RCIS Mock Exam 2023 53 Questions with complete solutions.

RCIS Mock Exam 2023 53 Questions with complete solutions. In normal fetal circulation the path of oxygenated blood returning from the placenta passes though severalfetal shunts. One of these normal fetal pathways between the aorta and PA can be described as a: a- L>R shunt termed the PDA b- R>L shunt termed the PDA c- L>R shunt termed the foramen ovale d- R>L shunt termed the foramen ovale - -the PA-AO shunt is the PDA and its right to left. When the left heart pressure begins to exceed the right heart pressure, that such a shunt would switch to left to right -What is the name of the coronary arteries which normally branch off the Cx artery towards the apex of the heart? a- diagonal branches b- OM branches c- acute marginal branches d- posterior descending branches - -The left sided AV groove artery is the Cx and its branches are termed OMs -The aortic dicrotic notch marks the beginning of ventricular: a- systole b- isometric relaxation c- end diastolic pressure d- slow filling phase - -B. The systolic pulse is divided by a midsystolic dip indicating a sudden ejection followed by increased resistance and then secondary release. -End-diastolic stretching of the ventricular muscle fibers is termed: a- preload b- afterload c- inotropism d- chronotropism - -Preload refers to the filling of the ventricular chambers in diastole -The greatest expenditure of O2 during the cardiac cycle is used to: a- open the aortic valve (isometric contraction) b- open the mitral valve (diastolic filling) c- eject blood out of the LV and into the AO (SEP) d- overcome friction of blood viscosity and muscle compliance - -A. One of the chief benefits of IABP is to lower the pressure at which the aortic valve opens, which decreases pressure work. This pressure work account for 90% of the work done by the LV -Which of the following is a common result of right sided heart failure? a- dyspnea b- pulmonary congestion c- pulmonary hypertension d- neck vein distension - -When the right side of the heart fails the RA and systemicveins become engorged with blood. Pulmonary hypertension is only a compensation to left sided failure -Which of the following is NOT a clinical manifestation of shock? a- pallor b- metabolic acidosis c- slow bounding pulse d- falling blood pressure - -Slow bounding pulse. Tachycardia usually results to compensate for decreased tissue perfusion -If an embolus were to lodge in the distal RCA at the crux, which segment of the heart would suffer damage? a- RV b- inferior LV wall c- anterior LV wall d- posterior lateral LV wall - -Inferior infarctions usually result from RCA infarction. The distal RCA feeds the lower 1/3 of the IV septum and the inferior aspect of the LV depending on the extent of posterior lateral RV branches -Aortic stenosis is classified as what type of disease? a- restrictive b- hypertrophic c- inflow obstructive d- outflow obstructive - -Obstructive refers to stenosis or inability to EXIT a chamber -An OLD myocardial infarct is seen on the ECG as a significant: a- Q wave b- inverted T wave c- elevated ST segment d- depressed ST segment - -Q waves never go away after myocardial tissue dies -What type of angina does the following describe: An attack of chest pain at rest during which the ECG shows changes identical with those of the early stage of MI, but returns to the previous pattern upon the termination of the attack. a- stable angina b- variant angina c- atypical angina d- asymptomatic angina - -Variant angina is the dynamic type believed to be caused by spasm and is usually relieved with nitro and Ca blocker medications -Which statement is true regarding "central" cyanosis? a- it is much more common than peripheral cyanosis b- it almost always indicates cardiopulmonary disease c- it reflects increased extraction of oxygen from the peripheral tissues d- it may be seen in normal individuals exposed to cold temperatures - -Central cyanosis is like an left to right shunt. Peripheral cyanosis is something we all get when cold -What happens to the venous pressures when significant cardiac tamponade is present: a- RA rises and PW rises b- RA rises and PW falls c- RA falls and PW falls d- RA falls and PW rises - -In tamponade all venous pressures rise -What type of chamber enlargement is associated with MR? a- LA dilation b- LA hypertrophy c- LV dilation d- LVhypertrophy - -LADilation. Regurgitation of a valve leads to dilation fo the chamber upstream, while stenosis of a valve leads to hypertrophy of the chamber upstream -Following a cath lab cardiac arrest and resuscitation a pt's arterial blood gases are as follows: pH-7.3, PCO2-52, pO2- 96. The most probable acid base diagnosis is: a- pure respiratory acidosis b- pure metabolic acidosis c- compensated respiratory acidosis d- partially compensated respiratory acidosis - -Pure respiratory acidosis. The pH is acid (down .10) while the Co2 is up 12. When this ratio is kept around (.10:10) the bicarb and BE remain normal indicating a pure respiratory component -When a patient with COPD comes for a heart cath which of the following sets of blood gases represent a situation in which giving high concentrations of oxygen would be dangerous? a- pO2-55, pCO2- 36 b- pO2-55, pCO2- 62 c- pO2-65, pCO2-28 d- pO2-65, pCO2- 42 - -B. Its the high CO2s and acidotic pH that indicates a chronic lunger who has lost his normal CO2 drive to breath due to chronic high CO2s -How long is the standard femoral LV pigtail catheter? a- 100 cm b- 110 cm c- 125 cm d- 145 cm - -Most doctors use 110cm LV cathetersdue to the longer distance the catheter must traverse. (coronaries are usually only 100 cm) -Which of the following is a relative contraindication for a heart cath, and should be brought to the catheterizing doctors attention before he begins the case? a- 4 PVCs/min b- hypotension (98/70) c- hypokalemia d- compensated CHF - -Hypokalemia is a contraindication leading to arrhythmia can usually be corrected prior to cath -What french size is a catheter with a diameter of 2.66mm? a- 5 Fr b- 6 Fr c- 7 Fr d- 8Fr - -8 Fr. Each french size is 1/3 of a mm so 6Fr=2mm, 9Fr=3mm. -The IMA catheter looks similar to what other catheter? a- MPA b- Arani- double loop c- Judkins left coronary d- Judkins right coronary - -IMA is like a JR catheter with a more angulated primary bend -In relationship to the femoral artery, the femoral vein lies: a- superior b- inferior c- medial d- lateral - -Remember NAVL, landmarks for the right groin are Nerve, Artery, Vein, Ligament -Transseptal heart caths utilizes all of the following EXCEPT: a- brockenbrough catheter b- full pt heparinization c- right femoral vein puncture d- pressure monitoring through the transseptal needle - -Transseptal caths should be done WITHOUT full patient heparinization due to the possibility of accidental aortic puncture and tamponade -Which of the following types of catheters are used antegrade? a- swan ganz b- judkins c- sones d- amplatz - -Antegrade cath is with the flow, swans go with the venous flow -Which type of catheter exchange through a sheath is safest for the pt with a tortuous aorta? a- removal with no wire b- removal of sheath (seldinger technique) c- removal with catheter over wire (leaving wire in) d- removal with wire in catheter (removing wire and catheter together) - -Pulling the catheter while leaving the guide wire in is the safest method of exchange for tortuous vessels -What type of angiogram would be most likely to best define aortic insufficiency: a- aortic root injection b- left ventriculogram c- pulmonary angiogram d- thoracic aorta angiogram - -Aortic root injection. Valvular regurg can be diagnosed with angiography distal to the valve,while observing for incompetence backward through the valve -When the C-arm is angled into a cardiac view so that the xrays exit from the patients right clavicular area, what angiographic view is this: a- Cranial RAO b- Cranial LAO c- Caudal RAO d- Caudal LAO - -Cranial RAO, the views are labeled by the position of the fluoro in relationship to the pts anatomy. This is the same position as where the xrays exitthe body. -What angiography best diagnoses a VSD? a- RV gram in RAO b- RV gram in LAO c- LV gram in RAO d- LV gram in LAO - -LV gram injection in LAO because they are usually a L-R shunt. The best view is LAO because it arranges the 2 ventricles so they do not overlap, and the shunt can be seen connecting the 2 adjacent chambers -Which type of angiogram would bemost likely to define mitral insufficiency due to a flail leaflet: a- aortic root, LAO b- aortic root, RAO c- LV gram, LAO d- LV gram, RAO - -LV gram in RAO, Use RAO to see the valve on edge and the LA and LV where they dont overlap -In an person with a horizontal heart what fluoro view best defines the area where the LM bifurcates into the LAD and Cx coronary arteries: a- cranial RAO b- cranial LAO c- caudal RAO d- caudal LAO - -Caudal LAO (spider view) -What ECG change is seen on lead II immediately after injecting the RCA with angiographic dye? a- t wave inversions b- elevated t waves c- ST elevation d- tachycardia - -t wave inversions. Like an inferior infarction leads II,III, and aVF best show the inverted T waves and injury changes -VT may be mimicked by: a- disconnected leads b- paroxysmal atrial tachycardia c- SVT with aberrancy d- mobitz II block with rapid ventricular response - -SVT with aberrancy. VT and SVT with aberrancy are both wide complex tachycardia, but with totally implications and treatments -The mean QRS axis shows left axis deviation when the majority of the QRS complex is: a- upright in lead I & upright in lead aVF b- upright in lead I & down in lead aVF c- down in lead I & upright in lead aVF d- down in lead I & down in lead aVF` - -Upright in lead I and down in lead aVF. Upright lead I means the depolarization is leftward. Down in lead aVF means the depolarization is away from the positive foot lead. -Which physiologic pacemaker mode is rate responsive? A sensed P wave precedes each ventricular artifact? a- AAI b- VAT c- VVT d- DVi - -VAT is an atrial triggered ventricular pacer, an artificial AV node. This pacer requires 2 leads, one sensor in the atrium and one pacing lead in the ventricle -A HIS bundle electrogram has the following measurements: AH interval= 100 ms, HV interval= 90 ms. Which diagnosis is most likely? a- BBB b- AV node disease c- SA node disease d- WPW with preexcitation - -BBB, Normal AH intervals vary from 60-140 msec and HV intervals from 30-55 msec. Thus the HV conduction time is prolonged indicating a delay below the His bundle where the bundle branches are -Which HIS bundle electrogram most indicates the need for permanent pacemaker implantation? a- reduced AH interval b- reduced HV interval c- prolonged AH interval d- prolonged HV interval - -Prolonged HV interval. Long HV intervals often lead to complete heart block -When your IABP dependent patient goes into an SVT with a rate over 150 bpm what should you do to the IABP? a- turn it off b- go to internal fixed rate of 80/min c- time to 4:1 and trigger from R wave d- time to 2:1 and trigger from arterial pressure - -Time to 2:1 and trigger from arterial pressure. Data recommends that for rates over 120 the pump cannot inflate or deflate; so going 2:1 inflation ratio will allow adequate time for it to inflate -Which desired effect of IABP pumping is specifically due to the balloons inflation? a- increased preload b- decreased afterload c- decreased myocardial work d- increased coronary blood flow - -Increased coronary blood flow. Diastolic inflation of the IABP greatly increases the coronary perfusion pressure and flow, because most of the coronary flow occurs in diastole normally. Deflation during early systole actually pulls extrablood out of the LVand by dropping the systolic pressure reduces the pressure work of the LV -In which condition is the use of the IABP contraindicated? a- mitral stenosis b- aortic stenosis c- aortic regurg d- mitral regurg - -Aortic regurg/AI is a definite contraindication to IABP because the balloon will be inflating during diastole increasing the amount of regurg. -To convert a temporary demand pacer to asynchronous mode, what control should be adjusted: a- increase output b- increase refractory period c- decrease sensitivity d- decrease refractory period - -Decrease the sensitivity so that it will detect fewer and fewer QRS signals until none can be detected by the sensing amplifier. This is VOO, fixed rate, or asynchronous mode -When you are monitoring the V lead ECG from a TAP needle, what ECG change will you observe when the needle touched the epicardium? a- ST elevation b- broadened QRS c- deep broad Q waves d- T wave depression - -ST elevation. Injury current monitoring can avoid accidental coronary artery laceration -In a pacemaker set to DVI mode, how many chambers are sensed and paced? a- 1 chamber sensed, 1 chamber paced b- 1 chamber sensed, 2 chambers paced c- 2 chambers sensed, 1 chamber paced d- 2 chambers sensed, 2 chambers paced - -1 chamber sensed, 2 chambers paced. The D in the first position of the code indicates 2 chambers paced, atrium and ventricle. The second letter is V, indicating only the ventricle is sensed -Successful defibrillation depends on all of the following EXCEPT: a- duration of V fib b- amount of chest resistance c- amount and type of electrode placement d- defibrillator electrode placement - -C. Chest resistance is reduced by electrode paste, and it is an important element is successful defibrillation. But all commercially available available pastes/pads adequately reduce skin resistance -ACLS protocols recommend that the first defibrillation attempt in unconscious adults be performed at what energy level:a a- 200-300 watt/sec of stored energy b- 200-300 watt/sec of delivered energy c- 300-360 watt/sec of stored energy