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RCIS 2026 Glowacki & Sommers Exam Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed Rationales –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Anatomy and Physiology | Q1 – Q20
Section 2 | Hemodynamics and Waveform Analysis | Q21 – Q40
Section 3 | Catheterization Laboratory Procedures | Q41 – Q60
Section 4 | Equipment, Radiation Safety, and Pharmacology | Q61 – Q80
Section 5 | Patient Care, Complications, and Emergency Management | Q81 – Q100
Instructions: Choose the single best answer. Pass: 75% in 150 minutes.
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SECTION 1: CARDIOVASCULAR ANATOMY AND PHYSIOLOGY Q1 – Q20
══════════════════════════════════════
Question 1 of 100
A 62-year-old male with exertional chest pain is referred for diagnostic coronary angiography.
During the procedure, the physician injects contrast into the right coronary artery and notes that
the posterior descending artery arises from this vessel and supplies the posterior septum. The
posterior left ventricular branch is also visualized arising from the same vessel.
A. The patient has a codominant coronary circulation
B. The left coronary artery supplies the AV node in this patient
C. The right coronary artery is the dominant vessel ✓ Correct Answer
D. The circumflex artery is larger than usual
Correct Answer: C
Rationale: When the posterior descending artery and the posterolateral branch both arise from the
right coronary artery, this defines right-dominant circulation present in roughly 85% of the
population. Codominance requires the PDA to arise from the RCA while the posterolateral
,2
branch arises from the circumflex, which is not described here. In true right dominance, the AV
nodal artery typically arises from the RCA as well.
Question 2 of 100
During a left ventriculogram in a 58-year-old female with mitral regurgitation, the interventional
team observes that the anterolateral papillary muscle receives its blood supply from the left
anterior descending artery and diagonal branches. The posteromedial papillary muscle appears
ischemic during the injection.
A. The posteromedial papillary muscle has a single blood supply, making it more vulnerable to
ischemia ✓ Correct Answer
B. Both papillary muscles always share identical dual blood supplies
C. The anterolateral papillary muscle is supplied only by the circumflex artery
D. Papillary muscles receive blood directly from the left atrium
Correct Answer: A
Rationale: The posteromedial papillary muscle typically receives blood from a single vessel,
usually the posterior descending artery, which explains its higher susceptibility to ischemic
dysfunction and rupture after inferior infarction. The anterolateral papillary muscle enjoys dual
supply from the LAD and circumflex systems, making it more resilient to single-vessel
occlusion.
Question 3 of 100
A 71-year-old male undergoing right heart catheterization has a blood sample drawn from the
coronary sinus. The saturation measured from this sample is unexpectedly high, and the operator
suspects anatomic variation in myocardial venous drainage.
A. The sample was contaminated with pulmonary artery blood
B. Coronary sinus blood should always match pulmonary capillary wedge saturation
C. Thebesian veins drain directly into the cardiac chambers and can elevate local saturation
readings
D. Thebesian veins drain directly into the cardiac chambers and can elevate local saturation
readings ✓ Correct Answer
Correct Answer: D
Rationale: Thebesian veins are small venous channels that drain myocardial blood directly into
the right atrium, right ventricle, and left ventricle, bypassing the coronary sinus and explaining
,3
higher-than-expected oxygen saturation in some samples. This normal anatomic variant is often
mistaken for an intracardiac shunt if not recognized during saturation runs.
Question 4 of 100
A 54-year-old male with syncope is found to have complete heart block on electrocardiogram.
During the electrophysiology study, the team maps the His bundle and notes that the block is
located distal to the AV node. The cardiologist discusses the vascular supply to the conduction
system.
A. The left anterior descending artery supplies the distal bundle branches exclusively
B. The AV node artery typically arises from the right coronary artery in a right-dominant system
✓ Correct Answer
C. The right coronary artery never contributes to AV nodal blood supply
D. The sinoatrial node receives blood only from the left circumflex artery
Correct Answer: B
Rationale: In the most common right-dominant circulation, the AV nodal artery arises from the
proximal posterior descending artery or the crux of the heart via the right coronary artery,
making proximal RCA occlusion a frequent cause of AV nodal ischemia. The SA node artery
arises from the RCA in about 55% of patients and from the circumflex in the remainder.
Question 5 of 100
During a diagnostic study in a 67-year-old female, the operator engages the right coronary artery
and identifies the conus branch as the first vessel visualized. The operator must decide whether
this branch has an independent origin.
A. The conus branch arises from the right coronary artery in most patients, but an independent
origin from the right aortic sinus occurs in up to 50% of cases ✓ Correct Answer
B. The conus branch always shares a common ostium with the RCA
C. The conus branch originates from the left main coronary artery
D. The conus artery supplies the lateral wall of the right ventricle
Correct Answer: A
Rationale: The conus branch has a separate ostium from the right coronary sinus in roughly one-
third to one-half of patients, a variant that can complicate selective engagement during diagnostic
angiography. When independently arising, it may require a separate injection or a non-selective
flush to visualize adequately.
, 4
Question 6 of 100
A 49-year-old male with anterior wall myocardial infarction is undergoing emergent
angiography. The operator injects the left main coronary artery and observes that it trifurcates
rather than bifurcating. A third vessel is identified between the LAD and circumflex.
A. This variant is called a ramus intermedius and is present in roughly 20-30% of patients
B. The ramus intermedius is an abnormal vessel requiring surgical bypass
C. A trifurcating left main is a congenital anomaly seen in less than 1% of the population
D. A ramus intermedius is present in roughly 20-30% of patients and represents a normal
anatomic variant ✓ Correct Answer
Correct Answer: D
Rationale: The ramus intermedius, or intermediate branch, arises from a trifurcating left main
coronary artery in approximately 20 to 30 percent of patients and supplies the lateral wall as a
normal variant. It is not considered anomalous and does not by itself indicate a need for
revascularization unless significant stenosis is present.
Question 7 of 100
A 35-year-old female with a secundum atrial septal defect is undergoing right heart
catheterization with serial oxygen saturation measurements. The operator samples blood from the
superior vena cava, right atrium, right ventricle, and pulmonary artery.
A. A significant step-up in saturation between the SVC and RA localizes a left-to-right shunt at
the ventricular level
B. A significant step-up between the RA and RV suggests an atrial septal defect
C. A step-up greater than 7% between the SVC and RA indicates an atrial level left-to-right shunt
✓ Correct Answer
D. Pulmonary artery saturation should normally be lower than SVC saturation
Correct Answer: C
Rationale: An oxygen saturation step-up of more than 7% between the SVC and RA samples is
the classic criterion for identifying an atrial level left-to-right shunt such as an ASD. A
ventricular septal defect would produce a step-up between the RA and RV, not at the atrial level.
Question 8 of 100
RCIS 2026 Glowacki & Sommers Exam Actual
Exam 2026/2027 | Complete Exam-Style
Questions | 100% Verified – Detailed Rationales –
Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Anatomy and Physiology | Q1 – Q20
Section 2 | Hemodynamics and Waveform Analysis | Q21 – Q40
Section 3 | Catheterization Laboratory Procedures | Q41 – Q60
Section 4 | Equipment, Radiation Safety, and Pharmacology | Q61 – Q80
Section 5 | Patient Care, Complications, and Emergency Management | Q81 – Q100
Instructions: Choose the single best answer. Pass: 75% in 150 minutes.
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR ANATOMY AND PHYSIOLOGY Q1 – Q20
══════════════════════════════════════
Question 1 of 100
A 62-year-old male with exertional chest pain is referred for diagnostic coronary angiography.
During the procedure, the physician injects contrast into the right coronary artery and notes that
the posterior descending artery arises from this vessel and supplies the posterior septum. The
posterior left ventricular branch is also visualized arising from the same vessel.
A. The patient has a codominant coronary circulation
B. The left coronary artery supplies the AV node in this patient
C. The right coronary artery is the dominant vessel ✓ Correct Answer
D. The circumflex artery is larger than usual
Correct Answer: C
Rationale: When the posterior descending artery and the posterolateral branch both arise from the
right coronary artery, this defines right-dominant circulation present in roughly 85% of the
population. Codominance requires the PDA to arise from the RCA while the posterolateral
,2
branch arises from the circumflex, which is not described here. In true right dominance, the AV
nodal artery typically arises from the RCA as well.
Question 2 of 100
During a left ventriculogram in a 58-year-old female with mitral regurgitation, the interventional
team observes that the anterolateral papillary muscle receives its blood supply from the left
anterior descending artery and diagonal branches. The posteromedial papillary muscle appears
ischemic during the injection.
A. The posteromedial papillary muscle has a single blood supply, making it more vulnerable to
ischemia ✓ Correct Answer
B. Both papillary muscles always share identical dual blood supplies
C. The anterolateral papillary muscle is supplied only by the circumflex artery
D. Papillary muscles receive blood directly from the left atrium
Correct Answer: A
Rationale: The posteromedial papillary muscle typically receives blood from a single vessel,
usually the posterior descending artery, which explains its higher susceptibility to ischemic
dysfunction and rupture after inferior infarction. The anterolateral papillary muscle enjoys dual
supply from the LAD and circumflex systems, making it more resilient to single-vessel
occlusion.
Question 3 of 100
A 71-year-old male undergoing right heart catheterization has a blood sample drawn from the
coronary sinus. The saturation measured from this sample is unexpectedly high, and the operator
suspects anatomic variation in myocardial venous drainage.
A. The sample was contaminated with pulmonary artery blood
B. Coronary sinus blood should always match pulmonary capillary wedge saturation
C. Thebesian veins drain directly into the cardiac chambers and can elevate local saturation
readings
D. Thebesian veins drain directly into the cardiac chambers and can elevate local saturation
readings ✓ Correct Answer
Correct Answer: D
Rationale: Thebesian veins are small venous channels that drain myocardial blood directly into
the right atrium, right ventricle, and left ventricle, bypassing the coronary sinus and explaining
,3
higher-than-expected oxygen saturation in some samples. This normal anatomic variant is often
mistaken for an intracardiac shunt if not recognized during saturation runs.
Question 4 of 100
A 54-year-old male with syncope is found to have complete heart block on electrocardiogram.
During the electrophysiology study, the team maps the His bundle and notes that the block is
located distal to the AV node. The cardiologist discusses the vascular supply to the conduction
system.
A. The left anterior descending artery supplies the distal bundle branches exclusively
B. The AV node artery typically arises from the right coronary artery in a right-dominant system
✓ Correct Answer
C. The right coronary artery never contributes to AV nodal blood supply
D. The sinoatrial node receives blood only from the left circumflex artery
Correct Answer: B
Rationale: In the most common right-dominant circulation, the AV nodal artery arises from the
proximal posterior descending artery or the crux of the heart via the right coronary artery,
making proximal RCA occlusion a frequent cause of AV nodal ischemia. The SA node artery
arises from the RCA in about 55% of patients and from the circumflex in the remainder.
Question 5 of 100
During a diagnostic study in a 67-year-old female, the operator engages the right coronary artery
and identifies the conus branch as the first vessel visualized. The operator must decide whether
this branch has an independent origin.
A. The conus branch arises from the right coronary artery in most patients, but an independent
origin from the right aortic sinus occurs in up to 50% of cases ✓ Correct Answer
B. The conus branch always shares a common ostium with the RCA
C. The conus branch originates from the left main coronary artery
D. The conus artery supplies the lateral wall of the right ventricle
Correct Answer: A
Rationale: The conus branch has a separate ostium from the right coronary sinus in roughly one-
third to one-half of patients, a variant that can complicate selective engagement during diagnostic
angiography. When independently arising, it may require a separate injection or a non-selective
flush to visualize adequately.
, 4
Question 6 of 100
A 49-year-old male with anterior wall myocardial infarction is undergoing emergent
angiography. The operator injects the left main coronary artery and observes that it trifurcates
rather than bifurcating. A third vessel is identified between the LAD and circumflex.
A. This variant is called a ramus intermedius and is present in roughly 20-30% of patients
B. The ramus intermedius is an abnormal vessel requiring surgical bypass
C. A trifurcating left main is a congenital anomaly seen in less than 1% of the population
D. A ramus intermedius is present in roughly 20-30% of patients and represents a normal
anatomic variant ✓ Correct Answer
Correct Answer: D
Rationale: The ramus intermedius, or intermediate branch, arises from a trifurcating left main
coronary artery in approximately 20 to 30 percent of patients and supplies the lateral wall as a
normal variant. It is not considered anomalous and does not by itself indicate a need for
revascularization unless significant stenosis is present.
Question 7 of 100
A 35-year-old female with a secundum atrial septal defect is undergoing right heart
catheterization with serial oxygen saturation measurements. The operator samples blood from the
superior vena cava, right atrium, right ventricle, and pulmonary artery.
A. A significant step-up in saturation between the SVC and RA localizes a left-to-right shunt at
the ventricular level
B. A significant step-up between the RA and RV suggests an atrial septal defect
C. A step-up greater than 7% between the SVC and RA indicates an atrial level left-to-right shunt
✓ Correct Answer
D. Pulmonary artery saturation should normally be lower than SVC saturation
Correct Answer: C
Rationale: An oxygen saturation step-up of more than 7% between the SVC and RA samples is
the classic criterion for identifying an atrial level left-to-right shunt such as an ASD. A
ventricular septal defect would produce a step-up between the RA and RV, not at the atrial level.
Question 8 of 100
