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Adult Echocardiography (AE) study materials
Adult Echocardiography (AE) study resources

Adult Echocardiography (AE) practice questions

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Question 1Cardiac anatomy and physiology

A normal adult aortic valve is composed of how many cusps or leaflets?

  1. Three Correct answer.
  2. Four
  3. One
  4. Two

Explanation

The normal aortic valve is tricuspid, consisting of right, left, and non-coronary cusps. A bicuspid valve is the most common congenital cardiac anomaly but does not represent normal adult anatomy.

Question 2Cardiac anatomy and physiology

Within the normal mitral valve, which leaflet is the taller, sail-shaped structure that separates inflow from the left ventricular outflow tract?

  1. Medial scallop
  2. Posterior leaflet
  3. Lateral scallop
  4. Anterior leaflet Correct answer.

Explanation

The anterior (aortic) mitral leaflet is taller and more mobile and lies between the inflow and outflow tracts. The posterior leaflet is shorter in height but attaches to a longer portion of the annulus and is divided into three scallops.

Question 3Cardiac anatomy and physiology

Which structure is a normal muscular band that crosses the right ventricular cavity from the septum to the free wall?

  1. Crista terminalis
  2. Moderator band Correct answer.
  3. Coumadin ridge
  4. Chiari network

Explanation

The moderator band (trabecula septomarginalis) traverses the right ventricular cavity and carries part of the right bundle branch. It is a reliable landmark for identifying the right ventricle.

Question 4Cardiac anatomy and physiology

A left ventricle has an end-diastolic volume of 120 mL and an end-systolic volume of 50 mL. What is the stroke volume?

  1. 2.4 mL
  2. 170 mL
  3. 50 mL
  4. 70 mL Correct answer.

Explanation

Stroke volume is the difference between end-diastolic and end-systolic volume: 120 mL minus 50 mL equals 70 mL.

Question 5Cardiac anatomy and physiology

Which range best represents a normal left ventricular ejection fraction by two-dimensional echocardiography?

  1. 30% to 45%
  2. 45% to 54%
  3. 55% to 70% Correct answer.
  4. 75% to 90%

Explanation

A normal left ventricular ejection fraction is generally 55% to 70%. Values between 45% and 54% are borderline, and values below 45% indicate reduced systolic function.

Question 6Cardiac anatomy and physiology

Left ventricular myocardial perfusion occurs predominantly during which phase of the cardiac cycle?

  1. Peak systole
  2. Diastole Correct answer.
  3. Isovolumic relaxation
  4. Isovolumic contraction

Explanation

Left coronary flow occurs mainly in diastole because systolic myocardial contraction compresses the intramural vessels. Tachycardia shortens diastole and can compromise subendocardial perfusion.

Question 7Cardiac anatomy and physiology

The normal tricuspid valve has how many leaflets?

  1. Three Correct answer.
  2. Five
  3. Two
  4. Four

Explanation

The tricuspid valve normally has three leaflets (anterior, posterior, and septal) and three papillary muscles.

Question 8Cardiac anatomy and physiology

Which pericardial layer lies directly on the surface of the myocardium?

  1. Parietal serous layer
  2. Visceral serous layer Correct answer.
  3. Fibrous pericardium
  4. Pericardial cavity

Explanation

The visceral serous pericardium, also called the epicardium, is applied directly to the myocardium. The parietal serous layer lines the fibrous pericardium, and the pericardial cavity separates the two serous layers.

Question 9Cardiac anatomy and physiology

The coronary sinus empties into which cardiac chamber?

  1. Left atrium
  2. Right atrium Correct answer.
  3. Right ventricle
  4. Left ventricle

Explanation

The coronary sinus collects most of the cardiac venous drainage and empties into the right atrium near the inferior vena cava and tricuspid annulus.

Question 10Cardiac anatomy and physiology

The left atrial appendage is best described as lying:

  1. Within the interatrial septum
  2. At the left ventricular apex
  3. Adjacent to the left upper pulmonary vein Correct answer.
  4. Posterior to the right superior pulmonary vein

Explanation

The left atrial appendage is a hook-shaped pouch at the anterolateral aspect of the left atrium, closely related to the left upper pulmonary vein and separated from it by the Coumadin ridge.

Question 11Cardiac anatomy and physiology

Within physiologic limits, increasing left ventricular preload produces which change according to the Frank-Starling relationship?

  1. Increased stroke volume Correct answer.
  2. Reduced stroke volume
  3. Reduced myocardial fiber length
  4. Reduced cardiac output

Explanation

Greater preload stretches the myocardial fibers and increases sarcomere length, which enhances force generation and raises stroke volume within physiologic limits.

Question 12Cardiac anatomy and physiology

Using the simplified Bernoulli equation, what pressure gradient corresponds to a peak velocity of 3 m/s?

  1. 9 mmHg
  2. 36 mmHg Correct answer.
  3. 18 mmHg
  4. 72 mmHg

Explanation

The simplified Bernoulli equation is ΔP = 4v². For a velocity of 3 m/s, 4 × 3² equals 36 mmHg.

Question 13Cardiac anatomy and physiology

Which expression correctly applies the continuity equation to calculate aortic valve area?

  1. LVOT area × aortic valve VTI ÷ LVOT VTI
  2. Aortic valve VTI ÷ LVOT VTI
  3. (LVOT area × LVOT VTI) ÷ aortic valve VTI Correct answer.
  4. (LVOT diameter × LVOT VTI) ÷ aortic valve VTI

Explanation

Conservation of flow requires that aortic valve area equals the LVOT cross-sectional area multiplied by the LVOT velocity-time integral, divided by the aortic valve velocity-time integral.

Question 14Cardiac anatomy and physiology

During isovolumic contraction, which statement about the mitral and aortic valves is true?

  1. Both the mitral and aortic valves are closed Correct answer.
  2. Both the mitral and aortic valves are open
  3. The mitral valve is open and the aortic valve is closed
  4. The aortic valve is open and the mitral valve is closed

Explanation

Isovolumic contraction begins with mitral closure and ends with aortic opening. During this interval both valves are closed and ventricular pressure rises at constant volume.

Question 15Cardiac anatomy and physiology

A reduced medial mitral annular e′ velocity on tissue Doppler most directly indicates:

  1. Impaired left ventricular relaxation Correct answer.
  2. Pericardial constriction
  3. Severe aortic stenosis
  4. Increased left ventricular contractility

Explanation

Annular e′ reflects the rate of myocardial lengthening in early diastole, so a low e′ indicates impaired relaxation and is less load-dependent than mitral inflow velocities.

Question 16Cardiac anatomy and physiology

A short mitral inflow E-wave deceleration time of less than 160 ms in a patient with reduced ejection fraction suggests:

  1. Mild grade I diastolic dysfunction
  2. Normal diastolic function
  3. Constrictive pericarditis
  4. Elevated left atrial pressure Correct answer.

Explanation

A short deceleration time reflects rapid equalization of left atrial and left ventricular pressures, a restrictive filling pattern associated with high left atrial pressure and adverse prognosis.

Question 17Cardiac anatomy and physiology

Which method is the recommended two-dimensional technique for measuring left ventricular volumes and ejection fraction?

  1. Cube formula
  2. Area-length method from long axis
  3. Teichholz formula
  4. Biplane disks method Correct answer.

Explanation

The biplane method of disks (modified Simpson's rule) traces the endocardial border in two orthogonal planes and sums disk volumes, making it the recommended two-dimensional approach.

Question 18Cardiac anatomy and physiology

According to the Laplace relationship, left ventricular wall stress increases when:

  1. Both radius and thickness decrease
  2. Both radius and thickness increase
  3. Chamber radius increases Correct answer.
  4. Wall thickness increases

Explanation

Wall stress is proportional to chamber radius and inversely proportional to wall thickness, so a larger chamber with unchanged wall thickness faces greater stress.

Question 19Cardiac anatomy and physiology

Regurgitant volume across an insufficient valve can be calculated as:

  1. Jet VTI divided by EROA
  2. EROA divided by VTI
  3. EROA times heart rate
  4. EROA times jet VTI Correct answer.

Explanation

Regurgitant volume equals the effective regurgitant orifice area multiplied by the velocity-time integral of the regurgitant jet.

Question 20Cardiac anatomy and physiology

The aortic valve opens at the moment when:

  1. Aortic pressure exceeds left ventricular pressure
  2. Left ventricular volume is at its minimum
  3. Left ventricular pressure exceeds aortic pressure Correct answer.
  4. Left atrial pressure exceeds left ventricular pressure

Explanation

The aortic valve opens when left ventricular pressure rises above aortic diastolic pressure, terminating isovolumic contraction and beginning ejection.

Question 21Cardiac anatomy and physiology

Coronary flow velocity reserve is calculated as:

  1. Hyperemic velocity minus resting velocity
  2. Resting velocity multiplied by heart rate
  3. Resting divided by hyperemic velocity
  4. Hyperemic divided by resting velocity Correct answer.

Explanation

Coronary flow velocity reserve is the ratio of hyperemic, usually adenosine-induced, to resting diastolic coronary flow velocity. A value below about 2.0 suggests impaired epicardial or microvascular reserve.

Question 22Cardiac anatomy and physiology

Under laminar flow conditions, volume flow through a vessel varies in proportion to which expression for the vessel radius?

  1. Cube of the vessel radius
  2. Square of the radius and vessel length
  3. Fourth power of radius Correct answer.
  4. First power of the radius

Explanation

In the Poiseuille relationship, resistance is inversely proportional to the fourth power of the radius, so flow varies with radius to the fourth power. Small changes in radius therefore produce large changes in flow.

Question 23Cardiac anatomy and physiology

In cardiac myocytes, calcium entering through L-type channels during the plateau phase triggers:

  1. Phosphorylation of myosin light chains
  2. Sarcoplasmic reticulum calcium release Correct answer.
  3. Mitochondrial calcium accumulation
  4. Closure of L-type calcium channels

Explanation

Calcium entry during the plateau triggers calcium-induced calcium release from the sarcoplasmic reticulum through ryanodine receptors. The resulting rise in cytosolic calcium initiates contraction.

Question 24Cardiac anatomy and physiology

At rest, the coronary circulation extracts approximately what fraction of the oxygen delivered in arterial blood?

  1. 70% to 80% Correct answer.
  2. 10% to 20%
  3. 25% to 35%
  4. 40% to 50%

Explanation

The myocardium extracts about 70% to 80% of delivered oxygen at rest, close to the maximum. Increased oxygen demand must therefore be met mainly by increasing coronary blood flow.

Question 25Cardiac anatomy and physiology

Which factor best explains the higher resting oxygen consumption of the left ventricle compared with the right ventricle?

  1. Higher systolic wall stress Correct answer.
  2. Lower coronary flow reserve
  3. Greater chamber compliance
  4. Thinner free wall

Explanation

Left ventricular systolic pressure and wall stress are far higher than those of the right ventricle, and wall stress is the major determinant of myocardial oxygen demand. Chamber compliance and coronary reserve do not explain the difference in demand.

Question 26Cardiac anatomy and physiology

Which cardiac chamber forms the apex of the heart?

  1. Right ventricle
  2. Left ventricle Correct answer.
  3. Left atrium
  4. Right atrium

Explanation

The left ventricle forms the cardiac apex because its thick myocardial wall extends inferiorly and to the left. The right ventricle forms most of the anterior surface, while the atria occupy the base of the heart.

Question 27Cardiac anatomy and physiology

The moderator band is a normal muscular structure located within which chamber?

  1. Left ventricular cavity
  2. Right ventricle Correct answer.
  3. Left atrial chamber
  4. Right atrial chamber

Explanation

The moderator band, or septomarginal trabecula, extends from the interventricular septum to the anterior papillary muscle in the right ventricle. It carries part of the conduction system and is a recognized right ventricular landmark.

Question 28Cardiac anatomy and physiology

The fossa ovalis is a remnant located on which structure?

  1. Mitral annulus
  2. Aortic root
  3. Interatrial septum Correct answer.
  4. Ventricular septum

Explanation

The fossa ovalis is the residual depression of the foramen ovale on the right atrial side of the interatrial septum. It is an important landmark for transseptal puncture and for identifying the atrial septum on echocardiography.

Question 29Cardiac anatomy and physiology

Which great vessel originates from the right ventricle?

  1. Pulmonary veins
  2. Aorta
  3. Pulmonary artery Correct answer.
  4. Superior vena cava

Explanation

The right ventricle ejects blood through the pulmonary valve into the main pulmonary artery. The aorta arises from the left ventricle, while the venae cavae and pulmonary veins return blood to the atria.

Question 30Cardiac anatomy and physiology

Which coronary artery most commonly supplies the anterior two-thirds of the interventricular septum?

  1. Posterior descending artery
  2. Left circumflex artery
  3. LAD artery Correct answer.
  4. Right coronary artery

Explanation

The left anterior descending artery gives off septal perforator branches that supply the anterior and middle portions of the interventricular septum. The posterior descending artery typically supplies the posterior one-third of the septum.

Question 31Cardiac anatomy and physiology

The sinoatrial node lies at the junction of which two structures?

  1. Pulmonary veins and left atrium
  2. Aorta and pulmonary trunk
  3. SVC and right atrium
  4. IVC and right atrium Correct answer.

Explanation

The sinoatrial node is located at the superior cavoatrial junction, where the superior vena cava enters the right atrium. This site allows it to serve as the dominant pacemaker of the heart.

Question 32Cardiac anatomy and physiology

The posteromedial papillary muscle differs from the anterolateral papillary muscle in that it usually:

  1. Attaches directly to the ventricular septum
  2. Supports the aortic leaflets
  3. Receives a dual blood supply
  4. Has a single blood supply Correct answer.

Explanation

The posteromedial papillary muscle usually receives blood from a single source, either the right coronary artery or the left circumflex artery. This makes it more vulnerable to ischemic rupture than the anterolateral papillary muscle, which often has a dual supply.

Question 33Cardiac anatomy and physiology

On an aortic pressure tracing, the dicrotic notch coincides with which event?

  1. Peak left atrial pressure
  2. Closure of the pulmonary valve
  3. Opening of the mitral valve
  4. Closure of the aortic valve Correct answer.

Explanation

The dicrotic notch reflects the brief reversal of aortic flow that occurs when the aortic valve closes at end systole. It marks the beginning of diastole in the aortic pressure waveform.

Question 34Cardiac anatomy and physiology

On a left ventricular pressure-volume loop, the area enclosed by the loop represents:

  1. Myocardial oxygen consumption
  2. Coronary flow reserve
  3. Left atrial work
  4. Stroke work Correct answer.

Explanation

The area within the pressure-volume loop equals stroke volume multiplied by the developed pressure, which is stroke work. Myocardial oxygen consumption correlates with work but is not directly equal to the loop area.

Question 35Cardiac anatomy and physiology

Which left ventricular wall segment is supplied by the posterior descending artery in a right-dominant system?

  1. Lateral wall
  2. Inferior wall Correct answer.
  3. Anterior septum
  4. Anterolateral wall

Explanation

In a right-dominant system, the posterior descending artery arises from the right coronary artery and supplies the inferior wall and posterior septum. The anterior septum and anterolateral wall are supplied mainly by the left anterior descending artery.

Question 36Cardiac anatomy and physiology

The great cardiac vein travels in which sulcus?

  1. Coronary sinus sulcus
  2. Posterior atrioventricular sulcus
  3. Anterior interventricular sulcus Correct answer.
  4. Right atrioventricular sulcus

Explanation

The great cardiac vein ascends in the anterior interventricular sulcus alongside the left anterior descending artery. It then curves around the left atrioventricular groove to continue as the coronary sinus.

Question 37Cardiac anatomy and physiology

During a normal cardiac cycle, which event occurs first after the QRS complex on the ECG?

  1. Opening of the mitral valve
  2. Peak mitral inflow E wave
  3. Closure of the aortic valve
  4. Closure of the mitral valve Correct answer.

Explanation

The QRS complex marks ventricular depolarization, which is followed almost immediately by mitral valve closure and the onset of isovolumic contraction. Aortic valve opening occurs later, after left ventricular pressure exceeds aortic pressure.

Question 38Cardiac anatomy and physiology

Which embryologic structure gives rise to the coronary sinus?

  1. Bulbus cordis
  2. Right horn of the sinus venosus
  3. Left horn of the sinus venosus Correct answer.
  4. Septum primum

Explanation

The coronary sinus develops from the left horn of the sinus venosus. The right horn of the sinus venosus contributes to the smooth-walled portion of the right atrium.

Question 39Cardiac anatomy and physiology

In a left-dominant coronary system, which artery gives rise to the posterior descending artery?

  1. Right coronary artery
  2. Left anterior descending artery
  3. Left circumflex artery Correct answer.
  4. First diagonal branch

Explanation

Coronary dominance is defined by the artery that supplies the posterior descending artery. In a left-dominant system, the posterior descending artery arises from the left circumflex artery.

Question 40Cardiac anatomy and physiology

Which pericardial recess lies posterior to the left atrium and is bounded by the pulmonary veins?

  1. Transverse sinus
  2. Oblique sinus Correct answer.
  3. Anterior interventricular sulcus
  4. Coronary sinus

Explanation

The oblique pericardial sinus is a blind recess posterior to the left atrium, bounded laterally by the pulmonary veins and inferiorly by the inferior vena cava. The transverse sinus lies more superiorly, posterior to the aorta and pulmonary trunk.

Question 41Ultrasound physics and instrumentation

Clinical ultrasound scanners assume an average propagation speed through soft tissue of:

  1. 4080 m/s
  2. 1540 m/s Correct answer.
  3. 1450 m/s
  4. 331 m/s

Explanation

Almost all soft-tissue imaging assumes a speed of 1540 m/s, which is used to convert echo return time into depth. Tissues with very different speeds, such as lung, bone and fat, cause the displayed position of structures to be inaccurate.

Question 42Ultrasound physics and instrumentation

If the transmitted frequency is increased while propagation speed stays constant, the wavelength:

  1. It decreases Correct answer.
  2. It stays the same
  3. It doubles
  4. It increases proportionally

Explanation

Wavelength equals propagation speed divided by frequency. With speed held constant, wavelength and frequency are inversely related, so a higher frequency produces a shorter wavelength and better axial resolution.

Question 43Ultrasound physics and instrumentation

The piezoelectric element of an imaging transducer functions to:

  1. It focuses the beam by refraction at the skin surface
  2. It converts electrical energy into acoustic energy and back Correct answer.
  3. It amplifies the returning echo signal before it is digitised
  4. It stores the returning echoes as digital data

Explanation

Piezoelectric crystals deform when a voltage is applied and generate a voltage when deformed, so the same element both transmits and receives. Beam formation, amplification and storage are handled by other components of the system.

Question 44Ultrasound physics and instrumentation

The purpose of time gain compensation is to:

  1. It increases the overall brightness of the entire image uniformly
  2. It compensates for attenuation by increasing gain with depth Correct answer.
  3. It filters out low-frequency Doppler shifts from moving tissue
  4. It narrows the sector width to improve frame rate

Explanation

Echoes from deeper structures are weaker because of attenuation along the round-trip path. Time gain compensation applies progressively greater amplification at later arrival times so that similar reflectors appear equally bright at all depths.

Question 45Ultrasound physics and instrumentation

Which practice best follows the ALARA principle during a transthoracic echocardiogram?

  1. Applying colour Doppler over the whole sector by default
  2. Prolonging the examination to document additional normal variants
  3. Using the lowest output power that gives diagnostic images Correct answer.
  4. Maximising output power to reduce noise in all patients

Explanation

ALARA means keeping acoustic exposure as low as reasonably achievable while still obtaining the diagnostic information needed. Output power, dwell time and selection of modes such as colour or Doppler all contribute to patient exposure.

Question 46Ultrasound physics and instrumentation

The thermal index displayed on an ultrasound system estimates the:

  1. Tissue heating from absorbed acoustic energy Correct answer.
  2. Peak negative pressure of the transmitted pulse
  3. Amount of signal amplification applied by the receiver
  4. Likelihood of microbubble collapse in tissue

Explanation

The thermal index relates to the potential for temperature rise as acoustic energy is absorbed and converted to heat. The mechanical index, in contrast, relates to non-thermal effects such as cavitation.

Question 47Ultrasound physics and instrumentation

Compared with two-dimensional imaging, M-mode provides:

  1. Better lateral resolution across the sector
  2. A wider field of view of the ventricles
  3. Improved colour Doppler sensitivity
  4. Better temporal resolution along one line Correct answer.

Explanation

M-mode samples a single line with a high pulse repetition frequency, so the sampling rate along that line is very high. This allows precise timing of rapid events such as valve motion or wall excursion, at the expense of spatial coverage.

Question 48Ultrasound physics and instrumentation

Continuous-wave Doppler is characterised by:

  1. Aliasing whenever velocity exceeds 1.5 m/s
  2. Continuous transmission with no range resolution Correct answer.
  3. A single crystal that alternates transmission and reception
  4. Range resolution that improves as PRF increases

Explanation

Continuous-wave Doppler uses separate elements to transmit and receive simultaneously along the whole line of sight. Because echoes are received continuously, no depth information is available, but there is no Nyquist limit and therefore no aliasing.

Question 49Ultrasound physics and instrumentation

Axial resolution is determined primarily by the:

  1. Beam width at the focal zone
  2. Spatial pulse length Correct answer.
  3. Line density of the scan converter
  4. Element thickness of the matching layer

Explanation

Axial resolution equals half the spatial pulse length, so shorter pulses discriminate reflectors that are closer together along the beam. Pulse length is set by the number of cycles and the wavelength, so higher frequency and fewer cycles both improve it.

Question 50Ultrasound physics and instrumentation

A pulsed-wave Doppler system operating at a pulse repetition frequency of 5000 Hz has a Nyquist limit of:

  1. 10 000 Hz
  2. 1250 Hz
  3. 2500 Hz Correct answer.
  4. 5000 Hz

Explanation

The Nyquist limit is half the pulse repetition frequency, so 5000 Hz gives 2500 Hz. Doppler shifts above this value are aliased and displayed at an incorrect velocity or direction.