RCIS EXAM 2026 COMPLETE
REVIEW STUDY GUIDE | FULL
PRACTICE CONCEPTS &
DETAILED EXPLANATIONS ||
UPDATED EDITION <RECENT
VERSION>
1. Which artery is most commonly used as the primary access site for coronary angiography
and intervention?
A) Brachial Artery
B) Radial Artery
C) Femoral Artery
D) Ulnar Artery
Explanation: While the femoral artery is also common, the radial artery is now the primary
recommended access site for most elective procedures due to lower bleeding complications and
improved patient comfort.
2. What is the normal approximate oxygen saturation (%) of blood in the main pulmonary
artery?
A) 65-75%
B) 95-100%
C) 98-100%
D) 70-80%
*Explanation: Mixed venous oxygen saturation (from the SVC, IVC, and coronary sinus) mixes in
the right ventricle and enters the pulmonary artery, typically ranging from 70-80%.*
,3. The "a wave" on a right atrial pressure waveform corresponds to:
A) Atrial relaxation
B) Ventricular contraction
C) Atrial contraction
D) Ventricular filling
Explanation: The a wave is generated by atrial systole (contraction). The v wave corresponds to
venous filling against a closed tricuspid valve.
4. A patient with severe aortic stenosis would most likely exhibit which hemodynamic
finding?
A) Wide pulse pressure
B) Increased cardiac output
C) Pressure gradient between the LV and aorta during systole
D) Elevated right atrial pressure
Explanation: The hallmark of valve stenosis is a pressure gradient across the valve. In aortic
stenosis, the left ventricle must generate higher pressure to eject blood, creating a systolic
gradient.
5. Which pharmacological agent is a direct thrombin inhibitor used as an alternative to
heparin during PCI in patients with HIT?
A) Clopidogrel
B) Bivalirudin
C) Enoxaparin
D) Ticagrelor
Explanation: Bivalirudin is a direct thrombin inhibitor and is a cornerstone anticoagulant for PCI,
especially in patients with or at risk for heparin-induced thrombocytopenia (HIT).
6. The term "dicrotic notch" on the aortic pressure waveform signifies:
A) Peak systole
B) Closure of the aortic valve
C) Atrial kick
D) Mitral valve opening
Explanation: The dicrotic notch is a brief, sharp decline followed by a small rise, caused by the
closure of the aortic valve and the elastic recoil of the aorta.
7. Which vessel gives rise to the posterior descending artery (PDA) in a right-dominant
coronary system?
A) Left Anterior Descending (LAD)
B) Circumflex Artery (LCx)
,C) Right Coronary Artery (RCA)
D) Left Main Coronary Artery
*Explanation: In an ~85% right-dominant system, the RCA supplies the PDA and the
posterolateral branches.*
8. What is the primary mechanism of action of nitroglycerin?
A) Beta-1 adrenergic blockade
B) Venodilation, reducing preload
C) Increased inotropy
D) Antiplatelet aggregation
Explanation: Nitroglycerin is a potent venodilator, which decreases venous return (preload),
reducing myocardial oxygen demand and relieving angina.
9. During a right heart catheterization, the catheter moves from the right atrium to the right
ventricle. What is the expected change in systolic pressure?
A) Decrease
B) Significant Increase
C) No change
D) Slight decrease
*Explanation: Right atrial systolic pressure is low (a wave, ~3-7 mmHg). Right ventricular systolic
pressure is significantly higher (15-30 mmHg) as it pumps against pulmonary vascular
resistance.*
10. The Left Main Coronary Artery typically bifurcates into:
A) LAD and RCA
B) RCA and LCx
C) LAD and LCx
D) PDA and OM
Explanation: The Left Main coronary artery divides into the Left Anterior Descending (LAD) and
the Left Circumflex (LCx) arteries.
11. Which hemodynamic formula is used to calculate cardiac output using the Fick principle?
A) CO = HR x SV
B) CO = (O2 consumption) / (A-V O2 difference x 10)
C) CO = (PA mean - PCWP) / PVR
D) CO = MAP / SVR
*Explanation: The Fick principle states CO = Oxygen Consumption / (Arterial O2 content -
Venous O2 content). It's often considered the gold standard.*
, 12. What is the most common complication of arterial access site management?
A) Infection
B) Arteriovenous Fistula
C) Hematoma
D) Distal Embolization
Explanation: Hematoma formation is the most frequent access site complication. Proper
technique and post-procedure compression are critical to minimize it.
13. The "V wave" on a left atrial or pulmonary capillary wedge pressure (PCWP) tracing
represents:
A) Atrial contraction
B) Passive venous filling of the atrium against a closed mitral valve
C) Ventricular contraction
D) Atrial relaxation
Explanation: The v wave peaks during ventricular systole when the mitral valve is closed, and
blood fills the left atrium from the pulmonary veins.
14. Which antiplatelet agent is an irreversible P2Y12 inhibitor that requires metabolic
activation?
A) Ticagrelor
B) Cangrelor
C) Clopidogrel
D) Aspirin
Explanation: Clopidogrel is a prodrug and an irreversible P2Y12 inhibitor. Its variable activation
is why genetic testing is sometimes used.
15. The artery of Adamkiewicz is a critical branch of the aorta that supplies blood to the:
A) Brain
B) Anterior spinal cord
C) Liver
D) Kidneys
Explanation: This artery, often arising from a lower intercostal or lumbar artery, is the major
supplier of the anterior spinal cord. Its occlusion can cause paralysis.
16. A damped arterial pressure waveform upon catheter engagement most likely indicates:
A) Severe aortic stenosis
B) Catheter tip obstruction (e.g., against the vessel wall)
C) Hypertension
D) Ventricular fibrillation
REVIEW STUDY GUIDE | FULL
PRACTICE CONCEPTS &
DETAILED EXPLANATIONS ||
UPDATED EDITION <RECENT
VERSION>
1. Which artery is most commonly used as the primary access site for coronary angiography
and intervention?
A) Brachial Artery
B) Radial Artery
C) Femoral Artery
D) Ulnar Artery
Explanation: While the femoral artery is also common, the radial artery is now the primary
recommended access site for most elective procedures due to lower bleeding complications and
improved patient comfort.
2. What is the normal approximate oxygen saturation (%) of blood in the main pulmonary
artery?
A) 65-75%
B) 95-100%
C) 98-100%
D) 70-80%
*Explanation: Mixed venous oxygen saturation (from the SVC, IVC, and coronary sinus) mixes in
the right ventricle and enters the pulmonary artery, typically ranging from 70-80%.*
,3. The "a wave" on a right atrial pressure waveform corresponds to:
A) Atrial relaxation
B) Ventricular contraction
C) Atrial contraction
D) Ventricular filling
Explanation: The a wave is generated by atrial systole (contraction). The v wave corresponds to
venous filling against a closed tricuspid valve.
4. A patient with severe aortic stenosis would most likely exhibit which hemodynamic
finding?
A) Wide pulse pressure
B) Increased cardiac output
C) Pressure gradient between the LV and aorta during systole
D) Elevated right atrial pressure
Explanation: The hallmark of valve stenosis is a pressure gradient across the valve. In aortic
stenosis, the left ventricle must generate higher pressure to eject blood, creating a systolic
gradient.
5. Which pharmacological agent is a direct thrombin inhibitor used as an alternative to
heparin during PCI in patients with HIT?
A) Clopidogrel
B) Bivalirudin
C) Enoxaparin
D) Ticagrelor
Explanation: Bivalirudin is a direct thrombin inhibitor and is a cornerstone anticoagulant for PCI,
especially in patients with or at risk for heparin-induced thrombocytopenia (HIT).
6. The term "dicrotic notch" on the aortic pressure waveform signifies:
A) Peak systole
B) Closure of the aortic valve
C) Atrial kick
D) Mitral valve opening
Explanation: The dicrotic notch is a brief, sharp decline followed by a small rise, caused by the
closure of the aortic valve and the elastic recoil of the aorta.
7. Which vessel gives rise to the posterior descending artery (PDA) in a right-dominant
coronary system?
A) Left Anterior Descending (LAD)
B) Circumflex Artery (LCx)
,C) Right Coronary Artery (RCA)
D) Left Main Coronary Artery
*Explanation: In an ~85% right-dominant system, the RCA supplies the PDA and the
posterolateral branches.*
8. What is the primary mechanism of action of nitroglycerin?
A) Beta-1 adrenergic blockade
B) Venodilation, reducing preload
C) Increased inotropy
D) Antiplatelet aggregation
Explanation: Nitroglycerin is a potent venodilator, which decreases venous return (preload),
reducing myocardial oxygen demand and relieving angina.
9. During a right heart catheterization, the catheter moves from the right atrium to the right
ventricle. What is the expected change in systolic pressure?
A) Decrease
B) Significant Increase
C) No change
D) Slight decrease
*Explanation: Right atrial systolic pressure is low (a wave, ~3-7 mmHg). Right ventricular systolic
pressure is significantly higher (15-30 mmHg) as it pumps against pulmonary vascular
resistance.*
10. The Left Main Coronary Artery typically bifurcates into:
A) LAD and RCA
B) RCA and LCx
C) LAD and LCx
D) PDA and OM
Explanation: The Left Main coronary artery divides into the Left Anterior Descending (LAD) and
the Left Circumflex (LCx) arteries.
11. Which hemodynamic formula is used to calculate cardiac output using the Fick principle?
A) CO = HR x SV
B) CO = (O2 consumption) / (A-V O2 difference x 10)
C) CO = (PA mean - PCWP) / PVR
D) CO = MAP / SVR
*Explanation: The Fick principle states CO = Oxygen Consumption / (Arterial O2 content -
Venous O2 content). It's often considered the gold standard.*
, 12. What is the most common complication of arterial access site management?
A) Infection
B) Arteriovenous Fistula
C) Hematoma
D) Distal Embolization
Explanation: Hematoma formation is the most frequent access site complication. Proper
technique and post-procedure compression are critical to minimize it.
13. The "V wave" on a left atrial or pulmonary capillary wedge pressure (PCWP) tracing
represents:
A) Atrial contraction
B) Passive venous filling of the atrium against a closed mitral valve
C) Ventricular contraction
D) Atrial relaxation
Explanation: The v wave peaks during ventricular systole when the mitral valve is closed, and
blood fills the left atrium from the pulmonary veins.
14. Which antiplatelet agent is an irreversible P2Y12 inhibitor that requires metabolic
activation?
A) Ticagrelor
B) Cangrelor
C) Clopidogrel
D) Aspirin
Explanation: Clopidogrel is a prodrug and an irreversible P2Y12 inhibitor. Its variable activation
is why genetic testing is sometimes used.
15. The artery of Adamkiewicz is a critical branch of the aorta that supplies blood to the:
A) Brain
B) Anterior spinal cord
C) Liver
D) Kidneys
Explanation: This artery, often arising from a lower intercostal or lumbar artery, is the major
supplier of the anterior spinal cord. Its occlusion can cause paralysis.
16. A damped arterial pressure waveform upon catheter engagement most likely indicates:
A) Severe aortic stenosis
B) Catheter tip obstruction (e.g., against the vessel wall)
C) Hypertension
D) Ventricular fibrillation
