CCI RCIS 5 ā Questions and Answers
Question 1: Ventricular tachycardia during left heart catheterization is MOST commonly triggered by:
- Contrast media injection into the right coronary artery
- Catheter contact with the ventricular endocardium (Correct answer)
- High-osmolar contrast causing systemic hyperosmolarity
- Rapid balloon deflation during PTCA
Correct answer: Catheter contact with the ventricular endocardium
Mechanical irritation of the ventricular myocardium from catheter tip contact is the most frequent cause of catheter-induced VT during left heart cath.
Question 2: In the sheath-to-catheter size conversion, a 6 French sheath accommodates catheters up to which size?
- 4 French
- 6 French (Correct answer)
- 7 French
- 8 French
Correct answer: 6 French
A 6 French sheath is sized to accommodate a 6 French catheter; the sheath inner lumen matches the outer diameter of the compatible catheter.
Question 3: The 'TIMI flow grade' system classifies coronary blood flow from 0 to 3. TIMI 2 is defined as:
- No perfusion ā contrast does not pass beyond the obstruction
- Partial perfusion ā contrast passes but fills and clears the distal vessel slowly (Correct answer)
- Complete perfusion ā contrast fills and clears normally
- Delayed but complete filling within 3 beats
Correct answer: Partial perfusion ā contrast passes but fills and clears the distal vessel slowly
TIMI 2 indicates partial reperfusion: contrast does opacify the distal vessel but clearing is slower than in an unobstructed artery.
Question 4: A patient with mitral regurgitation will show a prominent 'V wave' on the pulmonary artery wedge pressure tracing. This V wave represents:
- Right ventricular systole
- Passive left atrial filling against a closed mitral valve during ventricular systole (Correct answer)
- Left ventricular isovolumetric relaxation
- Aortic valve closure
Correct answer: Passive left atrial filling against a closed mitral valve during ventricular systole
V waves occur during ventricular systole when regurgitant flow from the LV rapidly fills the LA, generating a high-pressure wave visible on the wedge tracing.
Question 5: Which of the following is the PRIMARY indication for intra-aortic balloon pump (IABP) counterpulsation?
- Cardiogenic shock or hemodynamic instability refractory to medical therapy (Correct answer)
- Routine post-PCI prophylaxis in stable patients
- Hypertensive emergency
- Atrial fibrillation with rapid ventricular response
Correct answer: Cardiogenic shock or hemodynamic instability refractory to medical therapy
IABP is indicated for cardiogenic shock, acute MI with hemodynamic compromise, or high-risk PCI support to augment diastolic coronary perfusion and reduce afterload.
Question 6: During percutaneous coronary intervention, a coronary dissection that involves the coronary media and results in reduced TIMI flow is classified as NHLBI type:
- Type A
- Type B
- Type D
- Type E or F (Correct answer)
Correct answer: Type E or F
NHLBI types E and F dissections involve spiral luminal filling defects or total occlusions with no distal flow, representing the most severe dissection categories.
Question 7: Which safety measure is MOST effective in reducing operator radiation dose during fluoroscopy in the cath lab?
- Wearing a lead apron only without additional shielding
- Maximizing distance from the X-ray tube and using suspended lead shields (Correct answer)
- Reducing frame rate from 15 to 30 frames per second
- Standing directly behind the image intensifier
Correct answer: Maximizing distance from the X-ray tube and using suspended lead shields
Maximizing distance (inverse square law) combined with ceiling-suspended and table-mounted lead shields provides the greatest dose reduction for cath lab personnel.
CCI RCIS 5
Ventricular tachycardia during left heart catheterization is MOST commonly triggered by: