GLOWACKI & SOMMERS (RCIS QUESTIONS) 309 QUESTIONS
WITH COMPLETE SOLUTIONS | 55 PAGES 2026/2027
Comprehensive Certification Examination aligned with CCI (Cardiovascular Credentialing International) RCIS Exam Content Outline,
Invasive Cardiovascular Technology Competencies, and Cath Lab Standards (2026/2027 Edition). 150 questions across 11 sections.
Cognitive distribution: 25% recall, 50% application, 25% analysis. 75% scenario-based, 25% direct knowledge. Includes 25 hemodynamic
calculation/waveform interpretation questions, 20 angiography/image interpretation questions, and 15 pharmacology/contrast media
questions.
Section 1: Cardiovascular Anatomy & Physiology
Q1: During a left heart catheterization, the catheter tip is positioned in the coronary sinus. This vessel normally
drains venous blood directly into which cardiac chamber?
A. Left atrium
B. Right atrium *[CORRECT]*
C. Right ventricle
D. Superior vena cava
Correct Answer: B
Rationale: The coronary sinus is the largest cardiac vein and drains deoxygenated blood from the myocardium directly into
the right atrium, between the IVC opening and the tricuspid valve. CCI RCIS content outline requires mastery of cardiac
venous anatomy because coronary sinus catheterization is used for CS pacing leads and retrograde cardioplegia. Left atrium
(A) carries oxygenated pulmonary venous return; right ventricle (C) receives blood from the right atrium; and the SVC (D)
returns systemic upper-body venous blood to the right atrium but does not receive the coronary sinus.
Q2: A patient has an ejection fraction of 55% with an end-diastolic volume (EDV) of 120 mL. What is the stroke
volume?
A. 55 mL
B. 66 mL *[CORRECT]*
C. 75 mL
D. 120 mL
Correct Answer: B
Rationale: Stroke volume (SV) = EDV − ESV. Ejection fraction = SV / EDV, so SV = EF × EDV = 0.55 × 120 = 66 mL.
This is a core hemodynamic calculation per CCI RCIS content outline. Option A (55 mL) is the EF percentage mistaken as
a volume; option C (75 mL) would correspond to EF 62.5%; option D (120 mL) is the EDV itself and would imply an EF of
100%.
Q3: According to the Frank-Starling mechanism, increasing preload in a healthy ventricle results in:
A. Decreased stroke volume due to wall stress
B. Increased contractility and stroke volume up to a physiologic limit *[CORRECT]*
C. Decreased heart rate via baroreceptor reflex
D. Increased afterload to maintain perfusion
Correct Answer: B
Rationale: The Frank-Starling law states that increased ventricular filling (preload) stretches sarcomeres, optimizing
actin-myosin overlap and increasing the force of contraction, thereby raising stroke volume up to a physiologic plateau (~2.2
μm sarcomere length). CCI RCIS content outline requires understanding of preload-contractility relationships for
hemodynamic interpretation. Decreased SV (A) occurs only in decompensated heart failure on the descending limb. Heart
rate changes (C) are governed by autonomic reflexes, not Starling mechanics. Afterload (D) is determined by aortic
impedance and vascular resistance, not preload.
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,GLOWACKI & SOMMERS RCIS EXAMINATION | 2026/2027 Edition CCI RCIS Content Outline Aligned
Q4: Which coronary artery typically supplies the AV node in a right-dominant circulation?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery *[CORRECT]*
D. Ramus intermedius
Correct Answer: C
Rationale: In approximately 85-90% of patients (right-dominant circulation), the AV nodal branch arises from the
posterior descending artery, which is a branch of the right coronary artery (RCA). CCI RCIS content outline requires
knowledge of coronary dominance patterns. The LAD (A) supplies the anterior wall and most of the interventricular
septum; the LCx (B) supplies the lateral wall in left-dominant systems the LCx gives off the PDA; the ramus intermedius
(D) is an anatomic variant that arises between the LAD and LCx but does not supply the AV node.
Q5: A cath lab patient's ECG demonstrates a heart rate of 75 bpm with a blood pressure of 120/80 mmHg.
Calculate the rate-pressure product (RPP), an indirect measure of myocardial oxygen demand.
A. 8,400
B. 9,000 *[CORRECT]*
C. 10,000
D. 12,000
Correct Answer: B
Rationale: Rate-pressure product (RPP) = HR × systolic BP = 75 × 120 = 9,000. This index of myocardial oxygen demand
(MVO2) is a CCI RCIS-relevant hemodynamic parameter used to assess ischemic burden during cath lab procedures.
Option A (8,400) reflects 75 × diastolic 80 + systolic-30 error; option C (10,000) approximates a typical RPP at rest but is
not the calculation; option D (12,000) would correspond to HR 100 × SBP 120.
Q6: During systole, the mitral valve closes when:
A. Left atrial pressure exceeds left ventricular pressure
B. Left ventricular pressure exceeds left atrial pressure *[CORRECT]*
C. Aortic pressure exceeds left ventricular pressure
D. The QRS complex appears on ECG
Correct Answer: B
Rationale: The mitral valve closes at the beginning of isovolumetric contraction when left ventricular pressure rises above
left atrial pressure, preventing retrograde flow into the atrium. This event corresponds to the first heart sound (S1) on the
cardiac cycle diagram. CCI RCIS content outline requires understanding of valvular mechanics for waveform interpretation.
Atrial pressure exceeding ventricular (A) would open the mitral valve during diastole. Aortic pressure exceeding LV (C)
closes the aortic valve at the dicrotic notch. The QRS complex (D) initiates electrical depolarization ~30-40 ms before
mechanical contraction; the actual closure is mechanical, not electrical.
Q7: The Purkinje fibers of the cardiac conduction system distribute electrical impulses at velocities of
approximately:
A. 0.5 m/s
B. 1-2 m/s
C. 2-4 m/s
D. 5-10 m/s *[CORRECT]*
Correct Answer: D
Rationale: Purkinje fibers conduct at 5-10 m/s, the fastest conduction velocity in the heart, allowing rapid depolarization of
the ventricular myocardium and synchronous contraction. CCI RCIS content outline requires knowledge of conduction
velocities for EP waveform analysis. AV node conduction (A) is 0.05 m/s; bundle of His (B) is ~2 m/s; atrial/ventricular
muscle (C) is 0.3-1 m/s.
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,GLOWACKI & SOMMERS RCIS EXAMINATION | 2026/2027 Edition CCI RCIS Content Outline Aligned
Q8: A cath lab angiogram reveals a vessel originating from the proximal LAD, coursing across the anterior wall to
anastomose with the distal PDA in a patient with chronic total occlusion of the RCA. This vessel is most likely:
A. Kugel's artery
B. Vieussens' collateral *[CORRECT]*
C. Sohm's ring
D. Conus artery
Correct Answer: B
Rationale: Vieussens' collateral (also called the Vieussens ring) is an epicardial collateral that connects the conus branch of
the RCA with the proximal LAD, or in this case bridges the LAD to the distal PDA via an anterior ventricular branch. CCI
RCIS content outline requires identification of coronary collaterals for angiographic interpretation. Kugel's artery (A) is an
atrial collateral connecting the proximal RCA/LCx to the distal AV nodal artery. Sohm's ring (C) is not a standard coronary
collateral term. The conus artery (D) arises from the RCA ostium and supplies the RV outflow tract.
Q9: Which physiologic change occurs immediately after birth in the normal neonatal transition from fetal to adult
circulation?
A. Ductus venosus remains patent
B. Pulmonary vascular resistance decreases dramatically *[CORRECT]*
C. Foramen ovale opens widely
D. Ductus arteriosus constricts before pulmonary resistance drops
Correct Answer: B
Rationale: With the first breaths, lung expansion causes pulmonary vascular resistance to fall dramatically (from ~3.5
Wood units in utero to <0.5 within hours), reversing the right-to-left shunt through the foramen ovale and ductus arteriosus.
CCI RCIS content outline requires understanding of fetal-to-adult circulation transition for congenital catheterization cases.
Ductus venosus (A) closes functionally within minutes. The foramen ovale closes functionally due to LA pressure rising
above RA. Ductus arteriosus closure follows over hours to days, mediated by rising oxygen tension and falling
prostaglandins.
Q10: A patient has a cardiac output of 5.0 L/min, mean arterial pressure of 93 mmHg, and right atrial pressure of
5 mmHg. Calculate the systemic vascular resistance (SVR) in Wood units.
A. 11.6 WU
B. 17.6 WU *[CORRECT]*
C. 18.6 WU
D. 23.2 WU
Correct Answer: B
Rationale: SVR (Wood units) = (MAP − CVP) / CO = (93 − 5) / 5.0 = 17.6 WU. Normal SVR is 15-25 WU (or 800-1500
dynes·s/cm⁵ when multiplied by 80). CCI RCIS content outline requires Wood unit calculations and conversion to dynes.
Option A (11.6) reflects incorrect use of diastolic pressure; option C (18.6) reflects MAP 98; option D (23.2) reflects CO
3.8.
Q11: The left main coronary artery typically bifurcates into the LAD and LCx. In approximately what percentage
of patients does a third branch, the ramus intermedius, arise from this bifurcation (trifurcation)?
A. 10-20%
B. 20-37% *[CORRECT]*
C. 50-60%
D. 70-80%
Correct Answer: B
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, GLOWACKI & SOMMERS RCIS EXAMINATION | 2026/2027 Edition CCI RCIS Content Outline Aligned
Rationale: A trifurcation of the left main into LAD, LCx, and ramus intermedius occurs in approximately 20-37% of
patients, with the ramus supplying the anterolateral wall. CCI RCIS content outline requires recognition of anatomic
variants during angiographic interpretation to avoid misidentifying branches. Options A, C, and D represent under- or
overestimates that would lead to procedural misidentification of coronary segments.
Q12: Which statement best describes the anatomic position of the SA node?
A. Located in the inferior interatrial septum near the coronary sinus
B. Located at the junction of the SVC and right atrium near the crista terminalis *[CORRECT]*
C. Located in the upper interventricular septum
D. Located at the origin of the coronary sinus
Correct Answer: B
Rationale: The sinoatrial (SA) node is a subepicardial cluster of pacemaker cells located at the junction of the superior
vena cava and the right atrium, near the crista terminalis and the sulcus terminalis. CCI RCIS content outline requires
knowledge of conduction system anatomy for EP studies. The AV node (A) is in the inferior interatrial septum near the
coronary sinus ostium; the bundle of His (C) is in the upper interventricular septum; and the coronary sinus origin (D) is in
the posterior atrioventricular groove.
Q13: During right heart catheterization, blood samples drawn from the SVC, IVC, RA, RV, PA, and pulmonary
capillary wedge position show step-up in oxygen saturation at the RV level. This finding is most consistent with:
A. Atrial septal defect
B. Ventricular septal defect *[CORRECT]*
C. Patent ductus arteriosus
D. Pulmonary embolism
Correct Answer: B
Rationale: A step-up in oxygen saturation of ≥7% between the RA and RV indicates a left-to-right shunt at the ventricular
level, characteristic of a ventricular septal defect (VSD). CCI RCIS content outline requires oxygen saturation run
interpretation for shunt detection (Qp/Qs). An ASD (A) produces a step-up at the RA level; PDA (C) produces a step-up at
the PA level; pulmonary embolism (D) does not cause an oxygen step-up but may cause elevated PA pressures with normal
wedge pressure.
Q14: Cardiac output can be calculated by the Fick principle using which formula?
A. CO = HR × SV × BS
B. CO = VO₂ / (CaO₂ − CvO₂) *[CORRECT]*
C. CO = (MAP − CVP) / SVR
D. CO = HR × (EDV − ESV)
Correct Answer: B
Rationale: The Fick principle states CO = oxygen consumption / (arterial oxygen content − mixed venous oxygen content).
Direct Fick requires measurement of VO₂ and oxygen contents; indirect Fick uses estimated VO₂. CCI RCIS content outline
requires both Fick and thermodilution cardiac output methods. Option B is the correct Fick formula. Option A is a
non-standard formula; option C solves for SVR; option D is the stroke volume calculation.
Q15: A patient in the cath lab has a blood pressure of 140/90 mmHg. What is the calculated pulse pressure and
mean arterial pressure?
A. PP = 50 mmHg, MAP = 105 mmHg
B. PP = 50 mmHg, MAP = 107 mmHg *[CORRECT]*
C. PP = 140 mmHg, MAP = 110 mmHg
D. PP = 90 mmHg, MAP = 107 mmHg
Correct Answer: B
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