CCI RCIS 3 — Questions and Answers
Question 1: Which pharmacological agent is used to reverse heparin anticoagulation in the cath lab?
- Vitamin K
- Protamine sulfate (Correct answer)
- Bivalirudin
- Fresh frozen plasma
Correct answer: Protamine sulfate
Protamine sulfate binds and neutralizes heparin, rapidly reversing its anticoagulant effect.
Question 2: On a coronary angiogram, the left anterior descending (LAD) artery primarily supplies which cardiac territory?
- Inferior wall and posterior interventricular septum
- Anterior wall and anterior two-thirds of the interventricular septum (Correct answer)
- Lateral wall and posterior descending territory
- Right ventricular free wall exclusively
Correct answer: Anterior wall and anterior two-thirds of the interventricular septum
The LAD supplies the anterior left ventricular wall, apex, and anterior septum via diagonal and septal perforator branches.
Question 3: The normal activated clotting time (ACT) target during percutaneous coronary intervention (PCI) with unfractionated heparin is:
- 100–150 seconds
- 200–250 seconds (Correct answer)
- 300–350 seconds
- 400–450 seconds
Correct answer: 200–250 seconds
An ACT of 200–250 seconds is the standard therapeutic target for PCI with heparin alone to prevent thrombosis while minimizing bleeding risk.
Question 4: Which of the following is a TRUE statement about ionic versus non-ionic contrast media?
- Ionic contrast has fewer osmolarity-related side effects
- Non-ionic contrast is associated with lower rates of allergic-type reactions (Correct answer)
- Ionic contrast is preferred in patients with renal insufficiency
- Non-ionic contrast has higher osmolality than ionic contrast
Correct answer: Non-ionic contrast is associated with lower rates of allergic-type reactions
Non-ionic (low-osmolar) contrast agents carry a lower risk of anaphylactoid and hemodynamic reactions compared to high-osmolar ionic agents.
Question 5: A patient's aortic valve area calculated by the Gorlin formula is 0.6 cm². This finding is consistent with:
- Mild aortic stenosis
- Moderate aortic stenosis
- Severe aortic stenosis (Correct answer)
- Normal aortic valve
Correct answer: Severe aortic stenosis
An aortic valve area ≤0.6–1.0 cm² (with critical being <0.6 cm²) is classified as severe aortic stenosis per ACC/AHA guidelines.
Question 6: During balloon inflation in PTCA, ST-segment elevation in the monitored lead MOST likely represents:
- Reperfusion injury only
- Transient ischemia from balloon occlusion (Correct answer)
- Pericarditis
- Lead misplacement
Correct answer: Transient ischemia from balloon occlusion
Balloon inflation temporarily occludes coronary flow, causing ischemia in the supplied territory manifesting as transient ST elevation.
Question 7: Gadolinium-based contrast agents may be used in cath lab procedures primarily for patients with:
- Latex allergy
- Prior anaphylaxis to shellfish
- Severe contrast-induced nephropathy risk or ESRD on dialysis (Correct answer)
- Pregnancy
Correct answer: Severe contrast-induced nephropathy risk or ESRD on dialysis
Gadolinium can be used as an alternative angiographic contrast agent in patients at high risk of contrast nephropathy, though its angiographic quality is inferior.
CCI RCIS 3
Which pharmacological agent is used to reverse heparin anticoagulation in the cath lab?