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Sample ACS Practice Questions

Try these sample questions to review concepts for the ACS exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An ACS candidate is reviewing a study for exertional syncope. Which finding should be treated as immediately relevant to the interpreting physician before the final report is signed?
A.Mild tricuspid regurgitation with normal right-sided chamber size
B.Severe calcific aortic stenosis with a peak velocity of 4.6 m/s
C.Trace physiologic pulmonic regurgitation
D.A normal E/A ratio in a patient in sinus rhythm
Explanation: Syncope with severe aortic stenosis is a high-risk clinical combination. A peak aortic jet velocity of 4.6 m/s is in the severe range, and timely communication helps direct urgent clinical management.
2A patient with a recent anterior myocardial infarction has a technically limited apical window and suspected apical thrombus. What is the best next imaging step during transthoracic echocardiography?
A.Use ultrasound enhancing agent for left ventricular opacification
B.Measure mitral inflow only and defer the apex
C.Report the study as normal if global EF appears preserved
D.Switch to subcostal imaging only
Explanation: Recent anterior MI and apical wall-motion abnormality increase the pretest probability of LV thrombus. Contrast left ventricular opacification improves endocardial border definition and is specifically useful when the apex is not adequately seen.
3Which historical detail is most important to document before interpreting a prosthetic aortic valve gradient?
A.The patient's preferred sleeping position
B.The prosthesis type, size, and prior baseline gradient if available
C.The patient's distance from the parking lot to the lab
D.The brand of ECG electrodes used for the study
Explanation: Prosthetic valve interpretation depends on the valve type, size, expected normal Doppler profile, and comparison with the patient's baseline. A high gradient may reflect obstruction, patient-prosthesis mismatch, high flow, or measurement error, so context is essential.
4A patient is in atrial fibrillation during diastolic function assessment. Which reporting approach is most appropriate?
A.Average multiple representative beats and avoid relying on E/A ratio
B.Use one beat with the shortest RR interval for all measurements
C.Assign grade I diastolic dysfunction if the A wave is absent
D.Report normal diastolic function because atrial fibrillation invalidates all Doppler data
Explanation: Atrial fibrillation causes beat-to-beat variability and eliminates a reliable atrial A wave. Averaging representative beats and using parameters that remain interpretable is more defensible than forcing a sinus-rhythm grading algorithm.
5A study request says 'shortness of breath after chemotherapy.' Which echo data point is most directly tied to this history in a surveillance exam?
A.Biplane LVEF with comparison to prior LVEF and GLS when feasible
B.Mitral valve leaflet thickness alone
C.Pulmonary vein A-wave duration only
D.Aortic valve M-mode opening slope only
Explanation: Cancer therapy surveillance focuses on reproducible LV systolic function and serial change. Biplane LVEF and global longitudinal strain, when technically adequate, help detect cancer therapy-related cardiac dysfunction before symptoms progress.
6A preliminary worksheet lists moderate mitral regurgitation, but color Doppler clips show a wall-hugging eccentric jet after suspected posterior leaflet flail. What should the advanced sonographer do before report finalization?
A.Leave the worksheet unchanged because eccentric jets are always moderate
B.Flag the discrepancy and obtain or recommend quantitative MR assessment and focused review
C.Delete all color Doppler images to avoid confusion
D.Call the jet mild because wall-hugging jets appear small
Explanation: Eccentric Coanda jets may appear smaller by color area and can underestimate severe MR. A suspected flail leaflet warrants focused imaging, quantitative parameters, and communication of the discrepancy for physician review.
7A patient with fever and a prosthetic mitral valve has a technically limited TTE without a clear vegetation. Which recommendation best fits the clinical scenario?
A.No further imaging is needed if TTE does not show vegetation
B.TEE should be considered because prosthetic valves and endocarditis suspicion limit TTE sensitivity
C.Repeat TTE in one year if symptoms persist
D.Use only M-mode to inspect the prosthetic leaflets
Explanation: Prosthetic material produces shadowing and reduces TTE sensitivity for vegetations and periannular complications. With fever and suspected endocarditis, TEE is typically the more appropriate follow-up modality.
8During stress echo intake, which medication history most directly explains a submaximal heart-rate response during dobutamine stress?
A.Recent beta-blocker use
B.Topical antibiotic ointment
C.Inhaled nasal saline
D.Calcium carbonate antacid
Explanation: Beta-blockers blunt chronotropic response and can make dobutamine stress less effective unless atropine or protocol adjustments are used when appropriate. The medication history helps interpret whether the test reached adequate stress.
9A patient referred for pulmonary hypertension has an incomplete TR envelope and a plethoric IVC. What is the best interpretation practice?
A.Calculate RVSP from the incomplete envelope and report it as exact
B.State that pulmonary pressure estimation is limited and integrate other RV/RA findings
C.Ignore the IVC because it is unrelated to right atrial pressure
D.Assume severe pulmonary hypertension whenever TR is not measurable
Explanation: RVSP depends on an accurate peak TR velocity and estimated right atrial pressure. If the TR signal is incomplete, the pressure estimate should be described as limited while other right-heart findings are integrated.
10An outside report states 'severe AS,' but current Doppler shows Vmax 3.0 m/s, AVA 0.8 cm2, stroke volume index 28 mL/m2, and LVEF 30%. Which issue should be raised for physician interpretation?
A.Possible low-flow, low-gradient aortic stenosis requiring integrated assessment
B.Normal aortic valve function because Vmax is below 4.0 m/s
C.Severe mitral stenosis because AVA is under 1.0 cm2
D.Measurement is impossible whenever LVEF is reduced
Explanation: Discordant AS data with low EF and low stroke volume raise the possibility of classical low-flow, low-gradient AS. The sonographer should ensure careful LVOT and Doppler acquisition and flag the need for integrated assessment, often including dobutamine stress echo or CT calcium scoring in the clinical workflow.

About the ACS Exam

The CCI ACS credential validates advanced echocardiography practice, including synthesis of patient history and echo findings, advanced cardiovascular and valve assessment, structural intervention support, multimodality imaging, congenital heart disease, and lab quality responsibilities.

Exam sponsor: Cardiovascular Credentialing International (CCI) / Pearson VUE. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

170 total questions: 150 scored and 20 unscored pretest questions

Time Limit

3 hours

Passing Score

Scaled score reported by CCI

Exam / Certification Fees

$450

Exam sponsor website

Reported exam pass rate: 71.43%. CCI first-time test taker rate published on the ACS credential page. This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

10%

History and Echo Findings

Integrate clinical history, comparative studies, preliminary reports, and image findings.

40%

Cardiovascular Heart Disease

Assess advanced cardiac pathology, hemodynamics, stress echo, and right-heart or systemic findings.

15%

Valvular Heart Disease

Evaluate valve severity, prosthetic valves, and endocarditis patterns.

15%

Structural Procedures

Use echo before, during, and after structural-heart interventions.

9%

Advanced Imaging

Apply strain, 3D, TEE, and multimodality imaging concepts.

4%

Congenital Heart Disease

Recognize simple and complex congenital findings and post-repair patterns.

7%

Professional Practice

Support quality reporting, mentoring, communication, and lab standards.

Preparing for the ACS Exam

What You Need to Know

  • Passing score: Scaled score reported by CCI
  • Assessment: 170 total questions: 150 scored and 20 unscored pretest questions
  • Time limit: 3 hours
  • Exam / certification fees: $450 Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

ACS: Suggested Study Strategy

1Study from the official CCI task matrix and prioritize integrated interpretation over isolated definitions.
2Practice cases that combine quantitative echo data, report completeness, and communication of significant findings.

Frequently Asked Questions

How many questions are on the CCI ACS exam?

CCI lists the ACS exam as 170 questions in 3 hours, with 150 scored items and 20 unscored pretest items.

What is the largest ACS exam content area?

Assessing cardiovascular heart disease is the largest area, including cardiomyopathies, ischemic disease, stress echo, heart failure, right-heart disease, aortic disease, systemic disease, and hemodynamics.