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CCI Cardiovascular Credentialing International Cardiac
Sonography Exam Questions with Correct Answers and
explanations LATEST THIS YEAR -JUST RELEASED
CCI Cardiovascular Credentialing International Cardiac Sonography Exam
SUMMARIZED EXAM COVERAGE
The CCI (Cardiovascular Credentialing International) Cardiac Sonography certifications include several
credentials for cardiac sonographers: Registered Cardiac Sonographer (RCS) , Advanced Cardiac
Sonographer (ACS) , and Registered Congenital Cardiac Sonographer (RCCS) . The RCS exam contains
approximately 170 multiple-choice questions (150 scored, 20 unscored) with a 3-hour time limit .
The ACS exam also contains 170 questions with a 3-hour limit and is designed for experienced
sonographers with advanced clinical skills . All exams are computer-based and administered through
Pearson VUE Testing Centers .
The RCS exam is divided into 5 content domains : Preparing for Echocardiographic Procedure (5%),
Performing Echocardiographic Imaging (24%), Evaluating Valvular Echocardiographic Findings (25%),
Evaluating Anatomy, Physiology, and Hemodynamics (29%), and Applying the Physics of Ultrasound
(13%) . The passing score is 650 on a 200-900 scale . Exam fees include a $365 application fee and a $50
criminal history pre-application fee . The ACS credential requires a bachelor's degree, current RCS or
RDCS certification, and five years of experience .
1. A patient presents with exertional dyspnea and a mid-systolic click followed by a late systolic murmur.
Which valvular abnormality and associated finding is best identified by this auscultatory pattern?
A) Aortic stenosis with ejection click
B) Mitral valve prolapse with leaflet redundancy
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C) Tricuspid regurgitation with right ventricular dilation
D) Pulmonic stenosis with right ventricular hypertrophy
Answer: B
Rationale: The mid-systolic click and late systolic murmur are hallmark auscultatory findings of mitral
valve prolapse, often associated with myxomatous degeneration and leaflet redundancy .
2. A cardiac sonographer is performing an apical 4-chamber view and notices that the interventricular
septum is flattened during systole. What hemodynamic condition does this finding suggest?
A) Severe aortic stenosis
B) Right ventricular pressure overload (e.g., pulmonary hypertension)
C) Left ventricular volume overload
D) Hypertrophic cardiomyopathy
Answer: B
Rationale: Septal flattening during systole indicates that right ventricular pressure exceeds left
ventricular pressure, a classic finding in pulmonary hypertension and right ventricular pressure overload.
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3. In a patient with suspected aortic stenosis, the peak velocity across the aortic valve is measured as 4.5
m/s. Using the modified Bernoulli equation, what is the estimated peak gradient?
A) 18 mmHg
B) 36 mmHg
C) 81 mmHg
D) 162 mmHg
Answer: C
Rationale: The modified Bernoulli equation calculates pressure gradient as ΔP = 4V² (4 × 4.5² = 4 × 20.25
= 81 mmHg), providing the peak instantaneous gradient .
4. When performing pulse wave Doppler of mitral inflow, an E/A ratio >2 is observed with a deceleration
time <150 ms. What is the most likely grade of diastolic dysfunction?
A) Normal diastolic function
B) Grade I (impaired relaxation)
C) Grade II (pseudonormal)
D) Grade III (restrictive filling)
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Answer: D
Rationale: A restrictive filling pattern is characterized by E/A ratio >2 and shortened deceleration time
(<150 ms), indicating markedly elevated left atrial pressure and advanced diastolic dysfunction.
5. A patient undergoing stress echocardiography develops new regional wall motion abnormalities in the
mid-to-apical segments of the left ventricle with no prior history of coronary artery disease. What is the
most likely diagnosis?
A) Demand ischemia from inadequate heart rate response
B) Stress-induced cardiomyopathy (Takotsubo)
C) Normal physiologic response to exercise
D) Poor acoustic windows with artifact
Answer: B
Rationale: Takotsubo cardiomyopathy typically presents with apical ballooning and mid-ventricular
akinesis with basal hyperkinesis, often triggered by emotional or physical stress.
CCI Cardiovascular Credentialing International Cardiac
Sonography Exam Questions with Correct Answers and
explanations LATEST THIS YEAR -JUST RELEASED
CCI Cardiovascular Credentialing International Cardiac Sonography Exam
SUMMARIZED EXAM COVERAGE
The CCI (Cardiovascular Credentialing International) Cardiac Sonography certifications include several
credentials for cardiac sonographers: Registered Cardiac Sonographer (RCS) , Advanced Cardiac
Sonographer (ACS) , and Registered Congenital Cardiac Sonographer (RCCS) . The RCS exam contains
approximately 170 multiple-choice questions (150 scored, 20 unscored) with a 3-hour time limit .
The ACS exam also contains 170 questions with a 3-hour limit and is designed for experienced
sonographers with advanced clinical skills . All exams are computer-based and administered through
Pearson VUE Testing Centers .
The RCS exam is divided into 5 content domains : Preparing for Echocardiographic Procedure (5%),
Performing Echocardiographic Imaging (24%), Evaluating Valvular Echocardiographic Findings (25%),
Evaluating Anatomy, Physiology, and Hemodynamics (29%), and Applying the Physics of Ultrasound
(13%) . The passing score is 650 on a 200-900 scale . Exam fees include a $365 application fee and a $50
criminal history pre-application fee . The ACS credential requires a bachelor's degree, current RCS or
RDCS certification, and five years of experience .
1. A patient presents with exertional dyspnea and a mid-systolic click followed by a late systolic murmur.
Which valvular abnormality and associated finding is best identified by this auscultatory pattern?
A) Aortic stenosis with ejection click
B) Mitral valve prolapse with leaflet redundancy
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C) Tricuspid regurgitation with right ventricular dilation
D) Pulmonic stenosis with right ventricular hypertrophy
Answer: B
Rationale: The mid-systolic click and late systolic murmur are hallmark auscultatory findings of mitral
valve prolapse, often associated with myxomatous degeneration and leaflet redundancy .
2. A cardiac sonographer is performing an apical 4-chamber view and notices that the interventricular
septum is flattened during systole. What hemodynamic condition does this finding suggest?
A) Severe aortic stenosis
B) Right ventricular pressure overload (e.g., pulmonary hypertension)
C) Left ventricular volume overload
D) Hypertrophic cardiomyopathy
Answer: B
Rationale: Septal flattening during systole indicates that right ventricular pressure exceeds left
ventricular pressure, a classic finding in pulmonary hypertension and right ventricular pressure overload.
, Page 3 of 129
3. In a patient with suspected aortic stenosis, the peak velocity across the aortic valve is measured as 4.5
m/s. Using the modified Bernoulli equation, what is the estimated peak gradient?
A) 18 mmHg
B) 36 mmHg
C) 81 mmHg
D) 162 mmHg
Answer: C
Rationale: The modified Bernoulli equation calculates pressure gradient as ΔP = 4V² (4 × 4.5² = 4 × 20.25
= 81 mmHg), providing the peak instantaneous gradient .
4. When performing pulse wave Doppler of mitral inflow, an E/A ratio >2 is observed with a deceleration
time <150 ms. What is the most likely grade of diastolic dysfunction?
A) Normal diastolic function
B) Grade I (impaired relaxation)
C) Grade II (pseudonormal)
D) Grade III (restrictive filling)
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Answer: D
Rationale: A restrictive filling pattern is characterized by E/A ratio >2 and shortened deceleration time
(<150 ms), indicating markedly elevated left atrial pressure and advanced diastolic dysfunction.
5. A patient undergoing stress echocardiography develops new regional wall motion abnormalities in the
mid-to-apical segments of the left ventricle with no prior history of coronary artery disease. What is the
most likely diagnosis?
A) Demand ischemia from inadequate heart rate response
B) Stress-induced cardiomyopathy (Takotsubo)
C) Normal physiologic response to exercise
D) Poor acoustic windows with artifact
Answer: B
Rationale: Takotsubo cardiomyopathy typically presents with apical ballooning and mid-ventricular
akinesis with basal hyperkinesis, often triggered by emotional or physical stress.
