Free Registered Congenital Cardiac Sonographer (RCCS) Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Registered Congenital Cardiac Sonographer (RCCS) practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A newborn fails pulse oximetry screening, and an order arrives for immediate evaluation of possible critical congenital heart disease. Which assessment should the sonographer prioritize for definitive diagnosis?

   1. A. Physical examination
   2. B. Electrocardiography
   3. C. Echocardiography
   4. D. Chest radiography

   Answer: C

   Explanation: The ASE states, "a failed POS test mandates immediate evaluation for C-CHD" and "echocardiography is the diagnostic modality of choice for definitive diagnosis of CHD." Physical examination, chest X-ray, and ECG can assist, but do not replace the definitive echocardiographic evaluation in this setting.

   Reference: ASE Recommendations for the Adult Cardiac Sonographer Screening Newborns for Critical Congenital Heart Disease — Impact of a Failed Pulse Oximetry Screening Test, p. 209

2. 2During a pediatric echo, apparent atrial septal dropout is seen from an apical view. Which window should the sonographer use to examine the septum with the ultrasound beam nearly perpendicular to it?

   1. A. Suprasternal imaging
   2. B. Left parasternal imaging
   3. C. Subcostal imaging
   4. D. Apical imaging

   Answer: C

   Explanation: The ASE guideline states, "The atrial septum is easily evaluated in subcostal views because it is perpendicular or nearly perpendicular to the ultrasound beam." It cautions that the septum is usually parallel to the beam in apical and left parasternal views, where dropout may mimic a defect.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Standard Transthoracic Echocardiographic Views, subcostal views, p. 125

3. 3In a patient with suspected tetralogy of Fallot, the sonographer needs to examine conal septal deviation and the right ventricular outflow tract in one plane. Which modified subcostal view should be added?

   1. A. Subcostal sagittal view
   2. B. Subcostal left anterior oblique view
   3. C. Subcostal coronal view
   4. D. Subcostal right anterior oblique view

   Answer: D

   Explanation: ASE describes counterclockwise rotation from the subcostal coronal view to the "right anterior oblique view"; it "shows the RV inflow and outflow tracts in the same plane" and can display conal septal deviation in tetralogy of Fallot. The left anterior oblique view instead characterizes atrioventricular valves en face.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Standard Transthoracic Echocardiographic Views, modified subcostal views, p. 125

4. 4A child's left ventricular endocardial border is poorly delineated on standard two-dimensional echocardiography, limiting functional assessment. Which adjunct is specifically recommended for improving left ventricular cavity visualization?

   1. A. Agitated saline contrast injection
   2. B. Tissue Doppler velocity imaging
   3. C. An ultrasound enhancing agent
   4. D. Spectral Doppler flow interrogation

   Answer: C

   Explanation: ASE states, "A UEA may be considered when delineation of the LV endocardium to evaluate function by 2DE alone is challenging." Its microbubbles enhance LV cavity visualization; agitated saline is used chiefly to evaluate shunting.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Agitated Saline and UEAs, Key Points and Recommendations, p. 128

5. 5In postprocessing a pediatric right-ventricular focused apical study, the end-diastolic RV area is 20 cm² and the end-systolic area is 12 cm². What is the RV fractional area change?

   1. A. 8%
   2. B. 40%
   3. C. 60%
   4. D. 67%

   Answer: B

   Explanation: The ASE figure states that "RV ventricular FAC is calculated as [RV diastolic area—RV systolic area]/diastolic area". Thus (20 − 12) ÷ 20 × 100 = 40%; 8 omits the denominator, 60% uses systolic/diastolic area, and 67% uses systolic area as the denominator.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Figure 24, RV measurements from RV-focused apical four-chamber view, p. 155

6. 6A sonographer reviews initial outpatient transthoracic echo orders for children without previously known heart disease. Which syncope indication receives an Appropriate rating under the pediatric appropriate use criteria?

   1. A. Probable neurocardiogenic (vasovagal) syncope in a child
   2. B. Unexplained presyncope without a known trigger in a child
   3. C. Syncope with benign family history and normal ECG findings
   4. D. Exertional syncope during physical activity in a child

   Answer: D

   Explanation: The pediatric AUC lists "Exertional syncope" with rating "A (9)". Probable neurocardiogenic syncope is Rarely Appropriate, and unexplained presyncope is May Be Appropriate; the exertional presentation is the Appropriate one.

   Reference: ACC/AAP/AHA/ASE 2014 Appropriate Use Criteria for Initial Pediatric Outpatient Transthoracic Echocardiography — Table 2, Syncope, indications 18 and 23–25, pp. 1252–1253

7. 7A pediatric sonographer needs a long-axis view of a patent ductus arteriosus and the adjacent aortic isthmus. Which left parasternal view is designated the ductal view?

   1. A. High left parasternal transverse view
   2. B. Standard left parasternal short-axis view
   3. C. Standard left parasternal long-axis view
   4. D. High left parasternal sagittal view

   Answer: D

   Explanation: The ASE guideline identifies the "high left parasternal sagittal view" as the ductal view and states that it "allows long-axis evaluation of a patent ductus arteriosus" as well as the aortic isthmus. The transverse and standard parasternal views answer different imaging questions.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Standard Transthoracic Echocardiographic Views, left parasternal views, p. 125

8. 8A newborn with cyanosis has subcostal imaging showing right-to-left flow across a patent foramen ovale throughout the cardiac cycle and a small left atrium. Which congenital venous lesion should the sonographer suspect?

   1. A. Persistent left superior vena cava
   2. B. Partial anomalous pulmonary venous return
   3. C. Total anomalous pulmonary venous return
   4. D. Interrupted intrahepatic inferior vena cava

   Answer: C

   Explanation: ASE states, "Total anomalous pulmonary venous return should be suspected in newborns with cyanosis when subcostal imaging reveals right-to-left shunting across a patent foramen ovale throughout the cardiac cycle in association with a small LA." The constellation tests a total pulmonary venous return abnormality, not an isolated systemic venous anomaly.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Segmental Protocols, Systemic and Pulmonary Veins, p. 138

9. 9During an agitated saline study, the right atrium opacifies and microbubbles appear in the left atrium four cardiac cycles later. Which finding does this timing most strongly suggest?

   1. A. An interatrial right-to-left shunt
   2. B. An intrapulmonary right-to-left shunt
   3. C. A persistent left superior vena cava
   4. D. An interrupted inferior vena cava

   Answer: A

   Explanation: The ASE guideline states, "Appearance of contrast in the left atrium and left ventricle within three to six cardiac cycles after RA opacification with or without a Valsalva maneuver suggests interatrial shunting." Four cycles falls within that window.

   Reference: ASE Guidelines for a Comprehensive Pediatric Transthoracic Echocardiogram — Agitated Saline and UEAs, p. 128

10. 10For a patient with repaired tetralogy of Fallot and no residual RV outflow obstruction, the tricuspid regurgitation jet is 3 m/s and estimated right-atrial pressure is 5 mm Hg. What RV systolic pressure follows from the modified Bernoulli relation?

    1. A. 17 mm Hg
    2. B. 36 mm Hg
    3. C. 41 mm Hg
    4. D. 46 mm Hg

    Answer: C

    Explanation: The ASE repaired tetralogy guideline gives "4v2 + RA pressure" for the RV pressure estimate in the absence of residual RVOT obstruction. With v = 3 m/s and RA pressure = 5 mm Hg, the result is 4 × 3² + 5 = 41 mm Hg. The other values omit the square, omit RA pressure, or add it twice.

    Reference: ASE Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot — Echocardiography, Right Ventricle, Pressure, p. 119