NBE Pediatric Echocardiography 4

Question 1

When performing echocardiography on a premature neonate with a hemodynamically significant patent ductus arteriosus (PDA), which finding best indicates left heart volume overload?

Accepted Answer

Elevated LA:Ao ratio greater than 1.4:1

Answer

An LA:Ao ratio >1.4:1 indicates left atrial enlargement from increased pulmonary venous return, reflecting significant left heart volume overload from a large left-to-right PDA shunt.

Question 2

A 5-year-old child with a history of repaired tetralogy of Fallot now has significant pulmonary regurgitation. Which echocardiographic parameter is most important to monitor for timing of pulmonary valve replacement?

Accepted Answer

Right ventricular size and systolic function (including RV volumes by 3D echo or MRI correlation)

Answer

After TOF repair, progressive right ventricular dilation and dysfunction from pulmonary regurgitation are the primary indications for pulmonary valve replacement; RV size and function are monitored closely.

Question 3

In the subcostal view during pediatric echocardiography, which structure is best visualized to assess situs and atrial morphology?

Accepted Answer

Relationship of the inferior vena cava and aorta to the spine, and drainage into the right atrium

Answer

The subcostal view allows visualization of the IVC and aorta relative to the spine (IVC right, aorta left = situs solitus) and confirms IVC drainage into the morphologic right atrium.

Question 4

A pediatric patient with Marfan syndrome requires echocardiographic surveillance. Which measurement is the primary focus of aortic root monitoring?

Accepted Answer

Aortic root diameter at the sinuses of Valsalva with Z-score calculation

Answer

In Marfan syndrome, aortic root dilation at the sinuses of Valsalva is the most common and dangerous manifestation; serial measurement with Z-score normalization guides prophylactic surgery timing.

Question 5

Which echocardiographic finding is most consistent with cardiac tamponade in a child with pericardial effusion?

Accepted Answer

Right atrial systolic collapse and right ventricular diastolic collapse with respiratory variation in mitral inflow

Answer

Tamponade physiology is confirmed by right atrial systolic collapse, right ventricular diastolic collapse, and exaggerated respiratory variation (>25%) in mitral inflow velocity.

(NBE) National Board of Echocardiography Practice Test

(NBE) National Board of Echocardiography Practice Test

NBE Pediatric Echocardiography 4