Anesthesiology APPLIED Exam › OSCE: echocardiography and POCUS

The 11 TEE views

OSCE: echocardiography and POCUS·~5 min read· Physician-reviewed✓ Sourced · 3

Stem

Monitors and echo station. A 63-year-old man, 85 kg, is having a coronary bypass, and the facilitator plays a TEE loop. The left atrium sits at the top of the sector, the multiplane angle on the screen reads 15°, and below the atrium you see the left ventricle on the right of the screen, the right atrium and right ventricle on the left, and two atrioventricular valves opening together. No aortic valve is visible.

Question

Which view is this, and how do you orient yourself to any TEE loop?

Ideal answer

HeadlineMid-esophageal four-chamber: left atrium at the apex, 15°, four chambers, both atrioventricular valves, no outflow tract. I orient in three passes before naming disease.

Depth: left atrium on top means mid-esophageal; liver or gastric wall at the apex, transgastric; a lone aortic circle, descending aorta.
Multiplane angle, narrowing mid-esophageal views to two or three: four-chamber is about 10–20°, 30–35 cm from the incisors.¹
Anchor structures: chambers, valves, outflow tract or none; with the angle icon hidden, anatomy alone names the view.
View aloud, then function: name the chambers, global function, septal and lateral walls, regurgitation on color.

Breaking down the answer

View	Angle, depth	Identifying features	Main use
ME four-chamber	~10–20°, ~30–35 cm¹	LA at apex, all four chambers, mitral and tricuspid valves	Global function, septal and lateral walls, MR, TR, ASD
ME two-chamber	80–100°²	LA and LV only, left atrial appendage, no right heart	Anterior and inferior walls, appendage thrombus
ME long-axis	120–140°²	LVOT, aortic valve and root, mitral valve	Anteroseptal and inferolateral walls, AR, SAM
ME ascending aortic long-axis	90–110°, withdrawn	Tubular ascending aorta, right pulmonary artery in cross-section beneath	Dissection flap, aortic dilation
ME ascending aortic short-axis	0–30°, withdrawn	Circular ascending aorta, main PA and its bifurcation, SVC	Proximal PE, PA catheter position
ME aortic valve short-axis	25–45°²	Three cusps in a "Mercedes" sign, interatrial septum, RVOT	AS planimetry, AR origin, ASD
ME RV inflow-outflow	50–70° (comprehensive);² 60–90° (basic)¹	RA, tricuspid valve, RV wrapping around a central aortic valve to the pulmonary valve	RV function, TR, PA catheter course
ME bicaval	90–110°, turned right²	LA top, RA below, SVC on the right of the screen, IVC on the left	PFO, sinus venosus ASD, air, catheter tips
TG mid-papillary short-axis	0–20°, advanced into the stomach, anteflexed²	LV "doughnut" with both papillary muscles, RV crescent	Volume, global and regional function in all three coronary territories
Descending aortic short-axis	0–10°, turned left	Single circle with no cardiac structure	Dissection, atheroma, left pleural effusion
Descending aortic long-axis	~90–100°, turned left²	Tubular aorta across the screen	Extent of a flap, IABP position

Real loops of five more views, from cardiac surgery patients:

ME long-axis

ME two-chamber

ME bicaval

TG mid-papillary short-axis

Descending aorta

Orientation before diagnosis — orienting shows organization, the right view application of knowledge. The outline limits the station to 11 views,³ a finite list I can own.
TG mid-papillary first when the pressure falls — the one view with all three coronary territories and LV filling: hypovolemia, failure and ischemia at once.¹
ME four- versus two-chamber — the right heart discriminates: RV seen, four-chamber; appendage and no RV, roughly 90°.
Bicaval for air and PFO — air collects in the RA and the septum is perpendicular to the beam: my answer to "where do you look for paradoxical embolism?"

Follow-up question

The second loop is a mid-esophageal view with no angle icon and a dark, foreshortened sector. The facilitator asks which view it is and what is abnormal. How do you answer when you are not sure of the view?

Follow-up answer

HeadlineI state what I can identify, in order, and give my best view: mid-esophageal, three cusps in cross-section, so aortic valve short-axis.

Then the abnormality in that frame: heavily calcified, restricted cusps. Unsure, I name the structures and the view I would rotate to next to confirm. A confident wrong view loses more than a plain partial answer; naming structures still earns orientation.

Pitfalls that cost points

Naming the diagnosis before the view.
Confusing ME long-axis with ME ascending aortic long-axis because both show aorta.
Calling the descending aorta short-axis a pericardial effusion or a cyst.
Reading wall motion in a foreshortened four-chamber view and calling the apex akinetic.

Rapid-fire

Q: Why is the left atrium on top in mid-esophageal views? A: The esophagus lies directly behind it, so it is closest to the transducer.

Q: Which view shows all three coronary territories? A: The transgastric mid-papillary short-axis: anterior and anteroseptal LAD, lateral circumflex, inferior and inferoseptal right coronary.²

Q: Why can I not see the distal ascending aorta? A: The air-filled left main bronchus crosses between the esophagus and the aorta, hiding the distal ascending aorta and proximal arch, the TEE blind spot.²

Q: Where do I look for a sinus venosus ASD? A: The ME bicaval view, where the defect sits at the SVC–right atrial junction outside the fossa ovalis; PFO and secundum ASD are also seen here.¹

Numbers to know

Item	Value
Views in the outline	11 TEE
Probe depth, mid-esophageal	~30–35 cm from incisors¹
Probe depth, transgastric	Advance until papillary muscles appear¹
ME four-chamber angle	~10–20°²^,1
Doppler in the exam	Color only; no PW or CW³

Sources

1.Basic Perioperative Transesophageal Echocardiography Examination: A Consensus Statement · ASE/SCA, 2013 · asecho.orgLists RV inflow-outflow at 60-90 degrees; the comprehensive guideline lists 50-70 degrees.
2.Guidelines for Performing a Comprehensive Transesophageal Echocardiography Examination · ASE/SCA, 2013 · asecho.orgTable 10 (28 views): multiplane angles and maneuvers.
3.APPLIED Exam Objective Structured Clinical Examination (OSCE) Content Outline · ABA · theaba.org

Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.