Midterm Flashcards by Riyanna Day

What is the small downward deflection in the arterial pressure waveform that occurs when the aortic valve closes at the end of systole?

Dicrotic notch

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Spider view showcases which arteries?

Left main
Proximal Circumflex
Proximal Left anterior descending
Obtuse marginal
(This LAO, Cranial)

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In the construction of guidewires, what happens when the distance between the end of the central core and the spring tip is shorter?
A-The guidewire becomes more flexible
B-The guidewire becomes stiffer and more maneuverable
C-The guidewire becomes longer
D-The guidewire becomes less durable

B-The guidewire becomes stiffer and more maneuverable

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What is the purpose of connecting a 120–145-cm extension wire to a 145-cm guidewire in interventional cardiology procedures?
A-To create a shorter guidewire for better maneuverability.
B-To enhance the torque control of the guidewire.
C-To transform the guidewire into a long exchange wire for balloon catheter exchanges.
D-To increase the overall length of the guidewire for better support.

C-To transform the guidewire into a long exchange wire for balloon catheter exchanges.

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When are self-expanding stents typically used in medical procedures?
A-In coronary artery interventions
B-In balloon-expandable stent delivery
C-In peripheral vascular disease interventions
D-In stent deployment with memory metals

C-In peripheral vascular disease interventions

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How does predilation before stent placement affect the choice of stent size?
A-It makes the operator select a smaller stent.
B-It has no impact on stent size selection.
C-It often leads to choosing a larger stent than initially planned.
D-It decreases the need for stent placement.

C-It often leads to choosing a larger stent than initially planned.

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In what situations are extra-support or stiff guidewires typically used during interventional procedures?
A-To fold the intima of the vessel
B-To prevent pseudo-lesions
C-To assist with vessel straightening
D-To cross lesions with extreme angulation, calcification, or tortuosity

D-To cross lesions with extreme angulation, calcification, or tortuosity

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D-To cross lesions with extreme angulation, calcification, or tortuosity

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How is vasospasm typically managed when it occurs during a medical procedure?
A-It requires immediate cessation of the procedure.
B-It can be resolved with high-pressure inflations.
C-It often resolves on its own or with intracoronary nitroglycerin.
D-It requires stent removal.

C-It often resolves on its own or with intracoronary nitroglycerin.

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What is a potential issue with using compliant balloons for final stent inflations?
A-They are ineffective in resistant lesions.
B-They can cause vessel injury in adjacent unstented segments.
C-They are more likely to maintain a uniform diameter.
D-They are less resistant to high pressures.

B-They can cause vessel injury in adjacent unstented segments.

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What is a potential consequence of misplacing the postdilation balloon at the edge of a stent, particularly if the balloon is clearly oversized?
A-Improved stent stability
B-Reduced risk of dissection
C-Stent margin dissection
D-Enhanced vessel elasticity

C-Stent margin dissection

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What is the primary purpose of loop snares, basket retrieval devices, and biliary forceps in the context of embolized stent recovery?
A-To insert additional stents
B-To prevent embolization
C-To capture and retrieve embolized stents
D-To measure blood pressure

C-To capture and retrieve embolized stents

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Which pressure waveform abnormality encountered during cardiac catheterization is characterized by an abrupt drop in mean coronary pressure accompanied by a narrow pulse pressure?

Dampening

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Why might a coronary guidewire with a low tip load be unsuitable for crossing a heavily stenosed lesion?

A-It lacks the flexibility to navigate tortuous vessels.
B-It does not provide the required support for advancing devices.
C-It cannot generate sufficient force to cross resistant plaques.
D-It is prone to causing excessive endothelial injury.

C-It cannot generate sufficient force to cross resistant plaques.

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Where is the axillary artery located?

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Where is the radial artery located?

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Where is the innominate artery located?

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Why is the radial artery avoided for TRI in patients being considered for coronary artery bypass graft (CABG) surgery?

A-The artery may be needed as a graft conduit
B-The procedure increases the risk of graft failure
C-The artery is too superficial for effective intervention
D-The artery is unsuitable for bypass grafting

A-The artery may be needed as a graft conduit

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What does the Barbeau test measure during an assessment of palmar arch patency?

A-Presence of vasospasm in the ulnar artery
B-Blood flow changes in the hand under radial artery occlusion
C-Ischemic threshold for catheter-based interventions
D-Radial artery diameter using imaging

B-Blood flow changes in the hand under radial artery occlusion

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Which clinical scenario most strongly warrants early use of ultrasound guidance?

A-Patients undergoing diagnostic angiography
B-Patients with stable coronary artery disease
C-Patients with weak pulses due to peripheral vascular disease (PVD)
D-Patients with no prior history of vascular complications

C-Patients with weak pulses due to peripheral vascular disease (PVD)

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What is the ideal puncture site for radial artery access?

A-Less than 2 cm proximal to the radial styloid
B-Near the ulnar artery to minimize complications
C-Directly at the radial styloid
D-Greater than 2 cm proximal to the radial styloid

D-Greater than 2 cm proximal to the radial styloid

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What is recommended if a 7F or larger guide catheter is required during a radial access procedure?

A-Switch to femoral access to accommodate larger catheters
B-Consider using slender guides or sheathless guide insertions
C-Reduce the guide catheter size to avoid complications
D-Use a standard guide catheter regardless of size

B-Consider using slender guides or sheathless guide insertions

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What is the purpose of slowly withdrawing the angiocath catheter until pulsatile blood flow is observed during radial artery access?

A-To ensure the catheter is in the correct arterial lumen
B-To facilitate the advancement of a larger guidewire
C-To prevent hematoma formation at the puncture site
D-To confirm arterial spasm has been minimized

A-To ensure the catheter is in the correct arterial lumen

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Which guidewire is typically used after successful radial artery access with an angiocath?

A-0.035-inch stiff guidewire
B-0.014-inch hydrophilic coronary wire
C-0.021-inch guidewire
D-0.018-inch flexible guidewire

C-0.021-inch guidewire

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When using a dedicated radial band, what is the purpose of gradually decreasing the pressure until a small amount of blood is observed at the access site? A-To ensure complete hemostasis before removing the band B-To allow natural clot formation at the puncture site C-To identify the minimum pressure required to prevent bleeding D-To confirm adequate pressure for arterial occlusion

C-To identify the minimum pressure required to prevent bleeding

What step is performed after the band is deflated until bleeding occurs? A-The band is removed, and a sterile dressing is applied B-The band is left undisturbed for 2 to 4 hours C-The sheath is completely removed from the artery D-1 to 2 mL of air is reinflated into the band

D-1 to 2 mL of air is reinflated into the band

What is the primary purpose of the “patent hemostasis” technique? A-To shorten recovery time after the procedure B-To prevent bleeding from the puncture site C-To minimize patient discomfort during recovery D-To reduce the incidence of radial artery occlusion

D-To reduce the incidence of radial artery occlusion

What are common antispasmodic medications used during TRI to manage radial artery spasm? Verapamil and nitroglycerin Lidocaine and fentanyl Atropine and dopamine Epinephrine and norepinephrine

Verapamil and nitroglycerin

What dose of heparin is typically used for diagnostic procedures during TRI? 1000–2000 U 2000–5000 U 70–100 U/kg 5000–10,000 U

2000–5000 U

What is a potential risk of tightening the compression band too aggressively before the sheath is completely removed? Stripping any clot in the sheath into the artery Breaking the compression band Causing radial artery dissection Increasing the risk of radial artery occlusion

Stripping any clot in the sheath into the artery

Why is checking an activated clotting time not necessary before radial artery sheath removal? The radial artery is superficial and easily compressible. The radial artery has a small diameter. Compression techniques eliminate the need for clotting time measurements. Anticoagulants are ineffective in radial access procedures.

The radial artery is superficial and easily compressible.

What is the most serious complication of forearm bleeding and hematoma? Radial artery occlusion Compartment syndrome Venous thrombosis in the forearm Chronic regional pain syndrome

Compartment syndrome

What is the primary purpose of using a longer (>30 cm) or braided vascular sheath in cases of vessel tortuosity? To straighten tortuous vessel segments To increase guidewire flexibility To enhance balloon maneuverability To prevent vessel perforation

To straighten tortuous vessel segments

Which anatomical locations are commonly affected by atherosclerotic obstruction in patients with PVD? (Select two) Subclavian artery Common iliac Coronary artery Aortoiliac bifurcation Pulmonary artery

Common iliac Aortoiliac bifurcation

What is the recommended strategy for accessing a severely fibrotic or scarred groin? Successive dilation with gradually increasing sizes Immediate insertion of an 8F vascular sheath Switching to an ipsilateral radial approach Using a single large dilator

Successive dilation with gradually increasing sizes

Why is it rare to have a symptomatic AV shunt from a femoral AV fistula? The fistula is usually detected and treated early The shunt typically resolves on its own The femoral artery has a high capacity to compensate The shunt flow rarely exceeds 30% of cardiac output

The shunt flow rarely exceeds 30% of cardiac output

How long after placement is it considered safe to reaccess a site closed with a vascular closure device like Angio-Seal? 24 hours 2 to 4 weeks 6 months 1 week

2 to 4 weeks

What actions should be taken when transporting a patient with a femoral sheath still in place? (Select two) Use an appropriately sized obturator Use a compression device during transport Apply additional anticoagulants Keep the patient in a sitting position Frequently monitor for bleeding

Use an appropriately sized obturator Frequently monitor for bleeding

Which additional intervention can be used alongside Doppler-guided manual compression for treating a femoral pseudoaneurysm? Beta-blockers Diuretics Thrombin or collagen injection Antiplatelet therapy

Thrombin or collagen injection

Which type of guidewire is commonly used to navigate tortuous vessels safely? Benson guidewire Lunderquist guidewire Rosen guidewire Wholey guidewire

Benson guidewire Wholey guidewire

What is the recommended initial pressure setting of the FemoStop dome before sheath removal? 100 to 120 mm Hg 40 to 60 mm Hg 60 to 80 mm Hg 20 to 40 mm Hg

60 to 80 mm Hg

Which of the following strategies has been shown to improve outcomes in vascular access management? Using larger sheaths Increasing fluid intake post-procedure Smaller French sheaths Prolonging post-PCI heparin infusions

Smaller French sheaths

Which of the following are early warning signs of occult bleeding such as a retroperitoneal hematoma (RPH)? (Select two) Decreased respiratory rate Bradycardia Upward trend in heart rate Increased urine output Downward trend in blood pressure

Upward trend in heart rate Downward trend in blood pressure

Which of the following should be confirmed before removing a femoral PCI sheath? Blood pressure is above 180/100 mmHg The patient is fasting for at least 12 hours Activated clotting time (ACT) is less than 150 seconds Contraleteral access

Activated clotting time (ACT) is less than 150 seconds

What is a common cause of retroperitoneal hematoma (RPH) following cardiac catheterization? Low femoral arterial puncture Brachial arterial puncture High femoral arterial puncture Radial arterial puncture

High femoral arterial puncture

Which of the following actions should be taken to minimize complications during femoral sheath removal? Apply pressure exclusively with a compression device Remove venous sheath first Remove venous and arterial sheaths simultaneously Preserve venous access in case of IV failure

Preserve venous access in case of IV failure

Where should the FemoStop dome be positioned relative to the arterial puncture site? Directly over the puncture site Below the puncture site To the lateral side of the puncture site Above and slightly toward the midline of the puncture site

Above and slightly toward the midline of the puncture site

Which angiographic projection best visualizes the bifurcation of the profunda and superficial femoral arteries for the left femoral artery? Right anterior oblique (RAO) Left anterior oblique (LAO) Lateral Anteroposterior (AP)

Left anterior oblique (LAO)

Why is an oblique projection preferred when performing femoral angiography before device insertion? It provides a clearer view of the arterial bifurcation It requires less contrast injection It minimizes radiation exposure It enhances image contrast without contrast media

It provides a clearer view of the arterial bifurcation

Which of the following is a primary concern when using an AngioSeal device? Delayed wound healing Reduced arterial blood pressure Suture migration Thromboembolic complications

Thromboembolic complications

Which of the following is an appropriate practice for post-procedural wound care at the puncture site? Using clear transparent dressings Covering the site with an opaque dressing Leaving the site uncovered for air exposure Applying gauze, then a transparent dressings

Using clear transparent dressings

Which patient characteristics can contribute to an increased risk of hematoma formation after femoral catheterization? (Select two) Frequent ambulation post-procedure Obesity Low body mass index Amount of anticoagulants Low platelet count

Obesity Amount of anticoagulants

Which potential complication can arise from prolonged pressure application after femoral sheath removal? Myocardial infarction Skin necrosis Hypotension Pulmonary embolism

Skin necrosis

When considering myocardial perfusion, which of the following best explains the combined roles of the epicardial arteries, microcirculation, and myocardial bed? They rely solely on CFR for accurate physiological assessment. They serve as distinct entities, each with its unique physiologic measurement. They function independently to regulate different phases of cardiac output. They work collectively to determine overall blood flow to the myocardium

They work collectively to determine overall blood flow to the myocardium

Which of the following best explains why stress testing and intracoronary translesional physiology often show poor correlation with coronary angiography findings? Coronary angiography can detect both normal and diseased vessel segments equally well. Angiography provides higher accuracy in detecting ischemia compared to physiological testing. Stress testing and intracoronary measurements are prone to technical errors, unlike angiography. Angiography primarily evaluates the anatomical structure, while functional tests assess the physiological impact of lesions.

Angiography primarily evaluates the anatomical structure, while functional tests assess the physiological impact of lesions.

Which of the following best describes how FFR is calculated? It is the absolute coronary pressure measured beyond the stenosis. It is the ratio of resting coronary flow to maximal hyperemic flow. It is the difference between proximal and distal pressures during normal resting flow. It is the ratio of mean distal coronary pressure to mean proximal aortic pressure during maximal hyperemia.

It is the ratio of mean distal coronary pressure to mean proximal aortic pressure during maximal hyperemia.

What does the ratio of translesional pressure at maximal hyperemia represent in FFR assessment? The severity of coronary artery stenosis based on anatomic features. The difference between resting and hyperemic coronary blood flow. The ratio of poststenotic flow to normal coronary flow. The proportion of myocardial oxygen delivery compared to normal conditions.

The ratio of poststenotic flow to normal coronary flow.

calculation of FFR assume? That resting myocardial flow is sufficient for clinical assessment. That maximal myocardial flow occurs in the absence of the lesion. That myocardial flow remains constant regardless of stenosis severity. That the lesion is present but not causing significant obstruction.

That maximal myocardial flow occurs in the absence of the lesion.

Which factor is most critical when positioning the pressure wire relative to the guide catheter for equalization? The wire should be placed beyond the stenotic lesion before normalization. The wire should remain stationary throughout the entire procedure. The guide pressure should not be damped in the coronary ostium. The wire must be positioned exactly at the coronary ostium.

The guide pressure should not be damped in the coronary ostium.

What does a fractional flow reserve (FFR) value of less than 0.80 indicate in the context of coronary artery disease? The lesion severity cannot be determined without additional imaging. The lesion is hemodynamically significant and may benefit from PCI/CABG. The lesion is likely to regress over time without intervention. The lesion is hemodynamically insignificant and does not require intervention.

The lesion is hemodynamically significant and may benefit from PCI/CABG.

What is the recommended method to check for pressure signal drift? Comparing baseline pressure readings to those obtained post-hyperemia. Measuring the flow velocity across the lesion before and after the procedure. Performing an additional angiographic assessment of the coronary anatomy. Pulling the pressure wire back into the guide catheter to confirm equal pressure readings.

Pulling the pressure wire back into the guide catheter to confirm equal pressure readings.

What should be done if significant pressure signal drift is detected at the end of the procedure? The final measurements should be repeated after re-equalization of pressures in the guide catheter. The entire procedure should be restarted to ensure data accuracy. The operator should rely on the initial pre-procedure measurements instead. The data should be averaged to account for potential errors.

The final measurements should be repeated after re-equalization of pressures in the guide catheter.

What is a key characteristic of IV adenosine administration that makes it advantageous for pressure pullbacks? It eliminates the need for fractional flow reserve (FFR) measurements. It maintains sustained hyperemia, allowing precise lesion localization. It selectively targets only the most severe stenotic regions. It reduces heart rate variability during the procedure.

It maintains sustained hyperemia, allowing precise lesion localization.

Despite the widespread use of IV adenosine for more than three decades, why has there been a shift back to IC adenosine in recent studies? IC adenosine provides more reproducible results with fewer hemodynamic fluctuations. IC adenosine is more cost-effective and reduces procedure time. IV adenosine has been shown to have more severe side effects. IC adenosine is easier to administer than IV adenosine in all clinical settings.

IC adenosine provides more reproducible results with fewer hemodynamic fluctuations.

Why must FFR be measured during minimal and stable coronary resistance? To reduce the need for adenosine-induced hyperemia. To eliminate pressure wave reflections from the distal microcirculatory bed. To ensure that resting coronary resistance accurately reflects myocardial perfusion. To create a linear relationship between pressures and coronary flow ratios.

To create a linear relationship between pressures and coronary flow ratios. Not To ensure that resting coronary resistance accurately reflects myocardial perfusion.

What phase of the cardiac cycle does the wave-free period (WFP) occur in? Early systole Diastole Mid-systole Late diastole and early systole

Diastole

What characterizes the wave-free period (WFP) in coronary physiology? A phase in systole with the highest coronary resistance. A phase of diastole with the highest coronary flow variability. A diastolic phase with minimal influence from systolic and diastolic waves on coronary blood flow. A period during systole when coronary pressure is most variable.

A diastolic phase with minimal influence from systolic and diastolic waves on coronary blood flow.

What is a significant distinction between iFR and FFR in the context of PCI guidance? iFR requires hyperemia, while FFR does not. FFR is based on diastolic pressure ratios, while iFR uses systolic pressure ratios. iFR uses a specific threshold (0.89) without requiring hyperemia for assessment. FFR assesses coronary stenoses at rest, whereas iFR evaluates them during hyperemia.

iFR uses a specific threshold (0.89) without requiring hyperemia for assessment.

Where is the pressure sensor located on a pressure wire used for iFR or FFR? At the very tip of the wire for maximum sensitivity. At the proximal end of the wire for ease of access. Approximately 2 cm from the distal tip of the wire. At the junction between the radiopaque segment (visible under fluoroscopy) and the radiolucent segment of the wire

At the junction between the radiopaque segment (visible under fluoroscopy) and the radiolucent segment of the wire

What is the result of disengaging the guide catheter from the coronary ostium during FFR measurement? Stabilization of resting pressure gradients. Accurate reflection of the true physiologic pressure-flow relationship. Inaccurate reflection of the true physiologic pressure-flow relationship. Improved imaging resolution of coronary arteries.

Accurate reflection of the true physiologic pressure-flow relationship.

Which of the following is crucial for confirming a successful stent implantation? Complete absence of plaque in surrounding arteries Reduction in overall plaque burden Increased blood flow velocity within the coronary artery Absence of dissection, thrombus, and malpositioned stent struts

Absence of dissection, thrombus, and malpositioned stent struts

What key information does intravascular ultrasound (IVUS) provide during coronary interventions? Characterization of plaque, lesion length, and lumen dimensions Identifying myocarial ischemia Measurement of blood oxygen saturation The physiologic significance of a lesion

Characterization of plaque, lesion length, and lumen dimensions

Which of the following procedural steps helps prevent vasospasm during IVUS or OCT catheter placement? Use of an automated pullback device Administration of heparin Administration of intracoronary nitroglycerin Initial catheter flush with saline

Administration of intracoronary nitroglycerin

What solution is used to flush the catheter during mechanical IVUS and OCT imaging? Contrast for IVUS and oxygenated saline for OCT Nitroglycerin for IVUS and saline for OCT Saline for IVUS and contrast for OCT Heparinized blood for both IVUS and OCT

Saline for IVUS and contrast for OCT

What term describes a structure that reflects ultrasound waves effectively, appearing bright on an IVUS image? Hyperechoic Hypoechoic Anechoic Echogenic

Echogenic

Why is reduced pressure variation during end-diastole important for IVUS and OCT measurements? It reduces plaque accumulation in the vessel. It decreases vessel wall elasticity. It ensures accurate and reproducible measurements of vessel dimensions. It enhances systolic blood pressure monitoring.

It ensures accurate and reproducible measurements of vessel dimensions.

How is the percentage diameter stenosis determined in intravascular imaging? By dividing the lumen diameter within the lesion segment by the lumen diameter within the reference segment By calculating the mean diameter across multiple vessels By measuring the total vessel area at the lesion site By subtracting the plaque area from the vessel diameter

By dividing the lumen diameter within the lesion segment by the lumen diameter within the reference segment

What causes acoustic shadowing in the context of calcified plaques during IVUS imaging? The plaque reflects and scatters ultrasound waves, preventing visualization beyond it. The blood flow velocity is too high for accurate imaging. The ultrasound waves are absorbed by the plaque. The catheter distorts the ultrasound waves.

The plaque reflects and scatters ultrasound waves, preventing visualization beyond it.

Which feature of atherosclerotic lesions is associated with an increased risk of rupture, according to IVUS studies? Homogenous plaque composition Thick fibrous caps Uniform fibrous tissue distribution Lesion eccentricity and echolucent zones within the plaque

Lesion eccentricity and echolucent zones within the plaque

How does positive remodeling differ from negative remodeling in coronary artery disease? Positive remodeling eliminates the risk of plaque rupture. Positive remodeling reduces vessel compliance, while negative remodeling increases it. Positive remodeling preserves lumen diameter initially, while negative remodeling causes early narrowing. Positive remodeling leads to early stenosis, while negative remodeling prevents it.

Positive remodeling preserves lumen diameter initially, while negative remodeling causes early narrowing.

Which of the following is a key advantage of using IVUS and OCT for stent placement? It prevents coronary artery spasm. It helps optimize stent sizing and expansion. It decreases the risk of myocardial infarction without stent use. It eliminates the need for anticoagulant therapy.

It helps optimize stent sizing and expansion.

Which imaging modality is more effective at visualizing edge dissection after stent placement? IVUS OCT Coronary angiography Echocardiography

OCT

What is a primary limitation of OCT in renally compromised patients? t provide information on stent expansion. It cannot visualize lesions within the vessel lumen. It has poor resolution compared to IVUS. It requires contrast dye.

It requires contrast dye.

What is the primary function of a fibrous cap in atherosclerotic plaques? To prevent the inner core of the plaque from coming into contact with circulating blood To enhance blood flow through the artery To promote lipid accumulation within the plaque To increase plaque flexibility and vessel compliance

To prevent the inner core of the plaque from coming into contact with circulating blood

What is a common issue identified by IVUS studies regarding stent sizing during PCI?. Stents are typically underexpanded beyond vessel dimensions. Stents selected by visual sizing are typically 0.5 mm smaller than the true vessel dimensions. Stents selected by visual sizing are typically 0.5 mm larger than the true vessel dimensions. Stents are typically overexpanded beyond vessel dimensions.

Stents selected by visual sizing are typically 0.5 mm smaller than the true vessel dimensions.