazolam for TOE sedation. Question 12. During a TOE, which monitoring parameter is most critical for detecting hypoxia? A) ECG
Transoesophageal
Echocardiography TOE Ultimate
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B) Non-invasive blood pressure C) Pulse oximetry (SpO₂) D) End-tidal CO₂ Answer: C Explanation: SpO₂ continuously monitors arterial oxygen saturation, essential during sedation and airway manipulation. Question 13. The midesophageal four-chamber view is obtained by rotating the multiplane probe to approximately which angle? A) 0° B) 45° C) 90° D) 120° Answer: C Explanation: At 0° the probe shows the aortic valve; rotating to 90° displays the midesophageal four-chamber view. Question 14. Which transgastric view is best suited for assessing the left ventricular outflow tract (LVOT) velocity using continuous-wave Doppler? A) TG short-axis basal B) TG long-axis (mid-esophageal) C) Deep TG long-axis (0– 20 mm from the stomach) D) TG short-axis apical Answer: C Explanation: A deep TG long-axis aligns the Doppler beam parallel to the LVOT, enabling accurate CW measurement.
Transoesophageal
Echocardiography TOE Ultimate
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Explanation: Segment 9 corresponds to the basal inferolateral wall in the standardized 17-segment LV model. Question 18. In diastolic assessment, a mitral inflow E/A ratio >2 with a deceleration time <150 ms most likely indicates: A) Normal filling B) Grade 1 (impaired relaxation) diastolic dysfunction C) Pseudonormalisation D) Restrictive filling pattern Answer: D Explanation: High E velocity, low A, and rapid deceleration are hallmarks of restrictive (advanced) diastolic dysfunction. Question 19. Tricuspid annular plane systolic excursion (TAPSE) is measured in which imaging plane? A) Midesophageal four-chamber view B) Transgastric short-axis basal view C) Upper esophageal aortic arch view D) Deep TG long-axis view Answer: A Explanation: TAPSE is obtained by M-mode tracing of the lateral tricuspid annulus motion in the ME 4-chamber view. Question 20. Estimation of pulmonary artery systolic pressure (PASP) via TOE commonly uses the peak tricuspid regurgitant velocity together with an estimate of right atrial pressure. The Bernoulli equation converts the velocity to pressure using which constant? A) 2. B) 4.
Transoesophageal
Echocardiography TOE Ultimate
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C) 8.
D) 16.
Answer: B Explanation: ΔP = 4 × v² (where v is the TR jet velocity in m/s) converts velocity to pressure gradient. Question 21. According to Carpentier’s nomenclature, which scallop corresponds to the posterior medial portion of the mitral valve? A) P B) P C) P D) A Answer: B Explanation: P2 denotes the central posterior scallop (medial-lateral orientation) of the mitral valve. Question 22. The Proximal Isovelocity Surface Area (PISA) method for quantifying mitral regurgitation assumes what shape of the flow convergence zone? A) Cylindrical B) Spherical C) Conical D) Elliptical Answer: C Explanation: PISA assumes a hemi-spherical (conical) flow convergence, allowing calculation of regurgitant flow rate. Question 23. In mitral stenosis, a pressure half-time (PHT) of 120 ms corresponds approximately to a mitral valve area of:
Transoesophageal
Echocardiography TOE Ultimate
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Question 26. Which parameter is most reliable for grading tricuspid regurgitation severity on TOE? A) Peak TR velocity B) Vena contracta width C) Right atrial size D) Pulmonary artery pressure Answer: B Explanation: Vena contracta measurement provides a quantitative, flow-independent estimate of TR severity. Question 27. The Wilkins score for mitral stenosis assesses all EXCEPT: A) Leaflet mobility B) Subvalvular thickening C) Commissural calcification D) Annular dilation Answer: D Explanation: The Wilkins scoring system evaluates leaflet mobility, thickness, calcification, and subvalvular involvement; annular size is not included. Question 28. In the Stanford classification of aortic dissection, a type B dissection originates distal to which anatomic landmark? A) Ascending aorta B) Aortic arch C) Left subclavian artery origin D) Diaphragm Answer: C Explanation: Type B dissections begin distal to the left subclavian artery, involving the descending thoracic aorta.
Transoesophageal
Echocardiography TOE Ultimate
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Question 29. On TOE, an intramural hematoma appears as: A) A hypoechoic crescent within the aortic wall without an intimal flap B) A mobile echogenic flap within the lumen C) A pulsatile flow signal within the wall D) A calcified protrusion into the lumen Answer: A Explanation: Intramural hematoma is a non-flow-producing, crescent-shaped thickening of the aortic media without a visible intimal tear. Question 30. A “mobile atheromatous plaque” in the thoracic aorta is clinically significant because it is associated with: A) Hypertension only B) Increased risk of embolic stroke C) Reduced left ventricular ejection fraction D) Pulmonary hypertension Answer: B Explanation: Mobile aortic plaques are a source of systemic emboli, especially cerebral emboli leading to stroke. Question 31. In the assessment of pulmonary embolism via TOE, a “saddle embolus” is best visualized in which view? A. Midesophageal four-chamber B. Upper esophageal aortic arch short-axis C. Transgastric short-axis at the pulmonary artery bifurcation D. Deep transgastric long-axis of the left atrium Answer: C
Transoesophageal
Echocardiography TOE Ultimate
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C) Lower mortality D) Better response to antibiotics alone Answer: B Explanation: Larger vegetations (>10 mm) carry a higher embolic risk, influencing therapeutic decisions. Question 35. Which type of atrial septal defect is most commonly associated with a deficient superior rim and requires careful imaging of the superior vena cava? A) Secundum ASD B) Primum ASD C) Sinus venosus ASD (superior) D) Patent foramen ovale Answer: C Explanation: Superior sinus venosus ASD is located near the SVC and often lacks a superior rim, necessitating detailed TOE assessment. Question 36. During a bubble study for patent foramen ovale (PFO), the appearance of microbubbles in the left atrium within how many cardiac cycles after right atrial opacification is diagnostic? A) 1-2 cycles B) 3-5 cycles C) 6-8 cycles D) >10 cycles Answer: B Explanation: A delayed appearance (3-5 cardiac cycles) after right-to-left shunt suggests a PFO rather than an intrapulmonary shunt.
Transoesophageal
Echocardiography TOE Ultimate
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Question 37. In a bicuspid aortic valve, which TOE view best demonstrates the raphe and leaflet fusion pattern? A) Midesophageal long-axis at 120° B) Upper esophageal aortic arch short-axis at 0° C) Transgastric short-axis basal view D) Deep TG long-axis at 90° Answer: B Explanation: The UE short-axis view provides a cross-section of the aortic valve, clearly showing bicuspid morphology and raphe. Question 38. Coarctation of the aorta in adults is most reliably identified on TOE by visualizing: A) Narrowing of the descending thoracic aorta distal to the left subclavian artery B) Aortic valve prolapse C) Dilated ascending aorta with normal arch D) Mitral valve thickening Answer: A Explanation: Adult coarctation typically involves the post-subclavian descending thoracic aorta, which can be seen in the UE and deep TG views. Question 39. Ebstein’s anomaly is characterized by which of the following TOE findings? A) Apical displacement of the septal and posterior tricuspid leaflets B) Hypertrophic interventricular septum C) Mitral valve prolapse with regurgitation D) Dilated pulmonary artery with regurgitation Answer: A
Transoesophageal
Echocardiography TOE Ultimate
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D) No residual regurgitant jet on color flow Answer: A Explanation: Residual air manifests as spontaneous echo contrast; its disappearance confirms adequate de-airing. Question 43. In hypertrophic obstructive cardiomyopathy (HOCM) septal myectomy, intra-operative TOE monitors which parameter to assess relief of obstruction? A) LVOT peak gradient reduction B) Mitral valve area increase C) Right ventricular systolic pressure D) Pulmonary artery wedge pressure Answer: A Explanation: A decrease in LVOT gradient on Doppler after myectomy indicates successful obstruction relief. Question 44. For TAVI guidance, the “cusp-overlap” view is obtained by rotating the probe to approximately which angle? A) 0° B) 30° C) 45° D) 60° Answer: D Explanation: A 60° rotation aligns the right and left coronary cusps in overlap, optimizing fluoroscopic and TOE visualization for valve positioning. Question 45. In percutaneous edge-to-edge repair (MitraClip), the optimal TOE view to guide leaflet grasping is: A) Midesophageal four-chamber at 0°
Transoesophageal
Echocardiography TOE Ultimate
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B) Midesophageal commissural view at 60° C) Transgastric short-axis basal at 90° D) Upper esophageal aortic arch short-axis at 30° Answer: B Explanation: The commissural view provides a perpendicular view of the mitral leaflets, facilitating precise clip placement. Question 46. When sizing a left atrial appendage (LAA) occlusion device, which TOE measurement is most critical? A) LAA orifice diameter at maximal contraction B) LAA length from ostium to tip C) LAA volume at end-diastole D) Number of lobes visualized Answer: A Explanation: The maximal LAA orifice diameter determines the device size needed to achieve complete closure. Question 47. In patients supported with veno-arterial ECMO, TOE is used to verify correct positioning of the arterial cannula by visualizing: A) Retrograde flow in the descending aorta B) Presence of a “saw-tooth” pattern in the LVOT C) Cannula tip in the descending thoracic aorta just distal to the left subclavian artery D) Flow acceleration across the aortic valve Answer: C Explanation: Correct arterial cannula placement is confirmed when the tip lies in the descending thoracic aorta distal to the left subclavian artery, avoiding cerebral perfusion compromise.
Transoesophageal
Echocardiography TOE Ultimate
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Explanation: Bone’s higher attenuation converts more acoustic energy into heat, thus TIB values are higher to protect against excessive heating. Question 51. Which of the following adjustments will most directly reduce the mechanical index (MI) during a TOE study? A) Lowering the transmitted frequency B) Decreasing the pulse repetition frequency (PRF) C) Reducing the peak rarefactional pressure amplitude (PRPA) D) Increasing the gain Answer: C Explanation: MI = PRPA / √(frequency); lowering PRPA directly reduces MI, enhancing safety. Question 52. The “flash” technique in 3D TOE is used to: A) Acquire a single-beat full-volume dataset of the mitral valve B) Increase frame rate by reducing sector width C) Enhance color Doppler resolution D) Freeze the image for offline analysis Answer: A Explanation: The flash (or single-beat) acquisition captures a complete 3D volume in one cardiac cycle, useful for rapid valve assessment. Question 53. In the assessment of aortic valve area by planimetry on 3D TOE, which plane should be traced? A) The annular plane at the level of the three cusps B) The LVOT inlet plane C) The sinus of Valsalva plane D) The ascending aorta 2 cm distal to the valve
Transoesophageal
Echocardiography TOE Ultimate
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Answer: A Explanation: Direct planimetry of the aortic orifice is performed on the annular cross-section where the cusps meet. Question 54. A “systolic anterior motion” (SAM) of the mitral valve is most readily visualized in which TOE view? A) Midesophageal long-axis at 120° B) Upper esophageal aortic arch long-axis C) Transgastric short-axis basal view D) Deep TG long-axis at 0° Answer: A Explanation: The ME long-axis view aligns the LVOT and mitral valve, allowing clear observation of SAM during systole. Question 55. In the evaluation of prosthetic aortic valve function, which Doppler parameter is least affected by the prosthetic material? A) Peak velocity across the valve B) Mean pressure gradient C) Effective orifice area calculated by continuity equation D) Acceleration time Answer: C Explanation: The continuity equation uses flow measurements upstream (LVOT) and is less influenced by prosthetic artifacts, providing a reliable EOA. Question 56. During TOE-guided percutaneous closure of a secundum ASD, the device is visualized crossing the septum in which view? A) Midesophageal four-chamber at 0° B) Midesophageal bicaval view at 90°
