RCIS 2026 Glowacki & Sommers Exam
ACTUAL EXAM 2026/2027 | RCIS
Cardiovascular Interventional | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION A: HEMODYNAMICS (30 Questions — 25%)
Q1: During left heart catheterization, the pressure waveform in the LV shows an elevated end-diastolic
pressure of 28 mmHg and a dip-and-plateau configuration. This waveform is most consistent with which
condition?
A. Severe aortic regurgitation B. Constrictive pericarditis [CORRECT] C. Hypertrophic obstructive
cardiomyopathy D. Acute mitral regurgitation
Correct Answer: B Rationale: The dip-and-plateau (square root sign) waveform in the LV with elevated
end-diastolic pressure is a classic hemodynamic finding in constrictive pericarditis, caused by rapid early
diastolic filling abruptly halted by non-compliant pericardium.
Q2: When measuring pulmonary capillary wedge pressure (PCWP), a properly wedged tracing
demonstrates:
A. A wave larger than V wave, with oxygen saturation >95% B. V wave larger than A wave, with phasic
respiratory variation C. Atrial waveform with mean pressure ≤ LVEDP and no step-up [CORRECT] D.
Ventricular waveform with sharp upstroke and rapid decline
Correct Answer: C Rationale: A properly wedged PCWP tracing shows an atrial-type waveform (a and v
waves), mean pressure approximating LVEDP in absence of mitral disease, and no ventricularization,
confirming the balloon is wedged in a small pulmonary artery branch.
Q3: A patient undergoing right heart catheterization has the following pressures: RA 18 mmHg, RV
50/18 mmHg, PA 50/25 mmHg, PCWP 18 mmHg. The calculated pulmonary vascular resistance (PVR) is
4.5 Wood units. These findings are most consistent with:
,A. Acute pulmonary embolism B. Primary pulmonary hypertension C. Left-sided heart failure with
passive pulmonary hypertension [CORRECT] D. Chronic thromboembolic pulmonary hypertension
Correct Answer: C Rationale: Elevated PCWP (18 mmHg) with elevated PA pressures and a PVR <5
Wood units indicates passive (post-capillary) pulmonary hypertension secondary to left-sided heart
failure, where elevated left atrial pressure is transmitted backward.
Q4: During cardiac catheterization, the operator notes a systolic pressure gradient of 80 mmHg between
the LV and aorta with a Brockenbrough sign (post-PVC beat showing increased gradient). This finding is
diagnostic of:
A. Valvular aortic stenosis B. Hypertrophic obstructive cardiomyopathy [CORRECT] C. Subaortic
membrane D. Supravalvular aortic stenosis
Correct Answer: B Rationale: The dynamic outflow tract obstruction of HOCM worsens with increased
contractility; a post-PVC beat increases the Brockenbrough gradient due to enhanced contractility and
reduced ventricular volume, distinguishing it from fixed valvular stenosis.
Q5: A simultaneous LV and aortic pressure tracing during pullback from the LV to aorta shows no
pressure gradient at rest, but a 60 mmHg gradient appears after amyl nitrite inhalation. This response
indicates:
A. Fixed subvalvular stenosis B. Dynamic LVOT obstruction [CORRECT] C. Aortic regurgitation D. Mitral
stenosis
Correct Answer: B Rationale: Amyl nitrite reduces afterload and increases heart rate, decreasing
ventricular volume and worsening dynamic LVOT obstruction in HOCM, whereas fixed stenotic lesions
show little change or reduced gradients with vasodilation.
Q6: The Fick principle for cardiac output calculation requires measurement of:
A. Arterial and venous oxygen content plus oxygen consumption [CORRECT] B. Thermodilution curve
area and injectate temperature C. Doppler velocity-time integral and LV outflow tract diameter D.
Indicator dye concentration curve and blood sample analysis
Correct Answer: A Rationale: The Fick method calculates cardiac output as oxygen consumption divided
by the arteriovenous oxygen content difference, requiring direct measurement of oxygen consumption
and simultaneous arterial/venous blood samples.
,Q7: A thermodilution cardiac output curve shows a prolonged, low-amplitude decay without a clear
exponential downslope. The most likely cause is:
A. Tricuspid regurgitation [CORRECT] B. Low cardiac output state C. Injectate temperature too warm D.
Catheter positioned in pulmonary artery wedge
Correct Answer: A Rationale: Severe tricuspid regurgitation causes recirculation of the cold injectate
through the regurgitant valve, producing a prolonged, dampened thermodilution curve that lacks the
normal exponential decay, invalidating the cardiac output measurement.
Q8: During right heart catheterization, the operator advances the catheter into the pulmonary artery
and observes a dampened waveform with mean pressure of 12 mmHg, no respiratory variation, and
inability to obtain blood samples. The most appropriate action is:
A. Obtain a blood gas to confirm wedge position B. Deflate the balloon and reposition the catheter
[CORRECT] C. Inject contrast to confirm pulmonary artery anatomy D. Advance the catheter further to
obtain a true wedge
Correct Answer: B Rationale: A dampened waveform without respiratory variation and inability to
aspirate blood indicates the catheter tip is against the vessel wall or in a small branch; deflating and
repositioning prevents vessel injury and ensures accurate pressure measurement.
Q9: The mean arterial pressure (MAP) is calculated using the formula:
A. Systolic BP + 2(Diastolic BP) ÷ 3 [CORRECT] B. Systolic BP + Diastolic BP ÷ 2 C. 2(Systolic BP) + Diastolic
BP ÷ 3 D. Pulse pressure × Heart rate ÷ Stroke volume
Correct Answer: A Rationale: MAP represents the average pressure during the cardiac cycle, weighted
toward diastole since diastole occupies approximately two-thirds of the cycle; the formula [SBP +
2(DBP)] ÷ 3 accurately reflects this temporal weighting.
Q10: A patient with acute MI develops cardiogenic shock. The hemodynamic profile shows: CI 1.8
L/min/m², PCWP 24 mmHg, SVR 1800 dynes·sec/cm⁵. This profile represents:
A. Hypovolemic shock B. Cardiogenic shock with elevated afterload [CORRECT] C. Septic shock D.
Isolated right ventricular failure
Correct Answer: B Rationale: Low cardiac index (<2.2 L/min/m²) with elevated PCWP (>18 mmHg) and
high systemic vascular resistance (>1500 dynes·sec/cm⁵) defines classic cardiogenic shock with
compensatory vasoconstriction and elevated left-sided filling pressures.
, Q11: During left heart cath, the operator records simultaneous LV and PCWP pressures. The mean PCWP
is 8 mmHg lower than LVEDP. This discrepancy suggests:
A. Normal physiologic variation B. Mitral stenosis [CORRECT] C. Aortic regurgitation D. Mitral
regurgitation
Correct Answer: B Rationale: In mitral stenosis, the pressure gradient across the stenotic valve causes
PCWP to underestimate LVEDP because the wedge pressure reflects left atrial pressure rather than
ventricular end-diastolic pressure, with the gradient proportional to stenosis severity.
Q12: A Swan-Ganz catheter is advanced and the operator sees tall, sharp V waves on the PCWP tracing
during ventricular systole. This finding is characteristic of:
A. Atrial fibrillation B. Severe mitral regurgitation [CORRECT] C. Tricuspid stenosis D. Pulmonary
hypertension
Correct Answer: B Rationale: Giant V waves on PCWP tracing result from regurgitant volume entering
the left atrium during ventricular systole through an incompetent mitral valve; the height correlates
with regurgitant severity and left atrial compliance.
Q13: The most accurate method for determining cardiac output in the presence of significant tricuspid
regurgitation is:
A. Thermodilution method B. Fick method [CORRECT] C. Doppler echocardiography D. Indicator dilution
method
Correct Answer: B Rationale: The Fick method relies on oxygen extraction rather than indicator transit
time, making it unaffected by tricuspid regurgitation-induced recirculation artifacts that invalidate
thermodilution measurements in this setting.
Q14: During hemodynamic assessment, the dicrotic notch on the aortic pressure waveform corresponds
to:
A. Aortic valve opening B. Aortic valve closure [CORRECT] C. Peak ventricular ejection D. Isovolumetric
relaxation
Correct Answer: B Rationale: The dicrotic notch represents the brief pressure rise caused by aortic valve
closure and elastic recoil of the aortic wall, marking the end of ventricular systole and the beginning of
diastole.
ACTUAL EXAM 2026/2027 | RCIS
Cardiovascular Interventional | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION A: HEMODYNAMICS (30 Questions — 25%)
Q1: During left heart catheterization, the pressure waveform in the LV shows an elevated end-diastolic
pressure of 28 mmHg and a dip-and-plateau configuration. This waveform is most consistent with which
condition?
A. Severe aortic regurgitation B. Constrictive pericarditis [CORRECT] C. Hypertrophic obstructive
cardiomyopathy D. Acute mitral regurgitation
Correct Answer: B Rationale: The dip-and-plateau (square root sign) waveform in the LV with elevated
end-diastolic pressure is a classic hemodynamic finding in constrictive pericarditis, caused by rapid early
diastolic filling abruptly halted by non-compliant pericardium.
Q2: When measuring pulmonary capillary wedge pressure (PCWP), a properly wedged tracing
demonstrates:
A. A wave larger than V wave, with oxygen saturation >95% B. V wave larger than A wave, with phasic
respiratory variation C. Atrial waveform with mean pressure ≤ LVEDP and no step-up [CORRECT] D.
Ventricular waveform with sharp upstroke and rapid decline
Correct Answer: C Rationale: A properly wedged PCWP tracing shows an atrial-type waveform (a and v
waves), mean pressure approximating LVEDP in absence of mitral disease, and no ventricularization,
confirming the balloon is wedged in a small pulmonary artery branch.
Q3: A patient undergoing right heart catheterization has the following pressures: RA 18 mmHg, RV
50/18 mmHg, PA 50/25 mmHg, PCWP 18 mmHg. The calculated pulmonary vascular resistance (PVR) is
4.5 Wood units. These findings are most consistent with:
,A. Acute pulmonary embolism B. Primary pulmonary hypertension C. Left-sided heart failure with
passive pulmonary hypertension [CORRECT] D. Chronic thromboembolic pulmonary hypertension
Correct Answer: C Rationale: Elevated PCWP (18 mmHg) with elevated PA pressures and a PVR <5
Wood units indicates passive (post-capillary) pulmonary hypertension secondary to left-sided heart
failure, where elevated left atrial pressure is transmitted backward.
Q4: During cardiac catheterization, the operator notes a systolic pressure gradient of 80 mmHg between
the LV and aorta with a Brockenbrough sign (post-PVC beat showing increased gradient). This finding is
diagnostic of:
A. Valvular aortic stenosis B. Hypertrophic obstructive cardiomyopathy [CORRECT] C. Subaortic
membrane D. Supravalvular aortic stenosis
Correct Answer: B Rationale: The dynamic outflow tract obstruction of HOCM worsens with increased
contractility; a post-PVC beat increases the Brockenbrough gradient due to enhanced contractility and
reduced ventricular volume, distinguishing it from fixed valvular stenosis.
Q5: A simultaneous LV and aortic pressure tracing during pullback from the LV to aorta shows no
pressure gradient at rest, but a 60 mmHg gradient appears after amyl nitrite inhalation. This response
indicates:
A. Fixed subvalvular stenosis B. Dynamic LVOT obstruction [CORRECT] C. Aortic regurgitation D. Mitral
stenosis
Correct Answer: B Rationale: Amyl nitrite reduces afterload and increases heart rate, decreasing
ventricular volume and worsening dynamic LVOT obstruction in HOCM, whereas fixed stenotic lesions
show little change or reduced gradients with vasodilation.
Q6: The Fick principle for cardiac output calculation requires measurement of:
A. Arterial and venous oxygen content plus oxygen consumption [CORRECT] B. Thermodilution curve
area and injectate temperature C. Doppler velocity-time integral and LV outflow tract diameter D.
Indicator dye concentration curve and blood sample analysis
Correct Answer: A Rationale: The Fick method calculates cardiac output as oxygen consumption divided
by the arteriovenous oxygen content difference, requiring direct measurement of oxygen consumption
and simultaneous arterial/venous blood samples.
,Q7: A thermodilution cardiac output curve shows a prolonged, low-amplitude decay without a clear
exponential downslope. The most likely cause is:
A. Tricuspid regurgitation [CORRECT] B. Low cardiac output state C. Injectate temperature too warm D.
Catheter positioned in pulmonary artery wedge
Correct Answer: A Rationale: Severe tricuspid regurgitation causes recirculation of the cold injectate
through the regurgitant valve, producing a prolonged, dampened thermodilution curve that lacks the
normal exponential decay, invalidating the cardiac output measurement.
Q8: During right heart catheterization, the operator advances the catheter into the pulmonary artery
and observes a dampened waveform with mean pressure of 12 mmHg, no respiratory variation, and
inability to obtain blood samples. The most appropriate action is:
A. Obtain a blood gas to confirm wedge position B. Deflate the balloon and reposition the catheter
[CORRECT] C. Inject contrast to confirm pulmonary artery anatomy D. Advance the catheter further to
obtain a true wedge
Correct Answer: B Rationale: A dampened waveform without respiratory variation and inability to
aspirate blood indicates the catheter tip is against the vessel wall or in a small branch; deflating and
repositioning prevents vessel injury and ensures accurate pressure measurement.
Q9: The mean arterial pressure (MAP) is calculated using the formula:
A. Systolic BP + 2(Diastolic BP) ÷ 3 [CORRECT] B. Systolic BP + Diastolic BP ÷ 2 C. 2(Systolic BP) + Diastolic
BP ÷ 3 D. Pulse pressure × Heart rate ÷ Stroke volume
Correct Answer: A Rationale: MAP represents the average pressure during the cardiac cycle, weighted
toward diastole since diastole occupies approximately two-thirds of the cycle; the formula [SBP +
2(DBP)] ÷ 3 accurately reflects this temporal weighting.
Q10: A patient with acute MI develops cardiogenic shock. The hemodynamic profile shows: CI 1.8
L/min/m², PCWP 24 mmHg, SVR 1800 dynes·sec/cm⁵. This profile represents:
A. Hypovolemic shock B. Cardiogenic shock with elevated afterload [CORRECT] C. Septic shock D.
Isolated right ventricular failure
Correct Answer: B Rationale: Low cardiac index (<2.2 L/min/m²) with elevated PCWP (>18 mmHg) and
high systemic vascular resistance (>1500 dynes·sec/cm⁵) defines classic cardiogenic shock with
compensatory vasoconstriction and elevated left-sided filling pressures.
, Q11: During left heart cath, the operator records simultaneous LV and PCWP pressures. The mean PCWP
is 8 mmHg lower than LVEDP. This discrepancy suggests:
A. Normal physiologic variation B. Mitral stenosis [CORRECT] C. Aortic regurgitation D. Mitral
regurgitation
Correct Answer: B Rationale: In mitral stenosis, the pressure gradient across the stenotic valve causes
PCWP to underestimate LVEDP because the wedge pressure reflects left atrial pressure rather than
ventricular end-diastolic pressure, with the gradient proportional to stenosis severity.
Q12: A Swan-Ganz catheter is advanced and the operator sees tall, sharp V waves on the PCWP tracing
during ventricular systole. This finding is characteristic of:
A. Atrial fibrillation B. Severe mitral regurgitation [CORRECT] C. Tricuspid stenosis D. Pulmonary
hypertension
Correct Answer: B Rationale: Giant V waves on PCWP tracing result from regurgitant volume entering
the left atrium during ventricular systole through an incompetent mitral valve; the height correlates
with regurgitant severity and left atrial compliance.
Q13: The most accurate method for determining cardiac output in the presence of significant tricuspid
regurgitation is:
A. Thermodilution method B. Fick method [CORRECT] C. Doppler echocardiography D. Indicator dilution
method
Correct Answer: B Rationale: The Fick method relies on oxygen extraction rather than indicator transit
time, making it unaffected by tricuspid regurgitation-induced recirculation artifacts that invalidate
thermodilution measurements in this setting.
Q14: During hemodynamic assessment, the dicrotic notch on the aortic pressure waveform corresponds
to:
A. Aortic valve opening B. Aortic valve closure [CORRECT] C. Peak ventricular ejection D. Isovolumetric
relaxation
Correct Answer: B Rationale: The dicrotic notch represents the brief pressure rise caused by aortic valve
closure and elastic recoil of the aortic wall, marking the end of ventricular systole and the beginning of
diastole.
