Free RCIS Cath Lab Equipment and Instrumentation Questions and Answers — Questions and Answers
Question 1: Proper timing for an Intra-Aortic Balloon Pump (IABP) involves inflation at what point in the cardiac cycle?
- The peak of the R-wave
- The onset of the dicrotic notch (Correct answer)
- The peak of the T-wave
- The end of the P-wave
Correct answer: The onset of the dicrotic notch
The IABP is designed to augment diastolic pressure, thereby increasing coronary perfusion. Inflation should occur at the dicrotic notch on the arterial waveform, which signifies aortic valve closure and the beginning of diastole. Deflation occurs just before systole to reduce afterload.
Question 2: When zeroing a hemodynamic pressure transducer, it should be leveled to which anatomical landmark to ensure accuracy?
- The sternal notch
- The xiphoid process
- The phlebostatic axis (Correct answer)
- The point of maximal impulse (PMI)
Correct answer: The phlebostatic axis
The phlebostatic axis is the reference point for accurate hemodynamic monitoring, approximating the level of the right atrium. Leveling the transducer to this point (typically the 4th intercostal space, mid-axillary line) negates the effects of hydrostatic pressure. This ensures that the measured pressures accurately reflect the patient's intravascular pressures.
Question 3: Which of the following is the primary mechanism of action for a rotational atherectomy device (e.g., Rotablator)?
- Plaque compression against the vessel wall
- Laser vaporization of the lesion
- Extraction of thrombus material
- Ablation of calcified plaque into microparticles (Correct answer)
Correct answer: Ablation of calcified plaque into microparticles
Rotational atherectomy uses a diamond-coated burr that spins at high speeds to ablate calcified plaque. This process, known as differential cutting, selectively removes hard, inelastic tissue while sparing the softer, elastic vessel wall. The ablated particles are smaller than red blood cells and are cleared by the reticuloendothelial system.
Question 4: A Fractional Flow Reserve (FFR) value of ≤ 0.80 indicates what?
- A hemodynamically insignificant lesion
- A lesion causing ischemia-producing pressure loss (Correct answer)
- Normal coronary blood flow
- The need for a coronary artery bypass graft (CABG)
Correct answer: A lesion causing ischemia-producing pressure loss
FFR is a physiological measurement used to determine the hemodynamic significance of a coronary stenosis. A value of 0.80 means the stenosis is causing a 20% pressure drop across the lesion during maximal hyperemia, which is generally considered to be ischemia-producing. This finding often supports the decision to proceed with percutaneous coronary intervention (PCI).
Question 5: The Impella percutaneous ventricular assist device primarily functions to:
- Increase coronary perfusion by diastolic augmentation
- Improve gas exchange by oxygenating the blood
- Unload the left ventricle and increase cardiac output (Correct answer)
- Pace the heart during severe bradycardia
Correct answer: Unload the left ventricle and increase cardiac output
The Impella is a micro-axial flow pump that is typically placed across the aortic valve, with its inflow in the left ventricle and outflow in the ascending aorta. Its primary function is to actively pump blood from the LV to the aorta, thereby unloading the ventricle and improving systemic perfusion. This provides direct hemodynamic support in cases of cardiogenic shock or high-risk PCI.
Question 6: Which diagnostic catheter is characterized by a secondary curve designed to hook the ostium of the left coronary artery from above?
- Judkins Left (JL)
- Pigtail
- Multipurpose (MP)
- Amplatz Left (AL) (Correct answer)
Correct answer: Amplatz Left (AL)
The Amplatz Left (AL) catheter has a distinct shape with a secondary curve that allows it to engage the left main coronary artery from a superior position. This is different from the Judkins Left catheter, which engages from a more coaxial or inferior approach. The Amplatz design can be particularly useful in cases of unusual aortic root anatomy or a high takeoff of the left main.
Free RCIS Cath Lab Equipment and Instrumentation Questions and Answers
Proper timing for an Intra-Aortic Balloon Pump (IABP) involves inflation at what point in the cardiac cycle?