CCI RCS 2 ā Questions and Answers
Question 1: Which Doppler modality is MOST appropriate for measuring high-velocity jets such as severe aortic stenosis?
- Pulsed-wave Doppler
- Continuous-wave Doppler (Correct answer)
- Color flow Doppler
- Tissue Doppler imaging
Correct answer: Continuous-wave Doppler
Continuous-wave Doppler has no aliasing limit and can accurately measure high-velocity jets that exceed the Nyquist limit of pulsed-wave Doppler.
Question 2: On M-mode echocardiography, the E-point septal separation (EPSS) is used to estimate:
- Right ventricular pressure
- Left ventricular ejection fraction (Correct answer)
- Mitral valve area
- Pulmonary artery pressure
Correct answer: Left ventricular ejection fraction
EPSS reflects the distance between the anterior mitral leaflet E-point and the interventricular septum; a value >7 mm suggests reduced LVEF.
Question 3: A patient has a tricuspid regurgitation jet velocity of 3.5 m/s and an estimated right atrial pressure of 10 mmHg. What is the estimated RVSP?
- 49 mmHg
- 59 mmHg (Correct answer)
- 39 mmHg
- 69 mmHg
Correct answer: 59 mmHg
RVSP = 4vĀ² + RAP = 4(3.5)Ā² + 10 = 49 + 10 = 59 mmHg using the simplified Bernoulli equation.
Question 4: Which echocardiographic view best demonstrates the left ventricular outflow tract (LVOT) for velocity measurement by pulsed-wave Doppler?
- Parasternal short-axis at the aortic valve level
- Apical five-chamber view (Correct answer)
- Subcostal four-chamber view
- Parasternal long-axis with posterior angulation
Correct answer: Apical five-chamber view
The apical five-chamber view aligns the Doppler beam parallel to LVOT flow, minimizing the angle of incidence for accurate velocity measurement.
Question 5: Which tissue Doppler parameter is used as a surrogate for left ventricular filling pressure?
- E/e' ratio (Correct answer)
- S' velocity
- A' velocity
- e'/a' ratio
Correct answer: E/e' ratio
The E/e' ratio (transmitral E velocity divided by mitral annular e' velocity) correlates with mean left atrial pressure and LV diastolic filling pressure.
Question 6: In a patient with severe mitral regurgitation, which finding on color Doppler indicates a proximal isovelocity surface area (PISA) radius appropriate for calculating effective regurgitant orifice area?
- Vena contracta width >7 mm
- A hemispheric flow convergence zone proximal to the mitral valve (Correct answer)
- Pulmonary vein systolic flow reversal
- An eccentric jet impinging on the posterior left atrial wall
Correct answer: A hemispheric flow convergence zone proximal to the mitral valve
PISA method requires identifying a hemispheric convergence zone of accelerating flow proximal to the regurgitant orifice, which is then used with aliasing velocity to calculate EROA.
Question 7: Which congenital lesion classically produces a 'double density' sign on chest X-ray and a dilated right atrium on echocardiography?
- Ventricular septal defect
- Ebstein anomaly (Correct answer)
- Tetralogy of Fallot
- Coarctation of the aorta
Correct answer: Ebstein anomaly
Ebstein anomaly causes massive right atrial and atrialized right ventricular enlargement, producing a 'box-shaped' heart with a double density on CXR.
CCI RCS 2
Which Doppler modality is MOST appropriate for measuring high-velocity jets such as severe aortic stenosis?