ARDMS PE paediatric Echocardiography Certification Exam 2026:
Comprehensive Professional Practice Test — Cardiac Anatomy,
Congenital Heart Defects, Acquired Heart Disease, Postoperative
Anatomy & Echocardiographic Techniques — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Question 1
A neonate is undergoing a screening echocardiogram at 24 hours of life. The sonographer
demonstrates flow across the foramen ovale. What is the expected direction of this flow in a
normal neonate at this age?
A. Left-to-right
B. Right-to-left
C. Bidirectional, predominantly right-to-left
D. Bidirectional, predominantly left-to-right
Correct Answer: C
Explanation: Immediately after birth, pulmonary vascular resistance remains elevated, so
right-to-left shunting across the foramen ovale may persist briefly before transitioning to left-
to-right as PVR falls.
Question 2
A 5-year-old child presents with a continuous murmur at the left infraclavicular region.
Echocardiography demonstrates a patent ductus arteriosus. Which of the following Doppler
findings is most characteristic of this lesion?
,A. High-velocity diastolic flow in the main pulmonary artery
B. Continuous high-velocity flow in the main pulmonary artery throughout the cardiac cycle
C. Systolic flow reversal in the descending aorta
D. Holosystolic flow in the left pulmonary artery
Correct Answer: B
Explanation: A PDA produces continuous flow from the aorta to the pulmonary artery
throughout systole and diastole because aortic pressure exceeds pulmonary artery pressure
in both phases.
Question 3
A sonographer is performing a segmental analysis on a patient with suspected heterotaxy.
The abdominal situs is identified as left-sided liver and right-sided stomach. Which type of
situs is most consistent with this finding?
A. Situs solitus
B. Situs inversus
C. Situs ambiguus
D. Situs inversus totalis
Correct Answer: C
Explanation: Discordance between abdominal organ positions (e.g., left-sided liver with
right-sided stomach) defines situs ambiguus, which is commonly associated with heterotaxy
syndromes.
Question 4
,A 3-year-old child with a history of Kawasaki disease undergoes echocardiography. Which
coronary artery finding is most concerning for long-term morbidity?
A. Coronary artery dilation with Z-score of 1.5
B. Giant coronary aneurysm with Z-score ≥10
C. Mild coronary artery ectasia with Z-score of 2.0
D. Coronary artery Z-score of 2.5 at 6 weeks post-illness
Correct Answer: B
Explanation: Giant coronary aneurysms (Z-score ≥10) in Kawasaki disease carry the highest
risk for thrombosis, stenosis, and myocardial infarction, requiring long-term anticoagulation.
Question 5
During a fetal echocardiogram at 28 weeks gestation, the sonographer notes the ductus
venosus. Which vessel does the ductus venosus connect?
A. Umbilical artery to the descending aorta
B. Umbilical vein to the inferior vena cava
C. Main pulmonary artery to the descending aorta
D. Right atrium to the left atrium
Correct Answer: B
Explanation: The ductus venosus shunts oxygenated blood from the umbilical vein directly
into the inferior vena cava, bypassing the hepatic sinusoidal system.
Question 6
, A 12-year-old patient with Turner syndrome is referred for echocardiography. Which
cardiovascular abnormality is most strongly associated with this condition?
A. Bicuspid aortic valve with coarctation of the aorta
B. Ebstein anomaly
C. Tetralogy of Fallot
D. Total anomalous pulmonary venous return
Correct Answer: A
Explanation: Turner syndrome (45,X) is strongly associated with left-sided obstructive
lesions, particularly bicuspid aortic valve and coarctation of the aorta.
Question 7
A sonographer obtains a spectral Doppler tracing from the main pulmonary artery in a
healthy 2-year-old. Which of the following flow characteristics is normal?
A. Continuous retrograde flow throughout diastole
B. Systolic flow with a brief early diastolic reversal and mid-diastolic antegrade flow
C. High-velocity continuous flow exceeding 2.5 m/s
D. Absent systolic flow with only diastolic flow
Correct Answer: B
Explanation: Normal main pulmonary artery Doppler demonstrates antegrade systolic flow
with a small early diastolic reversal (from pulmonary valve closure) and low-velocity mid-
diastolic antegrade flow.
Comprehensive Professional Practice Test — Cardiac Anatomy,
Congenital Heart Defects, Acquired Heart Disease, Postoperative
Anatomy & Echocardiographic Techniques — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Question 1
A neonate is undergoing a screening echocardiogram at 24 hours of life. The sonographer
demonstrates flow across the foramen ovale. What is the expected direction of this flow in a
normal neonate at this age?
A. Left-to-right
B. Right-to-left
C. Bidirectional, predominantly right-to-left
D. Bidirectional, predominantly left-to-right
Correct Answer: C
Explanation: Immediately after birth, pulmonary vascular resistance remains elevated, so
right-to-left shunting across the foramen ovale may persist briefly before transitioning to left-
to-right as PVR falls.
Question 2
A 5-year-old child presents with a continuous murmur at the left infraclavicular region.
Echocardiography demonstrates a patent ductus arteriosus. Which of the following Doppler
findings is most characteristic of this lesion?
,A. High-velocity diastolic flow in the main pulmonary artery
B. Continuous high-velocity flow in the main pulmonary artery throughout the cardiac cycle
C. Systolic flow reversal in the descending aorta
D. Holosystolic flow in the left pulmonary artery
Correct Answer: B
Explanation: A PDA produces continuous flow from the aorta to the pulmonary artery
throughout systole and diastole because aortic pressure exceeds pulmonary artery pressure
in both phases.
Question 3
A sonographer is performing a segmental analysis on a patient with suspected heterotaxy.
The abdominal situs is identified as left-sided liver and right-sided stomach. Which type of
situs is most consistent with this finding?
A. Situs solitus
B. Situs inversus
C. Situs ambiguus
D. Situs inversus totalis
Correct Answer: C
Explanation: Discordance between abdominal organ positions (e.g., left-sided liver with
right-sided stomach) defines situs ambiguus, which is commonly associated with heterotaxy
syndromes.
Question 4
,A 3-year-old child with a history of Kawasaki disease undergoes echocardiography. Which
coronary artery finding is most concerning for long-term morbidity?
A. Coronary artery dilation with Z-score of 1.5
B. Giant coronary aneurysm with Z-score ≥10
C. Mild coronary artery ectasia with Z-score of 2.0
D. Coronary artery Z-score of 2.5 at 6 weeks post-illness
Correct Answer: B
Explanation: Giant coronary aneurysms (Z-score ≥10) in Kawasaki disease carry the highest
risk for thrombosis, stenosis, and myocardial infarction, requiring long-term anticoagulation.
Question 5
During a fetal echocardiogram at 28 weeks gestation, the sonographer notes the ductus
venosus. Which vessel does the ductus venosus connect?
A. Umbilical artery to the descending aorta
B. Umbilical vein to the inferior vena cava
C. Main pulmonary artery to the descending aorta
D. Right atrium to the left atrium
Correct Answer: B
Explanation: The ductus venosus shunts oxygenated blood from the umbilical vein directly
into the inferior vena cava, bypassing the hepatic sinusoidal system.
Question 6
, A 12-year-old patient with Turner syndrome is referred for echocardiography. Which
cardiovascular abnormality is most strongly associated with this condition?
A. Bicuspid aortic valve with coarctation of the aorta
B. Ebstein anomaly
C. Tetralogy of Fallot
D. Total anomalous pulmonary venous return
Correct Answer: A
Explanation: Turner syndrome (45,X) is strongly associated with left-sided obstructive
lesions, particularly bicuspid aortic valve and coarctation of the aorta.
Question 7
A sonographer obtains a spectral Doppler tracing from the main pulmonary artery in a
healthy 2-year-old. Which of the following flow characteristics is normal?
A. Continuous retrograde flow throughout diastole
B. Systolic flow with a brief early diastolic reversal and mid-diastolic antegrade flow
C. High-velocity continuous flow exceeding 2.5 m/s
D. Absent systolic flow with only diastolic flow
Correct Answer: B
Explanation: Normal main pulmonary artery Doppler demonstrates antegrade systolic flow
with a small early diastolic reversal (from pulmonary valve closure) and low-velocity mid-
diastolic antegrade flow.
