Percutaneous Coronary Intervention

Question 1

What type of equipment is used for PCI in cardiac catheterization laboratories?

A) Ultrasound machines
B) Radiographic equipment
C) MRI scanners
D) CT scanners

Answer 1

B) Radiographic equipment

Question 2

Which artery is increasingly preferred for arterial access during PCI?
A) Femoral artery
B) Brachial artery
C) Radial artery
D) Carotid artery

Answer 2

C) Radial artery

Question 3

What is one of the main advantages of the radial approach over the femoral approach?
A) Easier insertion
B) Infrequent access site bleeding
C) Higher patient mortality
D) Use of larger catheters

Answer 3

B) Infrequent access site bleeding

Question 4

Which of the following is NOT a disadvantage of the radial approach?
A) Significant learning curve
B) Radial artery occlusion potential
C) Ability to use larger catheters
D) Inability to use in patients with upper extremity renal access needs

Answer 4

C) Ability to use larger catheters

Question 5

Which benefit of the radial approach contributes to lower costs?
A) Earlier ambulation
B) Need for larger catheters
C) Complex learning curve
D) Requirement for hemodynamic support

Answer 5

A) Earlier ambulation

Question 6

What is the main reason interventional guide catheters are slightly larger than diagnostic catheters?
A) To provide better visualization
B) To accommodate balloons, stents, and other devices
C) To reduce arterial occlusion
D) To improve patient comfort

Answer 6

B) To accommodate balloons, stents, and other devices

Question 7

What is the purpose of pre-dilatation with a balloon during an angioplasty procedure?
A) To remove plaque completely
B) To visualize the artery better
C) To fracture and compress plaque, opening the obstruction
D) To deploy the stent

Answer 7

C) To fracture and compress plaque, opening the obstruction

Question 8

What is the role of the coronary guide wire in the angioplasty procedure?
A) To deliver contrast dye
B) To visualize the lesion
C) To advance across the lesion and position in the distal vessel
D) To inflate the balloon

Answer 8

C) To advance across the lesion and position in the distal vessel

Question 9

What happens after the stent is positioned at the target lesion?
A) The stent is removed
B) The balloon is inflated to deploy the stent
C) The guide wire is retracted
D) The artery is closed off

Answer 9

B) The balloon is inflated to deploy the stent

Question 10

Why is pre-dilatation sometimes skipped in modern stenting procedures?
A) Newer devices allow stents to be inserted and deployed without it
B) Pre-dilatation is ineffective
C) It increases procedure time
D) It causes more plaque to form

Answer 10

A) Newer devices allow stents to be inserted and deployed without it

Question 11

When is the femoral sheath typically removed following PCI?
A) Immediately after the procedure
B) Once activated clotting time returns to baseline
C) After 24 hours
D) When the patient is fully mobile

Answer 11

B) Once activated clotting time returns to baseline

Question 12

How has hemostasis traditionally been achieved following PCI with femoral access?
A) Through closure devices
B) Using anticoagulant medications
C) With manual compression
D) By applying cold packs

Answer 12

C) With manual compression

Question 13

What advantage do closure devices provide after femoral sheath removal?
A) Immediate hemostasis and earlier ambulation
B) Less pain for the patient
C) Lower risk of infection
D) Longer procedure time

Answer 13

A) Immediate hemostasis and earlier ambulation

Question 14

When can the radial sheath generally be removed following PCI?
A) After 24 hours
B) After the patient is fully mobile
C) Immediately after the procedure
D) Once the patient is no longer anticoagulated

Answer 14

C) Immediately after the procedure

Question 15

How is hemostasis achieved after radial sheath removal?
A) With manual compression
B) By suturing the artery
C) With pressure maintained via a secured compression device
D) By using a closure device

Answer 15

C) With pressure maintained via a secured compression device

Question 16

Why do patients receive aspirin before PCI and full anticoagulation during the procedure?
A) To prevent thrombus formation on intravascular devices
B) To reduce pain during the procedure
C) To increase platelet production
D) To prevent infection

Answer 16

A) To prevent thrombus formation on intravascular devices

Question 17

What anticoagulant has traditionally been used during PCI?
A) Warfarin
B) Heparin
C) Aspirin
D) Clopidogrel

Answer 17

B) Heparin

Question 18

In what type of patients are glycoprotein IIb/IIIa inhibitors added to anticoagulation therapy?
A) Patients with low bleeding risk
B) Patients undergoing elective procedures
C) High-risk patients, including those with acute coronary syndromes (ACS)
D) Patients with radial access

Answer 18

C) High-risk patients, including those with acute coronary syndromes (ACS)

Question 19

What is an advantage of bivalirudin over heparin?
A) Longer half-life
B) Lower cost
C) Shorter half-life and reduction in bleeding risk
D) Stronger inhibition of platelet aggregation

Answer 19

C) Shorter half-life and reduction in bleeding risk

Question 20

What is the recommended duration of dual antiplatelet therapy (DAPT) for patients receiving drug-eluting stents (DESs) for stable coronary indications?
A) 3 months
B) 6 months
C) 1 year
D) 2 years

Answer 20

B) 6 months

Question 21

Which newer antiplatelet agents are recommended for patients with ACS?
A) Aspirin and clopidogrel
B) Prasugrel or ticagrelor
C) Heparin and warfarin
D) Bivalirudin and heparin

Answer 21

B) Prasugrel or ticagrelor

Question 22

Which patients might benefit from a longer duration of DAPT?
A) Patients with low bleeding risk
B) Patients with first-generation stents or a history of myocardial infarction
C) Patients undergoing elective PCI
D) Patients with stable coronary indications

Answer 22

B) Patients with first-generation stents or a history of myocardial infarction

Question 23

What factors have contributed to improved outcomes in PCI procedures?
A) Greater operator experience and improved imaging systems
B) Larger stents and longer procedures
C) Less patient selection and no need for adjunctive therapies
D) Increased reliance on balloon angioplasty

Answer 23

A) Greater operator experience and improved imaging systems

Question 24

What is the expected procedural success rate for PCI in properly selected patients?
A) >80%
B) >85%
C) >90%
D) >95%

Answer 24

D) >95%

Question 25

What complication is now considered rare in the catheterization laboratory during PCI?
A) Coronary artery perforation
B) Stent thrombosis
C) Restenosis
D) Aneurysm formation

Answer 25

A) Coronary artery perforation

Question 26

What is the minimum number of PCI procedures an institution should perform annually according to AHA/ACC guidelines?
A) 200
B) 300
C) 400
D) 500

Answer 26

C) 400

Question 27

What was a major limitation of balloon angioplasty before the routine use of stents?
A) Coronary artery dissection
B) Vessel perforation
C) Restenosis
D) Stent migration

Answer 27

C) Restenosis

Question 28

What advantage do drug-eluting stents (DESs) have over bare-metal stents (BMSs)?
A) Reduced rates of late and very late stent thrombosis
B) Increased risk of restenosis
C) Shorter recovery time
D) Higher cost without significant benefit

Answer 28

A) Reduced rates of late and very late stent thrombosis

Question 29

In what percentage of patients was the need for repeat revascularization reduced with DESs compared to BMSs?
A) From 20% to 10%
B) From 15%-20% to 5%-7%
C) From 30% to 15%
D) From 25% to 8%

Answer 29

B) From 15%-20% to 5%-7%

Question 30

How has the need for coronary artery bypass grafting (CABG) changed with advances in PCI?
A) CABG is now required for most patients with coronary artery disease
B) PCI has made CABG unnecessary for all patients
C) CABG is only necessary in a smaller percentage of patients
D) The need for CABG has remained the same

Answer 30

C) CABG is only necessary in a smaller percentage of patients

Question 31

What is the most frequent type of complication with PCI procedures?
A) Cardiac arrhythmias
B) Access site complications
C) Stent thrombosis
D) Coronary artery dissection

Answer 31

B) Access site complications

Question 32

What is the approximate occurrence rate of bleeding and hematomas with the femoral approach in PCI patients?
A) 1%
B) 3% to 5%
C) 10%
D) 20%

Answer 32

B) 3% to 5%

Question 33

How is pseudoaneurysm formation at the access site typically managed?
A) Surgical intervention
B) Blood transfusions
C) Ultrasound-guided compression and/or thrombin injection
D) Immediate catheter replacement

Answer 33

C) Ultrasound-guided compression and/or thrombin injection

Question 34

What is a rare but potentially life-threatening complication of the femoral approach?
A) Hematoma
B) Retroperitoneal hemorrhage
C) Radial artery occlusion
D) Stent migration

Answer 34

B) Retroperitoneal hemorrhage

Question 35

What is the typical outcome of radial artery occlusion after transradial PCI procedures?
A) Requires immediate surgery
B) Frequently leads to hand ischemia
C) Usually asymptomatic due to dual blood supply of the hand
D) Causes permanent loss of blood flow to the hand

Answer 35

C) Usually asymptomatic due to dual blood supply of the hand

Question 36

What is a potential cardiac complication from balloon inflations or stent deployment during PCI?
A) Coronary artery perforation
B) Embolization of atheromatous debris to the distal coronary bed
C) Coronary artery dissection
D) Sudden cardiac arrest

Answer 36

B) Embolization of atheromatous debris to the distal coronary bed

Question 37

Which ischemia-induced arrhythmias may occur during PCI but are usually manageable?
A) Atrial fibrillation
B) Bradycardia
C) Ventricular tachycardia and ventricular fibrillation
D) Supraventricular tachycardia

Answer 37

C) Ventricular tachycardia and ventricular fibrillation

Question 38

What is a rare but severe complication of PCI that can result in Q-wave MI or emergency CABG?
A) Balloon rupture
B) PCI-induced coronary dissection and/or thrombotic occlusion
C) Complete heart block
D) Severe hematoma at the access site

Answer 38

B) PCI-induced coronary dissection and/or thrombotic occlusion