EACVI Cardiac Computed Tomography Practice Examination REAL LATEST QUESTIONS
AND CORRECT ANSWERS GRADE A
What is the primary clinical indication for coronary computed tomography angiography
(CCTA) in symptomatic patients?
A) First-line test in patients with low-to-intermediate pre-test probability of coronary artery
disease (CAD)
B) First-line test in all patients with chest pain
C) Alternative to invasive angiography in high-probability patients
D) Screening for CAD in asymptomatic individuals
**Answer:** A) First-line test in patients with low-to-intermediate pre-test probability of
coronary artery disease (CAD)
**Explanation:** Current guidelines recommend CCTA as a first-line test for symptomatic
patients with low-to-intermediate pre-test probability of obstructive CAD, due to its high
negative predictive value.
**Question 2:**
Which beta-blocker is most commonly used for heart rate control prior to CCTA?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Esmolol
**Answer:** A) Metoprolol
**Explanation:** Metoprolol is widely used orally or intravenously for heart rate control
before CCTA due to its cardioselective properties and predictable onset/duration.
,**Question 3:**
What is the target heart rate for optimal coronary artery imaging during retrospective ECG-
gated CCTA?
A) < 60 bpm
B) 60-70 bpm
C) 70-80 bpm
D) > 80 bpm is acceptable with modern scanners
**Answer:** A) < 60 bpm
**Explanation:** A heart rate below 60 bpm minimizes cardiac motion artifacts and allows
optimal coronary artery visualization, particularly important for retrospective gating.
**Question 4:**
Which coronary artery is most commonly associated with artifacts due to cardiac motion?
A) Left main coronary artery
B) Left anterior descending artery
C) Right coronary artery
D) Left circumflex artery
**Answer:** C) Right coronary artery
**Explanation:** The right coronary artery (RCA) is most susceptible to motion artifacts
due to its location along the right atrioventricular groove and proximity to the right atrium,
which contracts during systole.
**Question 5:**
What is the primary advantage of prospective ECG-triggering over retrospective ECG-gating
in CCTA?
,A) Better temporal resolution
B) Lower radiation dose
C) Ability to assess cardiac function
D) Better image quality in arrhythmia
**Answer:** B) Lower radiation dose
**Explanation:** Prospective triggering acquires data only during a specific phase of the
cardiac cycle (usually diastasis), resulting in significantly lower radiation exposure
compared to retrospective gating which acquires continuously.
**Question 6:**
Which of the following is a relative contraindication to iodinated contrast administration?
A) Diabetes mellitus
B) Hypertension
C) Severe renal impairment (eGFR < 30 mL/min/1.73m²)
D) Hyperlipidemia
**Answer:** C) Severe renal impairment (eGFR < 30 mL/min/1.73m²)
**Explanation:** Severe renal impairment increases the risk of contrast-induced
nephropathy, making it a relative contraindication requiring careful risk-benefit assessment
and possibly preventive measures.
**Question 7:**
What is the most appropriate reconstruction phase for evaluating the right coronary artery
in patients with high heart rates?
A) 40-50% of R-R interval (mid-diastole)
B) 70-80% of R-R interval (end-systole)
, C) 30-40% of R-R interval (early diastole)
D) 0-10% of R-R interval (early systole)
**Answer:** B) 70-80% of R-R interval (end-systole)
**Explanation:** At higher heart rates (>70 bpm), the right coronary artery often has
minimal motion during end-systole (70-80% phase) rather than mid-diastole.
**Question 8:**
Which coronary anomaly carries the highest risk of sudden cardiac death?
A) Anomalous origin of the left coronary artery from the right sinus of Valsalva with
interarterial course
B) Myocardial bridging
C) Coronary artery fistula
D) Separate origin of LAD and LCx from left sinus
**Answer:** A) Anomalous origin of the left coronary artery from the right sinus of Valsalva
with interarterial course
**Explanation:** This anomaly has the highest association with sudden cardiac death,
especially during exercise, due to potential compression between the aorta and pulmonary
artery.
**Question 9:**
What is the typical iodine concentration (mg/mL) used for coronary CTA?
A) 240-270
B) 300-370
C) 400-450
D) 150-200
AND CORRECT ANSWERS GRADE A
What is the primary clinical indication for coronary computed tomography angiography
(CCTA) in symptomatic patients?
A) First-line test in patients with low-to-intermediate pre-test probability of coronary artery
disease (CAD)
B) First-line test in all patients with chest pain
C) Alternative to invasive angiography in high-probability patients
D) Screening for CAD in asymptomatic individuals
**Answer:** A) First-line test in patients with low-to-intermediate pre-test probability of
coronary artery disease (CAD)
**Explanation:** Current guidelines recommend CCTA as a first-line test for symptomatic
patients with low-to-intermediate pre-test probability of obstructive CAD, due to its high
negative predictive value.
**Question 2:**
Which beta-blocker is most commonly used for heart rate control prior to CCTA?
A) Metoprolol
B) Atenolol
C) Propranolol
D) Esmolol
**Answer:** A) Metoprolol
**Explanation:** Metoprolol is widely used orally or intravenously for heart rate control
before CCTA due to its cardioselective properties and predictable onset/duration.
,**Question 3:**
What is the target heart rate for optimal coronary artery imaging during retrospective ECG-
gated CCTA?
A) < 60 bpm
B) 60-70 bpm
C) 70-80 bpm
D) > 80 bpm is acceptable with modern scanners
**Answer:** A) < 60 bpm
**Explanation:** A heart rate below 60 bpm minimizes cardiac motion artifacts and allows
optimal coronary artery visualization, particularly important for retrospective gating.
**Question 4:**
Which coronary artery is most commonly associated with artifacts due to cardiac motion?
A) Left main coronary artery
B) Left anterior descending artery
C) Right coronary artery
D) Left circumflex artery
**Answer:** C) Right coronary artery
**Explanation:** The right coronary artery (RCA) is most susceptible to motion artifacts
due to its location along the right atrioventricular groove and proximity to the right atrium,
which contracts during systole.
**Question 5:**
What is the primary advantage of prospective ECG-triggering over retrospective ECG-gating
in CCTA?
,A) Better temporal resolution
B) Lower radiation dose
C) Ability to assess cardiac function
D) Better image quality in arrhythmia
**Answer:** B) Lower radiation dose
**Explanation:** Prospective triggering acquires data only during a specific phase of the
cardiac cycle (usually diastasis), resulting in significantly lower radiation exposure
compared to retrospective gating which acquires continuously.
**Question 6:**
Which of the following is a relative contraindication to iodinated contrast administration?
A) Diabetes mellitus
B) Hypertension
C) Severe renal impairment (eGFR < 30 mL/min/1.73m²)
D) Hyperlipidemia
**Answer:** C) Severe renal impairment (eGFR < 30 mL/min/1.73m²)
**Explanation:** Severe renal impairment increases the risk of contrast-induced
nephropathy, making it a relative contraindication requiring careful risk-benefit assessment
and possibly preventive measures.
**Question 7:**
What is the most appropriate reconstruction phase for evaluating the right coronary artery
in patients with high heart rates?
A) 40-50% of R-R interval (mid-diastole)
B) 70-80% of R-R interval (end-systole)
, C) 30-40% of R-R interval (early diastole)
D) 0-10% of R-R interval (early systole)
**Answer:** B) 70-80% of R-R interval (end-systole)
**Explanation:** At higher heart rates (>70 bpm), the right coronary artery often has
minimal motion during end-systole (70-80% phase) rather than mid-diastole.
**Question 8:**
Which coronary anomaly carries the highest risk of sudden cardiac death?
A) Anomalous origin of the left coronary artery from the right sinus of Valsalva with
interarterial course
B) Myocardial bridging
C) Coronary artery fistula
D) Separate origin of LAD and LCx from left sinus
**Answer:** A) Anomalous origin of the left coronary artery from the right sinus of Valsalva
with interarterial course
**Explanation:** This anomaly has the highest association with sudden cardiac death,
especially during exercise, due to potential compression between the aorta and pulmonary
artery.
**Question 9:**
What is the typical iodine concentration (mg/mL) used for coronary CTA?
A) 240-270
B) 300-370
C) 400-450
D) 150-200
