CCI REGISTRY ACTUAL EXAM REVIEW 2026 EDITION 100 QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
OVERVIEW
The CCI Registry Exam 2026 is a professional certification assessment designed to evaluate a
sonographer’s knowledge and skills in performing and interpreting echocardiography studies.
The exam covers key areas such as cardiac anatomy and physiology, ultrasound physics, 2D
and Doppler imaging, hemodynamics, pathology recognition, measurements, and clinical
correlations. Typically consisting of multiple-choice questions, the test assesses both
theoretical understanding and practical competence. Successfully passing the exam
demonstrates proficiency in echocardiography, validates clinical expertise, and enhances
career opportunities in the field.
1. A patient with conduction abnormalities, asymmetric LVH, and hyper echoic endocardial layer most
likely suffers from?
A. Hypertrophic Cardiomyopathy
B. Fabry Disease
C. Restrictive Cardiomyopathy
D. Amyloidosis
Answer: B
Rationale: Fabry Disease often presents with conduction abnormalities, asymmetric left ventricular
hypertrophy, and hyper-echoic endocardial layers due to glycosphingolipid accumulation.
2. What measurements are needed to calculate Left Atrial Pressure?
A. E/A ratio and IVRT
B. Mitral E velocity and LVEDP
C. MR velocity and Systolic BP
D. LA Volume Index and E/E' ratio
Answer: C
Rationale: Left atrial pressure can be estimated using the peak velocity of mitral regurgitation and the
patient’s systolic blood pressure.
3. Congenital Pulmonary Stenosis (PS) is most commonly associated with what?
A. Atrial Septal Defect
B. Ventricular Septal Defect (VSD)
C. Patent Ductus Arteriosus
D. Coarctation of the Aorta
Answer: B
Rationale: Congenital PS is often associated with a VSD due to developmental defects affecting the right
ventricular outflow tract.
,4. What is the first parameter to consider when assessing a patient for diastolic dysfunction?
A. E/A ratio
B. LV Ejection Fraction
C. LA Volume Index
D. Pulmonary Vein Flow
Answer: B
Rationale: LV ejection fraction is the initial parameter to consider, as systolic function impacts diastolic
evaluation.
5. Describe the difference between a true aneurysm of the LV and a pseudoaneurysm of the LV?
A. True aneurysm involves endocardial rupture, pseudoaneurysm involves all layers
B. True aneurysm involves weakening of the myocardial layer, pseudoaneurysm is a rupture of
endocardium and myocardium contained by pericardium
C. True aneurysm occurs only post-MI, pseudoaneurysm occurs only congenital
D. There is no difference
Answer: B
Rationale: A true aneurysm involves myocardial wall thinning, while a pseudoaneurysm results from
rupture, contained only by the pericardium.
6. In a patient with a PDA, normal intracardiac pressures can be assumed if the peak pressure gradient
across the ductus is equivalent to?
A. 50 mmHg
B. 100 mmHg
C. 120 mmHg
D. 80 mmHg
Answer: B
Rationale: A peak gradient of ~100 mmHg suggests normal intracardiac pressures, indicating a small or
restrictive PDA.
7. Which of the following will cause an increase in preload?
A. Mitral Stenosis
B. Patent Ductus Arteriosus (PDA)
C. Aortic Regurgitation
D. Pulmonary Embolism
Answer: B
Rationale: PDA increases preload due to left-to-right shunting, increasing volume return to the left
heart.
, 8. _________________ are small fibrous nodular areas that are normally identified on the central part
of the aortic cusps.
A. Nodules of Arantius
B. Fibroelastomas
C. Calcific deposits
D. Commissural thickening
Answer: A
Rationale: Nodules of Arantius are normal fibrous structures on aortic valve cusps and serve to improve
valve coaptation.
9. Aortic coarctation between the origin of the left common carotid and the origin of the left
subclavian artery will have what effect on the brachial pressures?
A. Increased left arm pressure, decreased right arm pressure
B. Equal pressures
C. Increased right arm pressure, decreased left arm pressure
D. Decreased pressures in both arms
Answer: C
Rationale: Coarctation in this location elevates right arm pressure and reduces left arm pressure due to
obstruction proximal to the left subclavian artery.
10. What type of magnification provides the highest frame rate and best image resolution?
A. Post-processing
B. Pre-processing
C. Digital zoom
D. Interpolation
Answer: B
Rationale: Pre-processing magnification improves spatial resolution while maintaining a high frame rate.
11. What level of Pulmonary HTN is present with an acceleration time of 50 m/sec for the pulmonary
valve Doppler tracing?
A. Mild
B. Moderate
C. Severe
D. Normal
Answer: C
Rationale: Short pulmonary valve acceleration times (<60 ms) indicate severe pulmonary hypertension.
12. Which of the following describes the RV?
A. No chordae attach to the wall
B. Several chordae tendineae attach directly to the ventricular wall
AND CORRECT ANSWERS WITH RATIONALES
OVERVIEW
The CCI Registry Exam 2026 is a professional certification assessment designed to evaluate a
sonographer’s knowledge and skills in performing and interpreting echocardiography studies.
The exam covers key areas such as cardiac anatomy and physiology, ultrasound physics, 2D
and Doppler imaging, hemodynamics, pathology recognition, measurements, and clinical
correlations. Typically consisting of multiple-choice questions, the test assesses both
theoretical understanding and practical competence. Successfully passing the exam
demonstrates proficiency in echocardiography, validates clinical expertise, and enhances
career opportunities in the field.
1. A patient with conduction abnormalities, asymmetric LVH, and hyper echoic endocardial layer most
likely suffers from?
A. Hypertrophic Cardiomyopathy
B. Fabry Disease
C. Restrictive Cardiomyopathy
D. Amyloidosis
Answer: B
Rationale: Fabry Disease often presents with conduction abnormalities, asymmetric left ventricular
hypertrophy, and hyper-echoic endocardial layers due to glycosphingolipid accumulation.
2. What measurements are needed to calculate Left Atrial Pressure?
A. E/A ratio and IVRT
B. Mitral E velocity and LVEDP
C. MR velocity and Systolic BP
D. LA Volume Index and E/E' ratio
Answer: C
Rationale: Left atrial pressure can be estimated using the peak velocity of mitral regurgitation and the
patient’s systolic blood pressure.
3. Congenital Pulmonary Stenosis (PS) is most commonly associated with what?
A. Atrial Septal Defect
B. Ventricular Septal Defect (VSD)
C. Patent Ductus Arteriosus
D. Coarctation of the Aorta
Answer: B
Rationale: Congenital PS is often associated with a VSD due to developmental defects affecting the right
ventricular outflow tract.
,4. What is the first parameter to consider when assessing a patient for diastolic dysfunction?
A. E/A ratio
B. LV Ejection Fraction
C. LA Volume Index
D. Pulmonary Vein Flow
Answer: B
Rationale: LV ejection fraction is the initial parameter to consider, as systolic function impacts diastolic
evaluation.
5. Describe the difference between a true aneurysm of the LV and a pseudoaneurysm of the LV?
A. True aneurysm involves endocardial rupture, pseudoaneurysm involves all layers
B. True aneurysm involves weakening of the myocardial layer, pseudoaneurysm is a rupture of
endocardium and myocardium contained by pericardium
C. True aneurysm occurs only post-MI, pseudoaneurysm occurs only congenital
D. There is no difference
Answer: B
Rationale: A true aneurysm involves myocardial wall thinning, while a pseudoaneurysm results from
rupture, contained only by the pericardium.
6. In a patient with a PDA, normal intracardiac pressures can be assumed if the peak pressure gradient
across the ductus is equivalent to?
A. 50 mmHg
B. 100 mmHg
C. 120 mmHg
D. 80 mmHg
Answer: B
Rationale: A peak gradient of ~100 mmHg suggests normal intracardiac pressures, indicating a small or
restrictive PDA.
7. Which of the following will cause an increase in preload?
A. Mitral Stenosis
B. Patent Ductus Arteriosus (PDA)
C. Aortic Regurgitation
D. Pulmonary Embolism
Answer: B
Rationale: PDA increases preload due to left-to-right shunting, increasing volume return to the left
heart.
, 8. _________________ are small fibrous nodular areas that are normally identified on the central part
of the aortic cusps.
A. Nodules of Arantius
B. Fibroelastomas
C. Calcific deposits
D. Commissural thickening
Answer: A
Rationale: Nodules of Arantius are normal fibrous structures on aortic valve cusps and serve to improve
valve coaptation.
9. Aortic coarctation between the origin of the left common carotid and the origin of the left
subclavian artery will have what effect on the brachial pressures?
A. Increased left arm pressure, decreased right arm pressure
B. Equal pressures
C. Increased right arm pressure, decreased left arm pressure
D. Decreased pressures in both arms
Answer: C
Rationale: Coarctation in this location elevates right arm pressure and reduces left arm pressure due to
obstruction proximal to the left subclavian artery.
10. What type of magnification provides the highest frame rate and best image resolution?
A. Post-processing
B. Pre-processing
C. Digital zoom
D. Interpolation
Answer: B
Rationale: Pre-processing magnification improves spatial resolution while maintaining a high frame rate.
11. What level of Pulmonary HTN is present with an acceleration time of 50 m/sec for the pulmonary
valve Doppler tracing?
A. Mild
B. Moderate
C. Severe
D. Normal
Answer: C
Rationale: Short pulmonary valve acceleration times (<60 ms) indicate severe pulmonary hypertension.
12. Which of the following describes the RV?
A. No chordae attach to the wall
B. Several chordae tendineae attach directly to the ventricular wall
