CCI RCIS 4 â Questions and Answers
Question 1: Which of the following describes a 'type A' coronary lesion morphology per the ACC/AHA classification?
- Chronic total occlusion >3 months duration
- Discrete lesion <10 mm, concentric, non-angulated, smooth contour (Correct answer)
- Lesion with thrombus or heavy calcification
- Bifurcation lesion requiring side-branch protection
Correct answer: Discrete lesion <10 mm, concentric, non-angulated, smooth contour
Type A lesions are discrete, concentric, accessible, and non-calcified, carrying the highest procedural success and lowest complication rates.
Question 2: Fractional flow reserve (FFR) of 0.75 in a 70% stenosis coronary lesion indicates:
- Hemodynamically non-significant lesion â defer PCI
- Hemodynamically significant ischemia â revascularization is warranted (Correct answer)
- Normal coronary flow â no intervention needed
- Indeterminate result requiring repeat testing
Correct answer: Hemodynamically significant ischemia â revascularization is warranted
An FFR â€0.80 (especially â€0.75) indicates physiologically significant ischemia, supporting revascularization to improve outcomes.
Question 3: When using a thermodilution catheter to measure cardiac output, which injectate temperature produces the MOST accurate results?
- Room temperature (approximately 22°C)
- Iced saline (approximately 0â4°C) (Correct answer)
- Body temperature (37°C)
- Temperature does not affect accuracy
Correct answer: Iced saline (approximately 0â4°C)
Iced injectate creates a larger temperature differential, improving signal-to-noise ratio and accuracy of the thermodilution curve.
Question 4: Which ECG finding is MOST concerning for left main coronary artery disease during stress testing or symptom onset?
- ST elevation in V1 and aVR with diffuse ST depression in other leads (Correct answer)
- Isolated T-wave inversion in V1âV2
- ST elevation in II, III, and aVF
- Right bundle branch block pattern
Correct answer: ST elevation in V1 and aVR with diffuse ST depression in other leads
ST elevation in aVR with diffuse ST depression suggests global subendocardial ischemia, classically associated with left main or proximal LAD disease.
Question 5: The 'normal' pulmonary vascular resistance (PVR) in a patient without cardiopulmonary disease is approximately:
- 500â800 dynes·sec·cmâ»â”
- 50â150 dynes·sec·cmâ»â” (Correct answer)
- 1000â1500 dynes·sec·cmâ»â”
- 200â400 dynes·sec·cmâ»â”
Correct answer: 50â150 dynes·sec·cmâ»â”
Normal PVR is 50â150 dynes·sec·cmâ»â”, far lower than systemic resistance, reflecting the low-resistance pulmonary circuit.
Question 6: During coronary intervention, 'no-reflow' phenomenon is BEST managed with which of the following agents?
- Intracoronary adenosine or verapamil (Correct answer)
- Intravenous atropine
- Systemic heparin bolus
- Intracoronary epinephrine
Correct answer: Intracoronary adenosine or verapamil
Intracoronary vasodilators such as adenosine, verapamil, or nitroprusside are first-line treatments for no-reflow due to microvascular spasm and dysfunction.
Question 7: Which parameter is calculated using the formula: (MAP â CVP) / CO Ă 80?
- Pulmonary vascular resistance
- Systemic vascular resistance (Correct answer)
- Cardiac index
- Stroke volume index
Correct answer: Systemic vascular resistance
SVR = (MAP â CVP) / CO Ă 80, expressing the opposition the left ventricle overcomes to eject blood into the systemic circulation.
CCI RCIS 4
Which of the following describes a 'type A' coronary lesion morphology per the ACC/AHA classification?