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 RCS exam has 170 questions and runs 2 hours 50 minutes.
These 10 free RCS questions are organized by exam domain, so you can see how each part of the Registered Cardiac Sonographer blueprint is tested. Reveal the answer and explanation under each question.
While scanning an inpatient shortly after catheter ablation, the sonographer sees a new circumferential pericardial effusion measuring 1.4 cm and early-diastolic RV collapse. The patient becomes confused, with blood pressure falling from 122/74 to 82/50 mmHg. What takes priority over completing the routine imaging protocol?
Correct answer: D - Call the bedside team immediately for suspected tamponade.
Three adjacent LV segments remain poorly visualized despite optimizing the apical windows. Lumason has been ordered for LV opacification. The patient reports hives after iodinated CT contrast but no known hypersensitivity to sulfur hexafluoride microspheres or polyethylene glycol. She is clinically stable, and the laboratory has trained staff and resuscitation equipment. How should the contrast portion of the examination proceed?
Correct answer: A - Use the ordered Lumason with low-mechanical-index contrast imaging.
During a symptom-limited treadmill stress echocardiogram, the patient reaches 88% of age-predicted maximum heart rate. He remains comfortable and wishes to continue. Blood pressure has risen from 124/76 to 166/78 mmHg, with no ischemic ECG changes or significant arrhythmia. A colleague suggests ending exercise because the heart-rate target has been met. What should happen at this point?
Correct answer: B - Continue the symptom-limited protocol with ECG and blood-pressure monitoring.
The mitral regurgitation jet in a patient with a new systolic murmur occupies only a small portion of the left atrium. Closer inspection shows a flail posterior leaflet, an anteriorly directed wall-hugging jet, a vena contracta width of 0.82 cm, and systolic flow reversal in two pulmonary veins. How should these apparently conflicting findings be reconciled?
Correct answer: C - Severe primary regurgitation; wall adherence makes the color jet look deceptively small.
Two LVOT pulsed-wave recordings are saved during evaluation of a calcified aortic valve. A sample within the near-valve flow-acceleration region gives a VTI of 40 cm. After the sample is moved just proximal to that region, the clean LVOT envelope has a VTI of 24 cm. LVOT diameter is 2.2 cm, and the highest well-aligned aortic continuous-wave envelope has a VTI of 75 cm. The continuity-equation aortic valve area is closest to:
Correct answer: C - 1.22 cm²
The mean gradient across a surgical aortic bioprosthesis has increased from 15 to 31 mmHg in a patient being treated for iron-deficiency anemia. Doppler velocity index remains 0.44, acceleration time is 65 ms, and the systolic envelope is triangular and early-peaking. Leaflet motion and effective orifice area are unchanged; indexed effective orifice area is 0.96 cm²/m². Stroke-volume index is elevated at 59 mL/m². How should the higher gradient be interpreted?
Correct answer: B - A flow-related increase without supporting Doppler evidence of prosthetic obstruction.
An echocardiogram for exertional dyspnea shows LVEF 61%, mitral E/A 1.3, septal e' 5 cm/s, lateral e' 6 cm/s, average E/e' 18, and estimated pulmonary artery systolic pressure 48 mmHg. The patient is in sinus rhythm, with no significant mitral disease or pulmonary disease. Using the ASE 2025 general approach, which description of resting diastolic function fits these measurements?
Correct answer: A - Grade II diastolic dysfunction with increased left atrial pressure.
A patient with known valvular pulmonic stenosis has a complete, reproducible tricuspid regurgitation envelope with peak velocity 4.0 m/s. Estimated right atrial pressure is 8 mmHg. The pulmonary valve Doppler recording confirms an obstructive gradient. Which pressure statement can be entered from the tricuspid regurgitation measurement?
Correct answer: C - Estimated RV systolic pressure is 72 mmHg; it cannot be equated with pulmonary artery systolic pressure.
Ascites and elevated jugular venous pressure persist in a patient who underwent cardiac surgery several years ago. LVEF is preserved. Echocardiography shows an inspiratory leftward septal shift, medial mitral annular e' of 11 cm/s, lateral e' of 6 cm/s, and prominent hepatic venous diastolic flow reversal during expiration. Taken together, these findings favor which diagnosis?
Correct answer: D - Constrictive pericarditis
A high-velocity systolic jet is localized by color Doppler. Its pulsed-wave spectrum remains aliased despite using the highest available pulse repetition frequency at that depth and adjusting the baseline. Beam alignment is satisfactory. Which change will allow measurement of the peak velocity, accepting the loss of precise depth localization?
Correct answer: B - Switch to continuous-wave Doppler aligned with the jet.
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