Download PrepIQ EACVI in Congenital Heart Disease Echocardiography Echo CHD Ultimate Exam and more Exams Technology in PDF only on Docsity!
Disease Echocardiography Echo
CHD Ultimate Exam
Question 1. Which ultrasound frequency range is most appropriate for imaging a newborn’s cardiac structures? A) 1- 2 MHz B) 2- 4 MHz C) 5- 7 MHz D) 8- 12 MHz Answer: C Explanation: Neonates have small thoracic windows and require higher-frequency transducers (5- 7 MHz) to achieve adequate spatial resolution while maintaining sufficient penetration. Question 2. In Doppler echocardiography, the simplified Bernoulli equation (ΔP = 4v²) is used to estimate which of the following? A) Cardiac output B) Pressure gradient across a valve C) Myocardial strain D) Flow volume through a shunt Answer: B Explanation: The simplified Bernoulli equation relates the peak velocity (v) of blood flow to the pressure gradient (ΔP) across a stenotic or regurgitant valve. Question 3. Which artifact is most commonly produced by multiple reflections between the transducer and a highly reflective interface, resulting in equally spaced duplicate structures? A) Side-lobes B) Reverberation C) Mirror image D) Attenuation Answer: B
Disease Echocardiography Echo
CHD Ultimate Exam
Explanation: Reverberation creates multiple equally spaced echoes due to repeated reflections, often seen as duplicate images of structures. Question 4. In segmental analysis, “atrioventricular discordance” refers to which of the following relationships? A) Right atrium connects to left ventricle B) Left atrium connects to right ventricle C) Both atria connect to a single ventricle D) Atrial and ventricular situs are inversed Answer: B Explanation: AV discordance means the left atrium is connected to the morphologic right ventricle and the right atrium to the morphologic left ventricle. Question 5. The most reliable echocardiographic view to assess a secundum atrial septal defect in an infant is: A) Subcostal four-chamber B) Parasternal long-axis C) Apical five-chamber D) Suprasternal notch Answer: A Explanation: The subcostal four-chamber view provides a direct, perpendicular view of the interatrial septum, ideal for visualizing secundum ASDs. Question 6. Which of the following is true regarding a perimembranous ventricular septal defect (VSD)? A) It is located entirely within the muscular septum. B. It lies adjacent to the membranous septum and the aortic valve. C. It is always associated with aortic valve prolapse. D. It is best visualized only by transesophageal echocardiography.
Disease Echocardiography Echo
CHD Ultimate Exam
D) Left ventricular fractional shortening (FS) Answer: B Explanation: TAPSE measures longitudinal motion of the tricuspid annulus and is a simple, reproducible indicator of RV systolic performance. Question 10. When performing a three-dimensional (3D) echo of a fetal heart, which of the following is a primary advantage over 2D imaging? A) Higher temporal resolution B) Ability to visualize the entire cardiac volume in a single acquisition C) Elimination of acoustic shadowing D) Direct measurement of myocardial strain without post-processing Answer: B Explanation: 3D echo captures a volumetric dataset, allowing reconstruction of any plane and better appreciation of complex anatomy. Question 11. In a child with coarctation of the aorta, which Doppler finding best suggests significant obstruction? A) Continuous flow in the descending aorta B) Diastolic run-off in the abdominal aorta C) Normal systolic velocity in the pre-ductal arch D) Reversal of flow in the carotid arteries Answer: B Explanation: Diastolic runoff (rapid decline of diastolic velocity) distal to a coarctation reflects significant narrowing and reduced diastolic pressure. Question 12. The “isthmus” measurement in coarctation assessment is taken between which two anatomical landmarks? A) Aortic valve and left subclavian artery B. Ascending aorta and aortic arch
Disease Echocardiography Echo
CHD Ultimate Exam
C. Left subclavian artery and ductus arteriosus (or ligamentum) D. Descending aorta and diaphragmatic hiatus Answer: C Explanation: The aortic isthmus lies between the origin of the left subclavian artery and the ductal insertion (or ligamentum arteriosum), the typical site of coarctation. Question 13. Which of the following best describes a “sinus venosus ASD” on echocardiography? A) Defect adjacent to the fossa ovalis with a superior rim of tissue B) Defect near the entry of the superior or inferior vena cava into the right atrium C) Defect involving the atrioventricular valve leaflets D) Defect located within the coronary sinus Answer: B Explanation: Sinus venosus ASDs are situated near the SVC or IVC insertion and are often associated with anomalous pulmonary venous return. Question 14. In a patient with Tetralogy of Fallot (ToF), the most reliable echocardiographic indicator of severe pulmonary regurgitation is: A) Peak systolic gradient across the pulmonary valve B) Diastolic flow reversal in the main pulmonary artery on PW Doppler C) Increased right ventricular outflow tract (RVOT) diameter D) Presence of a VSD shunt ratio >2: Answer: B Explanation: Pulmonary regurgitation produces a diastolic flow reversal signal in the pulmonary artery, quantifiable by PW Doppler. Question 15. Which view is optimal for evaluating the size and morphology of the aortic arch in a neonate with suspected interrupted aortic arch? A) Parasternal short-axis at the level of the great vessels B) Suprasternal notch long-axis view
Disease Echocardiography Echo
CHD Ultimate Exam
C) Ratio of VTI (velocity-time integral) across the pulmonary and aortic valves multiplied by cross-sectional areas D) Ratio of peak Doppler velocities across the VSD and ASD Answer: C Explanation: Qp/Qs is derived from the product of VTI and the cross-sectional area of the outflow tracts (pulmonary and aortic), reflecting flow through each circuit. Question 19. In a patient with Ebstein’s anomaly, which echocardiographic finding is most characteristic? A) Atrioventricular valve attached at the apex of the ventricle B) Apical displacement of the septal and posterior tricuspid leaflets C) Bicuspid aortic valve with stenosis D) Right atrial enlargement without valve displacement Answer: B Explanation: Ebstein’s anomaly is defined by apical displacement of the septal and posterior tricuspid leaflets, leading to atrialized right ventricle. Question 20. The “tei index” (myocardial performance index) is calculated by: A) (Isovolumic contraction time + Isovolumic relaxation time) / Ejection time B) (Ejection time + Isovolumic relaxation time) / Isovolumic contraction time C) (Peak systolic velocity + Peak diastolic velocity) / Mean velocity D) (Stroke volume / End-diastolic volume) × 100% Answer: A Explanation: The Tei index combines systolic and diastolic time intervals to assess global ventricular performance. Question 21. Which transducer type provides the highest frame rate for real-time imaging of fast fetal heart rates? A) Phased-array
Disease Echocardiography Echo
CHD Ultimate Exam
B) Curvilinear C) Linear high-frequency D) Matrix array Answer: A Explanation: Phased-array transducers can electronically steer beams, achieving higher frame rates essential for capturing rapid fetal cardiac motion. Question 22. In a child who has undergone a Blalock-Taussig-Thomas (BTT) shunt, the most important echocardiographic measurement to assess shunt patency is: A) Diameter of the main pulmonary artery B) Peak velocity across the shunt conduit C) Left ventricular outflow tract gradient D) Mitral inflow E/A ratio Answer: B Explanation: The peak velocity across the BTT shunt reflects flow through the conduit; a low velocity may suggest obstruction or thrombosis. Question 23. Which of the following best describes the “double-chambered right ventricle” (DCRV) on echocardiography? A) A right ventricle divided by an anomalous muscle bundle creating a proximal high-pressure chamber and a distal low-pressure chamber B) A right ventricle with two distinct papillary muscles C) A right ventricle with two separate outflow tracts to the pulmonary artery D) A right ventricle fused with the left ventricle forming a single chamber Answer: A Explanation: DCRV is characterized by an anomalous muscular obstruction that partitions the RV into two chambers with different pressures.
Disease Echocardiography Echo
CHD Ultimate Exam
Explanation: TEE offers high-resolution, close-up imaging of coronary origins and fistulous connections, especially when transthoracic windows are limited. Question 27. In a patient with a univentricular heart post-Fontan, the most common echocardiographic complication is: A) Baffle leak B) Pulmonary valve stenosis C) Aortic coarctation D) Mitral valve prolapse Answer: A Explanation: After Fontan completion, baffle or conduit leaks are frequent and can be detected by color flow Doppler. Question 28. Which of the following statements about the “infundibular” (sub-valvular) pulmonary stenosis is correct? A) It is best visualized in the parasternal long-axis view. B) It is associated with a “systolic doming” of the pulmonary valve leaflets. C) It causes aortic regurgitation. D) It is typically associated with a large VSD. Answer: A Explanation: The infundibular region is best seen in the parasternal long-axis (right ventricular outflow tract) view, allowing measurement of the narrowing. Question 29. The presence of a “scooped” interventricular septum on echocardiography is most indicative of which condition? A) Hypertrophic cardiomyopathy B) Ventricular septal defect C) Pulmonary hypertension D) Post-operative residual shunt
Disease Echocardiography Echo
CHD Ultimate Exam
Answer: C Explanation: Chronic pressure overload from pulmonary hypertension can cause a flattened or “scooped” septal configuration in the short-axis view. Question 30. In a neonate with a large ductus arteriosus, the direction of flow on color Doppler is most likely: A) Right-to-left (R→L) throughout systole and diastole B) Left-to-right (L→R) throughout systole and diastole C) Bidirectional with predominant left-to-right flow in systole and right-to-left in diastole D) No flow detectable Answer: B Explanation: In most newborns, the PDA shunts left-to-right due to higher systemic pressures relative to pulmonary pressures. Question 31. Which of the following best describes the “double-chambered” appearance of the left ventricle in a patient with a large ventricular septal defect? A) Two distinct chambers separated by a muscular ridge within the LV cavity B) A left ventricle with an additional apical pouch C) A left ventricle that appears divided by a prominent moderator band D) A left ventricle with a separate inflow and outflow tract visualized in the parasternal short-axis view Answer: D Explanation: Large VSDs can cause a distinct separation of inflow and outflow tracts in the LV, giving a double-chambered appearance on short-axis imaging. Question 32. In a patient with a common arterial trunk (truncus arteriosus), which echocardiographic finding is essential for diagnosis? A) Single arterial valve overriding a ventricular septal defect B) Two separate semilunar valves with a single arterial trunk
Disease Echocardiography Echo
CHD Ultimate Exam
A) Parasternal short-axis at the level of the left atrium B) Suprasternal notch view of the aortic arch C) Subcostal coronal view sweeping from the diaphragm to the left atrium D) Apical four-chamber view with color Doppler Answer: C Explanation: The subcostal coronal sweep allows visualization of all pulmonary veins as they drain into the left atrium or anomalous connections. Question 36. In a 2-year-old with a bicuspid aortic valve, which Doppler finding suggests early aortic stenosis? A) Peak systolic velocity > 2.5 m/s across the valve B) Diastolic flow reversal in the descending aorta C) Continuous flow across the valve throughout the cardiac cycle D) No detectable flow across the valve Answer: A Explanation: A peak systolic velocity > 2.5 m/s (corresponding to a gradient > 25 mmHg) indicates hemodynamically significant aortic stenosis. Question 37. The “gradient” measured across a ventricular septal defect by continuous-wave Doppler reflects: A) The pressure difference between the left and right ventricles during systole B) The pressure difference between the RV and pulmonary artery C) The pressure difference between the LV and aorta D) The pressure difference between the right atrium and right ventricle Answer: A Explanation: CW Doppler across a VSD captures the systolic pressure gradient between the higher-pressure LV and lower-pressure RV.
Disease Echocardiography Echo
CHD Ultimate Exam
Question 38. Which of the following is the most appropriate method to assess the size of a surgical conduit (e.g., a Gore-Tex conduit) in a patient after a Rastelli repair? A) Linear measurement on 2D echo in the short-axis view B) Color Doppler mapping of flow turbulence C) M-mode measurement of conduit wall motion D) 3D volume rendering to calculate cross-sectional area Answer: D Explanation: 3D echo allows accurate measurement of the conduit’s true cross-sectional area, accounting for non-circular geometry. Question 39. In a newborn with suspected pulmonary atresia with intact ventricular septum, which echocardiographic finding is pathognomonic? A) Absence of forward flow across the pulmonary valve on PW Doppler B) Presence of a large VSD with left-to-right shunt C) Ductal-dependent systemic circulation with right-to-left shunt through the ductus D) Dilated right atrium with tricuspid regurgitation Answer: A Explanation: Pulmonary atresia is defined by the complete lack of antegrade flow across the pulmonary valve, evident on PW Doppler. Question 40. Which of the following is the most common cause of a residual shunt after percutaneous device closure of an atrial septal defect? A) Improper sizing of the device leading to a gap B) Device embolization into the right atrium C) Development of a new VSD D) Formation of a thrombus on the device surface Answer: A Explanation: Inadequate device sizing can leave a residual rim of flow around the device, manifesting as a residual shunt on color Doppler.
Disease Echocardiography Echo
CHD Ultimate Exam
Explanation: VA discordance describes the situation where the aorta originates from the morphologic RV and the pulmonary artery from the morphologic LV, as seen in D-TGA. Question 44. In a child with an atrial septal defect, which flow pattern on Doppler across the defect indicates a significant left-to-right shunt? A) Low-velocity, bidirectional flow B) High-velocity, unidirectional left-to-right flow with a peak velocity > 2 m/s C) No detectable flow D) Right-to-left flow during systole only Answer: B Explanation: A high-velocity left-to-right jet reflects a sizable pressure gradient between left and right atria, indicating a significant shunt. Question 45. The most accurate echocardiographic method to assess left ventricular mass in a child with hypertrophic cardiomyopathy secondary to a genetic syndrome is: A) M-mode measurement of interventricular septal thickness only B) 2D planimetry of the LV cavity area C) 3D volumetric reconstruction with dedicated software D) Estimation based on body surface area alone Answer: C Explanation: 3D echocardiography provides precise volumetric data and wall thickness measurements, allowing accurate LV mass calculation. Question 46. Which of the following is the hallmark echocardiographic finding of an unbalanced atrioventricular septal defect? A) Equal-sized common atrioventricular valve leaflets B) Dominant left or right ventricle with a small counterpart C) Presence of a single atrial septal defect only
Disease Echocardiography Echo
CHD Ultimate Exam
D) Absence of any atrioventricular valve tissue Answer: B Explanation: Unbalanced AVSDs have a markedly hypoplastic one ventricle (left or right) with a dominant counterpart, leading to functional single-ventricle physiology. Question 47. In a patient with aortopulmonary window, the defect is best visualized in which echocardiographic view? A) Parasternal short-axis at the level of the great vessels B) Apical three-chamber view C) Subcostal longitudinal view D) Suprasternal notch long-axis view Answer: A Explanation: The parasternal short-axis at the great vessels level directly displays the communication between the aorta and pulmonary artery. Question 48. Which of the following color Doppler settings is most appropriate to reduce aliasing when evaluating high-velocity flow across a stenotic pulmonary valve? A) Low scale (≤ 30 cm/s) B) High scale (≥ 200 cm/s) C) Narrow sector width D) Increased gain Answer: B Explanation: Raising the velocity scale (Nyquist limit) above the expected peak velocity reduces aliasing artifacts in high-velocity jets. Question 49. The most reliable echocardiographic sign of a large left-to-right shunt causing volume overload of the left heart is: A) Dilated right atrium B) Elevated pulmonary artery pressure
Disease Echocardiography Echo
CHD Ultimate Exam
Question 52. In a child with an interrupted inferior vena cava (IVC) and azygos continuation, which echocardiographic view best demonstrates the anomalous venous return? A) Subcostal transverse view with color Doppler of the hepatic veins B) Apical four-chamber view focusing on the IVC entry C) Suprasternal notch view of the aortic arch D) Parasternal long-axis view of the descending aorta Answer: A Explanation: The subcostal transverse view can show the hepatic veins draining into the atrium and the azygos continuation of the IVC. Question 53. Which parameter is most useful for estimating right ventricular afterload in a child with pulmonary hypertension? A) Tricuspid annular plane systolic excursion (TAPSE) B) Right ventricular fractional area change (RV FAC) C) Pulmonary artery acceleration time (PA AT) D) Left ventricular ejection fraction (LVEF) Answer: C Explanation: PA AT shortens with increased pulmonary artery pressure, making it a reliable surrogate for RV afterload. Question 54. The “Z-score” of an echocardiographic measurement in pediatrics is used to: A) Convert raw dimensions into standardized units for comparison across ages and body sizes B) Determine the absolute size of a structure in millimeters C) Estimate the pressure gradient across a valve D) Predict the likelihood of a genetic syndrome Answer: A
Disease Echocardiography Echo
CHD Ultimate Exam
Explanation: Z-scores express how many standard deviations a measurement deviates from the mean for a given body surface area or age. Question 55. In a patient with a repaired Tetralogy of Fallot, which finding on color Doppler most strongly suggests pulmonary regurgitation requiring intervention? A) Small central jet with peak velocity < 2 m/s B) Wide-origin, holosystolic jet extending into the main pulmonary artery C) Diastolic flow reversal occupying > 30 % of the pulmonary artery diameter D) No detectable regurgitant jet Answer: C Explanation: A large diastolic regurgitant jet occupying a substantial portion of the PA diameter indicates severe pulmonary regurgitation. Question 56. Which of the following is the primary advantage of using a matrix-array transducer for 3D/4D echocardiography in CHD assessment? A) Higher penetration depth than phased-array B) Real-time volumetric acquisition without mechanical steering C) Lower cost and easier maintenance D) Ability to perform continuous-wave Doppler simultaneously Answer: B Explanation: Matrix-array technology utilizes a grid of elements to acquire real-time 3D volumes, essential for dynamic assessment of complex CHD anatomy. Question 57. In a neonate with a large VSD, the presence of a “restrictive” VSD is best indicated by which Doppler characteristic? A) Low-velocity, laminar flow across the defect (≤ 2 m/s) B) High-velocity, turbulent flow (≥ 4 m/s) with a small jet width C) Bidirectional shunt with predominant right-to-left flow D) Absence of any detectable flow across the septum
