EACVI/AEPC CONGENITAL HEART DISEASE ECHOCARDIOGRAPHY
(ECHO CHD) PRACTICE EXAM |2026 QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES EACH | CURRENTLY TESTING
AND FREQUENTLY TESTED QUESTIONS| EXPERT VERIFIED FOR
GUARANTEED PASS |LATEST UPDATE
SECTION 1: GENERAL CONCEPTS (Questions 1–20)
1. What is the primary clinical role of echocardiography in paediatric and
congenital heart disease?
A) To replace cardiac catheterisation in all cases
B) To provide anatomical and haemodynamic information for diagnosis, surgical
planning, and follow-up
C) To assess only ventricular function
D) To screen for coronary artery disease
E) To measure cardiac output exclusively
Answer: B
Rationale: Echocardiography in CHD serves multiple roles: initial diagnosis,
assessment for surgical or catheter intervention, post-procedural review, and
long-term follow-up. It cannot replace catheterisation in all cases (A), is not
limited to ventricular function (C), and coronary assessment is not its primary role
in CHD (D). Measuring cardiac output is one component but not the sole purpose
(E).
2. Which of the following is NOT a recognised advantage of a physiologist-led
echocardiography service in CHD?
A) Improved continuity of care
B) Reduced waiting times
C) Independent reporting of complex CHD cases without physician oversight
D) Cost-effectiveness
E) Standardised image acquisition protocols
Answer: C
Rationale: Physiologist-led services offer continuity, efficiency, and
standardisation, but complex CHD cases require physician oversight for reporting.
Independent reporting of complex cases without oversight is not a recognised
advantage and may be unsafe.
1
,3. What is the most important safety consideration when performing
echocardiography in a child requiring conscious sedation?
A) Using the highest possible acoustic power to reduce scan time
B) Ensuring appropriate monitoring, dosage, and recovery facilities
C) Avoiding the use of colour Doppler
D) Performing the study without parental consent
E) Using only M-mode imaging
Answer: B
Rationale: Conscious sedation in children requires appropriate monitoring
(oxygen saturation, heart rate), correct weight-based dosage, and recovery
facilities. Power levels should be kept as low as reasonably achievable (ALARA),
and consent is mandatory.
4. In the context of ultrasound safety, what does the ALARA principle stand for?
A) As Low As Reasonably Achievable
B) Always Limit Acoustic Radiation Amplitude
C) Adjust Level According to Required Accuracy
D) Apply Lowest Attenuation for Rapid Assessment
E) Avoid Long Acquisitions with Rapid Angling
Answer: A
Rationale: ALARA (As Low As Reasonably Achievable) is the fundamental safety
principle in ultrasound, meaning output power and exposure time should be
minimised while obtaining diagnostic images.
5. Which document defines the standard terminology for describing congenital
heart disease?
A) The Montreal Classification
B) Segmental sequential analysis
C) The NYHA classification
D) The ACC/AHA valve guidelines
E) The REACH registry
Answer: B
Rationale: Segmental sequential analysis is the internationally accepted method
for describing CHD, systematically defining atrial situs, ventricular loop, and
ventriculoarterial connections.
6. In the segmental approach, what does “visceroatrial situs solitus” mean?
2
,A) Right atrium on the left, liver on the left
B) Right atrium on the right, liver on the right
C) Right atrium on the right, liver on the left
D) Right atrium on the left, liver on the right
E) Both atria on the right
Answer: B
Rationale: Situs solitus describes the normal arrangement: right atrium on the
right, left atrium on the left, liver on the right, and stomach on the left.
7. Which of the following defines ventriculoarterial concordance?
A) Right atrium connects to right ventricle
B) Right ventricle connects to aorta
C) Right ventricle connects to pulmonary artery
D) Left ventricle connects to pulmonary artery
E) Both ventricles connect to the aorta
Answer: C
Rationale: Ventriculoarterial concordance means the right ventricle connects to
the pulmonary artery and the left ventricle connects to the aorta — the normal
arrangement.
8. A heart with atrioventricular discordance and ventriculoarterial discordance is
best described as:
A) Tetralogy of Fallot
B) Transposition of the great arteries (d-TGA)
C) Congenitally corrected TGA (l-TGA)
D) Double outlet right ventricle
E) Truncus arteriosus
Answer: C
Rationale: l-TGA (congenitally corrected TGA) has both atrioventricular and
ventriculoarterial discordance, resulting in physiologically corrected circulation.
9. What is the normal relationship of the great arteries in the parasternal short-
axis view?
A) Aorta anterior and right of the pulmonary artery
B) Pulmonary artery anterior and left of the aorta
C) Aorta posterior and right of the pulmonary artery
D) Pulmonary artery posterior and left of the aorta
E) Both arteries side by side
3
, Answer: B
Rationale: In the normal heart, the pulmonary artery wraps around the aorta. In
the parasternal short-axis view, the pulmonary artery is anterior and left of the
central aorta.
10. Which of the following is a characteristic echocardiographic feature of the
morphological right ventricle?
A) Smooth septal surface
B) Presence of a moderator band
C) Bicuspid atrioventricular valve
D) Elliptical shape in short-axis
E) Absence of trabeculations
Answer: B
Rationale: The morphological RV is identified by a moderator band, coarse
trabeculations, and a trileaflet (tricuspid) atrioventricular valve.
11. The “criss-cross” heart is characterised by:
A) Parallel orientation of the atrioventricular valves
B) Crossing of the atrioventricular valve inflows
C) Absence of the atrial septum
D) A common atrioventricular valve
E) Double outlet right ventricle
Answer: B
Rationale: In criss-cross heart, the atrioventricular connections are crossed, so the
atrial and ventricular septa are not aligned, creating a crossing appearance of the
inflows.
12. Which of the following defines an “overriding” aorta?
A) The aorta arises entirely from the right ventricle
B) The aorta is positioned above a ventricular septal defect, with its annulus
committed to both ventricles
C) The aorta arises from the left ventricle but is positioned anteriorly
D) The aorta is hypoplastic
E) The aorta is posterior to the pulmonary artery
Answer: B
Rationale: An overriding aorta is positioned above a VSD and receives blood from
both ventricles, a key feature of Tetralogy of Fallot.
4
(ECHO CHD) PRACTICE EXAM |2026 QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES EACH | CURRENTLY TESTING
AND FREQUENTLY TESTED QUESTIONS| EXPERT VERIFIED FOR
GUARANTEED PASS |LATEST UPDATE
SECTION 1: GENERAL CONCEPTS (Questions 1–20)
1. What is the primary clinical role of echocardiography in paediatric and
congenital heart disease?
A) To replace cardiac catheterisation in all cases
B) To provide anatomical and haemodynamic information for diagnosis, surgical
planning, and follow-up
C) To assess only ventricular function
D) To screen for coronary artery disease
E) To measure cardiac output exclusively
Answer: B
Rationale: Echocardiography in CHD serves multiple roles: initial diagnosis,
assessment for surgical or catheter intervention, post-procedural review, and
long-term follow-up. It cannot replace catheterisation in all cases (A), is not
limited to ventricular function (C), and coronary assessment is not its primary role
in CHD (D). Measuring cardiac output is one component but not the sole purpose
(E).
2. Which of the following is NOT a recognised advantage of a physiologist-led
echocardiography service in CHD?
A) Improved continuity of care
B) Reduced waiting times
C) Independent reporting of complex CHD cases without physician oversight
D) Cost-effectiveness
E) Standardised image acquisition protocols
Answer: C
Rationale: Physiologist-led services offer continuity, efficiency, and
standardisation, but complex CHD cases require physician oversight for reporting.
Independent reporting of complex cases without oversight is not a recognised
advantage and may be unsafe.
1
,3. What is the most important safety consideration when performing
echocardiography in a child requiring conscious sedation?
A) Using the highest possible acoustic power to reduce scan time
B) Ensuring appropriate monitoring, dosage, and recovery facilities
C) Avoiding the use of colour Doppler
D) Performing the study without parental consent
E) Using only M-mode imaging
Answer: B
Rationale: Conscious sedation in children requires appropriate monitoring
(oxygen saturation, heart rate), correct weight-based dosage, and recovery
facilities. Power levels should be kept as low as reasonably achievable (ALARA),
and consent is mandatory.
4. In the context of ultrasound safety, what does the ALARA principle stand for?
A) As Low As Reasonably Achievable
B) Always Limit Acoustic Radiation Amplitude
C) Adjust Level According to Required Accuracy
D) Apply Lowest Attenuation for Rapid Assessment
E) Avoid Long Acquisitions with Rapid Angling
Answer: A
Rationale: ALARA (As Low As Reasonably Achievable) is the fundamental safety
principle in ultrasound, meaning output power and exposure time should be
minimised while obtaining diagnostic images.
5. Which document defines the standard terminology for describing congenital
heart disease?
A) The Montreal Classification
B) Segmental sequential analysis
C) The NYHA classification
D) The ACC/AHA valve guidelines
E) The REACH registry
Answer: B
Rationale: Segmental sequential analysis is the internationally accepted method
for describing CHD, systematically defining atrial situs, ventricular loop, and
ventriculoarterial connections.
6. In the segmental approach, what does “visceroatrial situs solitus” mean?
2
,A) Right atrium on the left, liver on the left
B) Right atrium on the right, liver on the right
C) Right atrium on the right, liver on the left
D) Right atrium on the left, liver on the right
E) Both atria on the right
Answer: B
Rationale: Situs solitus describes the normal arrangement: right atrium on the
right, left atrium on the left, liver on the right, and stomach on the left.
7. Which of the following defines ventriculoarterial concordance?
A) Right atrium connects to right ventricle
B) Right ventricle connects to aorta
C) Right ventricle connects to pulmonary artery
D) Left ventricle connects to pulmonary artery
E) Both ventricles connect to the aorta
Answer: C
Rationale: Ventriculoarterial concordance means the right ventricle connects to
the pulmonary artery and the left ventricle connects to the aorta — the normal
arrangement.
8. A heart with atrioventricular discordance and ventriculoarterial discordance is
best described as:
A) Tetralogy of Fallot
B) Transposition of the great arteries (d-TGA)
C) Congenitally corrected TGA (l-TGA)
D) Double outlet right ventricle
E) Truncus arteriosus
Answer: C
Rationale: l-TGA (congenitally corrected TGA) has both atrioventricular and
ventriculoarterial discordance, resulting in physiologically corrected circulation.
9. What is the normal relationship of the great arteries in the parasternal short-
axis view?
A) Aorta anterior and right of the pulmonary artery
B) Pulmonary artery anterior and left of the aorta
C) Aorta posterior and right of the pulmonary artery
D) Pulmonary artery posterior and left of the aorta
E) Both arteries side by side
3
, Answer: B
Rationale: In the normal heart, the pulmonary artery wraps around the aorta. In
the parasternal short-axis view, the pulmonary artery is anterior and left of the
central aorta.
10. Which of the following is a characteristic echocardiographic feature of the
morphological right ventricle?
A) Smooth septal surface
B) Presence of a moderator band
C) Bicuspid atrioventricular valve
D) Elliptical shape in short-axis
E) Absence of trabeculations
Answer: B
Rationale: The morphological RV is identified by a moderator band, coarse
trabeculations, and a trileaflet (tricuspid) atrioventricular valve.
11. The “criss-cross” heart is characterised by:
A) Parallel orientation of the atrioventricular valves
B) Crossing of the atrioventricular valve inflows
C) Absence of the atrial septum
D) A common atrioventricular valve
E) Double outlet right ventricle
Answer: B
Rationale: In criss-cross heart, the atrioventricular connections are crossed, so the
atrial and ventricular septa are not aligned, creating a crossing appearance of the
inflows.
12. Which of the following defines an “overriding” aorta?
A) The aorta arises entirely from the right ventricle
B) The aorta is positioned above a ventricular septal defect, with its annulus
committed to both ventricles
C) The aorta arises from the left ventricle but is positioned anteriorly
D) The aorta is hypoplastic
E) The aorta is posterior to the pulmonary artery
Answer: B
Rationale: An overriding aorta is positioned above a VSD and receives blood from
both ventricles, a key feature of Tetralogy of Fallot.
4
