10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The CCEeXAM exam has 200 questions and runs 4 hours 30 minutes.
These 10 free CCEeXAM questions are organized by exam domain, so you can see how each part of the Critical Care Echocardiography blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Functional Anatomy
Question 1
The mean gradient across a surgical aortic bioprosthesis has risen from 12 to 38 mmHg during an admission for gastrointestinal bleeding. Hemoglobin is 6.8 g/dL. Current Doppler shows an early-peaking triangular envelope, acceleration time 68 ms, and dimensionless velocity index 0.41, compared with 0.42 on the stable baseline study. Leaflet excursion is preserved. The measurements have been checked from multiple windows. What best accounts for the higher gradient?
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Correct answer: D - Increased transprosthetic flow associated with severe anemia.
Question 2
A 64-year-old patient is evaluated for acute dyspnea in sinus rhythm at 78/min. LVEF is 60%; there is no significant mitral disease, annular calcification, or pulmonary vascular or parenchymal disease. Reliable measurements are: mitral E/A 1.2, septal e′ 4 cm/s, lateral e′ 5 cm/s, average E/e′ 19, estimated pulmonary artery systolic pressure 48 mmHg, and left atrial volume index 30 mL/m². How should diastolic function be reported using the 2025 ASE approach?
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Correct answer: D - Grade II diastolic dysfunction with increased left atrial pressure.
Question 3
A left internal jugular catheter follows the left mediastinal border on radiography, although the transduced waveform is venous. Echocardiography shows a markedly enlarged coronary sinus. Agitated saline injected through a separate left-arm peripheral IV opacifies the coronary sinus before the right atrium; no bubbles enter the left atrium. The contrast sequence identifies which venous connection?
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Correct answer: D - A persistent left superior vena cava draining through the coronary sinus.
Domain 2: Clinical Diagnosis and Management
Question 4
A patient with septic shock becomes more hypotensive after dobutamine is added to norepinephrine for presumed low cardiac output. Echocardiography now shows a small, hyperdynamic left ventricle, systolic anterior motion of the mitral valve with septal contact, posteriorly directed mitral regurgitation, and a late-peaking LV outflow tract Doppler envelope. Which immediate medication change is most likely to improve forward flow?
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Correct answer: C - Stop dobutamine while maintaining vasopressor support.
Question 5
During a technically reproducible passive leg raise in a patient with septic shock, LVOT velocity-time integral rises from 16.0 to 19.0 cm, then returns to baseline after repositioning. Heart rate and Doppler alignment remain unchanged. An earlier fluid bolus was followed by a new oxygen requirement and diffuse bilateral B-lines. Which conclusion reconciles the flow response with the pulmonary findings?
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Correct answer: A - About 19% more flow; responsiveness does not establish tolerance of more fluid.
Question 6
Four days after an inferior myocardial infarction, a patient abruptly develops hypotension and pulmonary edema. The systolic murmur is soft. Echocardiography shows preserved global LV ejection fraction, a normal-sized left atrium, and an eccentric mitral regurgitant jet that hugs the atrial wall and appears small on color Doppler. The jet has a vena contracta of 0.9 cm, and pulmonary venous systolic flow is reversed. Which complication is most likely?
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Correct answer: C - Papillary muscle rupture causing acute severe mitral regurgitation.
Question 7
PEEP is increased from 8 to 16 cm H2O in a passively ventilated patient with ARDS. Within minutes, mean arterial pressure falls from 72 to 51 mmHg and LVOT VTI falls from 18 to 11 cm. Compared with the preceding study, the RV is larger, systolic septal flattening is more pronounced, and the LV cavity is smaller despite preserved contraction. Bilateral lung sliding remains present. Why has forward flow deteriorated?
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Correct answer: B - Increased RV afterload has impaired RV output and reduced LV filling.
On transesophageal imaging, several faint parallel echoes appear at equal depth intervals beyond a strongly reflective aortic wall. One crosses the aortic lumen and resembles an intimal flap. The echoes move with the wall rather than independently and disappear when the insonation angle changes. These repeated lines are produced by:
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Correct answer: B - Reverberation from repeated reflections between strongly reflective interfaces along the beam.
Question 9
An echocardiographic cardiac-output calculation is being checked in a patient with severe mitral regurgitation, no aortic regurgitation or intracardiac shunt, and a heart rate of 100/min. LV end-diastolic and end-systolic volumes are 140 and 60 mL. The LVOT diameter at the laminar-flow sampling level is 2.0 cm. A pulsed-wave trace sampled in the proximal flow-acceleration zone has a VTI of 20 cm; repositioning the sample just proximal to that zone produces a clean laminar-flow VTI of 12 cm. Which value best estimates forward systemic cardiac output?
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Correct answer: A - 3.8 L/min
Domain 4: Integrated ultrasound imaging
Question 10
Immediately after intubation of a 158-cm woman, oxygen saturation falls to 86% despite an inspired oxygen fraction of 1.0. The tube is secured at 27 cm at the incisors, and a sustained capnography waveform is present. Right-sided breath sounds and lung sliding are present. On the left, breath sounds are absent; the pleural line does not slide with ventilation but pulsates with each heartbeat. What is the most appropriate immediate response?
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Correct answer: B - Withdraw the tube until tracheal positioning and bilateral ventilation are restored.
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