RCIS Study 2023 with verified questions and answers

Treatment of pseudoaneuryms Cover stent, US probe compression of the neck, US guided THROMBIN injection, open surgical ligation Treatment for vasovagal reaction Atropine Rotational atherectomy burr speed 160,000 rpms Regurgitant Fraction Formula SV (valve) - SV (systemic) / SV (valve) Ejection Fraction Formula SV / LVEDV Laser safety equipment goggles, yes wear UV safety goggles Where is the Laser situated in relation to the lesion for it to work? Directed at a lesion to photo ablate it Reversal agent for Fentanyl ( Naloxone Treatment for radial artery spasm Verapamil Minimum time after administering Heparin to check ACT 3-5 minutes to 10 Minutes What is a potassium 3.5 called Hypokalemia Information needed for Patient Identification Name, Date of Birth Chemical used for sterilization Ethylene Oxide Most important factors in steam sterilization Pressure, Time, Temperature, Con What equipment is used in mitral valvuloplasty Mullins Sheath and a transseptal needle (Brockenbrough needle) What leads point to an inferior MI? II, III, aVF What is the starting dose for versed and fentanyl? 0.5 to 1.0 mg Versed, 25-50 mcg Fentanyl Common stick resulting in a PSA (Pseudoaneyurism) Low Stick 1cm below the inguinal fold Common stick for retroperineal bleed High Stick Common stick resulting in a Hematoma Multi sticks Meds for PEA and Asystole Epinephrine and Vasopressin How do you test the defib monitor Discharge paddles into aa dummy load Common place for radiation badge On lead near neck by thyroid Yearly dose for cath lab staff 5 REM What does Pulmonary Stenosis look like hemodynamically? Pressure gradient across pulmonic valve upon pullback into RV. BE SURE TO CHECK SCALE AND IDENTIFY CORRECT CHAMBER WAVEFORMS Which calculation is used for low Cardiac Output FICK What does a subvalvular gradient between the AO and LV suggest? HOCM - Hypertrophic obstructive cardiomyopathy When are balloon expandable stents used? Coronary Arteries Where do you stick a patient for a left Femoral Artery Stic One finger breadth below the inguinal fold Mark where to hold pressure for a femoral artery sheath pull 2-3 fingers above the puncture site What is the rotational speed of a rotoblator burr 160-220,000 rpm The components of the angioseal are bioabsorbable Perclose sutures are Permanent What view shows the LV lateral free wall LAO What view shows the inferior wall? RAO Recognize atrial tenting on ultrasound ... What do you do first if patient brads to systole the comes back after an injection into the RCA Prepare transcutaneous pacing What size is a 2.33 mm sheath 7 French 1 french size equals? .33mm What size is a 2.66mm sheath? 8 french What do you do if you feel resistance and the patient states he has pain while inflating a foley balloon? Deflate the balloon and attempt advancement Anterior Leads V2 - V5 When do the valves open and close (wiggers diagram) Beginning of Isovolumic Contraction: A-V valves close End of Isovolumic contraction: Aortic Valve opens Beginning of Isovolumic relaxation: Aortic Valve closes End of Isovolumic relaxation: A-V valve opens What do you do if the pressure tracing ventricularizes Adjust the catheter until pressure tracing normalizes What does an injury current during periocardiocentisis mean? The needle is in the myocardium What stent is best used in tortuous Situations Open Cell stent What piece of equipment should you prepare for a rotablator case Temp pacer should be prepped and placed What should you do prior to a PCI of the RCA for a patient with a LBBB Place a temp pacer Fick Formula O2 consumption / (Hgb x 1.34 x AO2)-(Hgb x 1.34 x PO2) x 10 Regurgitant Fraction (CO angio) - (CO fick) / (CO angio) Qp/Qs Ao sat - RA sat / PV sat - PA sat Qp/Qs 1 Left to right shunt Qp/Qs 1 Right to Left shunt Where must an ASD be located in order to perform a closure Ostium Secundum or Fossa Ovalis When is distal protection best used Carotids and Grafts What is the wire size on a distal protection device 0.014 What equipment is needed for a PCI Guide catheter, guide wire, tuoghy, inflation device What may happen is the roughy is overtightened The balloon will not inflate What is the best device for stent opposition? OCT or IVUS Can the PFO closure device be resheathed before it is deployed Yes TIMI Flows TIMI 0 - No perfusion, no flow beyond the coronary occlusion TIMI 1 - Penetration without perfusion, faint integrate flow beyond the occlusion with incomplete filling of the distal coronary bed TIMI 2 - Partial perfusion, delayed or sluggish antegrade flow with complete filling of the coronary bed TIMI 3 - Normal, normal flow with complete filling of distal coronary bed Pacer Codes First Letter - Chamber paced (A, V, D) Second Letter - Chamber sensed (A, V, D) Third Letter - Pacer's Response (Trigger, Inhibit, Dual) Ejection Fraction formula EF = SV / EDV Stroke Volume formula SV = EDV-ESV What vessel feeds the inferior wall of the LV RCA What vessel feeds the IV septum LAD What hemodynamic wave represents ventricular contraction on RA waveform "c" wave on X-decent What are mitral clips used to fix perivalvular leak What do you do after a 2 second pause following an injection? Prepare transcutaneous pacing Where is the temp pacing lead placed in the heart? In the RV Where is the LAD in the LAO Caudal spider view LAD is on the left Normal values ABGs pH 7.35-7.45, CO2 35-45, HCO3 22-26 What is the normal range of Potassium (K+) in the blood 3.5-5.0 Name some anti platelet meds ASA, Ticlid, Plavix If a patient has a high creatinine, what should you consider? Use as small amount of contrast as possible, pre procedure fluid hydration (3ml/kg) How does Heparin prevent clot formation? Prevents the conversion of prothrombin to thrombin, combines with antithrombin to make it more effective What is the action of Reopro? inhibits IIb/IIIa INR measures the levels of what drug? Coumadin Lovenox impacts what? Antithrombin, Factor Xa What might be the medication of choice for SVT? adenosine What short acting benzodiazepine is commonly used in the cath lab for sedation Versed What is a quick and easy way to check a patients clotting time after being given heparin ACT How do Ticlid and Plavix act? Turn off receptor sites on the platelets (super aspirin) If a patient is on NPH insulin, what medication should not be given? Protamine What does ASA (aspirin) do? ASA prevents platelet adhesion TPA acts by? Dissolving fibrin, Activates plasminogen What labs look at kidney function? BUN and Creatinine, GFR, Creatinine clearance The most accurate measure of cardiac muscle fiber damage after an MI is what? Troponin Which lab value does not evaluate the extent of an MI? SGOT Serum Creatinine CK-MB LDH Serum Creatinine Post procedure renal dysfunction is more likely to occur in patients with? Diabetes Pre-procedure dehydration Frequent NSAID use ACE Inhibitors What is a pseudoaneyurysm? Pseudoanuerysm is a false aneurysm, Often a pulsatile mass near the sheath site with a bruit present If the transducer is positioned to low at the side of a table, the patients pressure will read? falsely high If you are checking the radial/ulnar pulse when you press and release one side at a time, what test are you performing? Allen's test What is the best way to calculate a patients pulse rate? Check pulse for one minute If the patients IV is infiltrated, what should you do? Turn it off Metabolic acidosis has a low level of what? HCO3 (Bicarb) A pH less than 7.35 or greater than 7.45 is called what? Uncompensated What would be the appropriate intervention for a patient with repiratory acidosis Increase ventilations The primary drive to breath comes from a patients? CO2 level Hyperventilating prior to suctioning is done to? Increase arterial PO2 Interpret the following blood gas: pH:7.25 CO2: 60 HCO3: 22 Uncompensated Respiratory Acidosis A high CO2 will impact the pH how? it will lower the pH Increased bicarb will do what to the ph? it will increase pH What is the most common type of cardiac tumor? Left atrial myxoma The innermost layer of an artery is what/ the intima What type of intervention is best used for a calcified lesion? Rotablator What type of ballon is best used on a calcified lesion? A cutting or scoring balloon They symptoms of increased heart rate, decreased BP, and SOB during biopsy indicate what? Cardiac perforation What diagnostic catheter is best utilized for visualizing the LAD when the patient has a dilated aortic root? JL5 2.66 mm diameter is what size catheter 8 Fr What device uses saline to dissolve and suction thrombus during and acute MI? Angiojet During a rotablator intervention, what is the most common cause of "no flow"? Distal embolization Where does the needle enter for a pericardialcentisis? Sub-xyphoid process What is a possible complication of over tightening the tuoghy? Inability to inflate the balloon If a patient has a heart rate of 150, assist on the IABP should be set at? 1:2 What is the best balloon to use on an artery that has a tendency to close? A perfusion balloon Jugular Vein Distention (JVD) can be caused by? RV Infarct, Pulmonary Hypertension, Tricuspid Regurgitation Shortness of breath indicates left or Right sided heart failure? Left sided Ventricular Arrhythmias are most common during injection of which coronary artery? RCA Osmolality refers to the ability of the contrast to? Pull fluid into the intravascular space The ideal contrast volume to be given to the patient is? 3ml/kg Synchronous (demand) pacemakers have what unique ability? They sense the hearts intrinsic activity and pace only when needed In order, the first three letter of the pacemaker code mean what? Chamber paced, chamber sensed, chamber triggered The purpose of biventricular pacemakers is to To synchronize the contraction of both ventricles The purpose of ICDs is to? Monitor bradycardia, tachycardia, VT, and V-Fib and convert if necessary In the terms RAO and LAO, the R and L refer to what? The position of the Image intensifier What is the best view to see the LAD and circle bifurcation LAO caudal (spider view) On an EKG, what shows a "true" posterior infarct? V7-V9, V1 and V2 What catheter does an IMA (internal mammory artery) catheter resemble? JR4 If the pt. has a dilated aortic root, which catheter might you need to cannulate the right coronary system? JR5 In a routine PTCA, what might be some complications caused by the handling of the wire? Arterial dissection or perforation What does RAD stand for? Radiation Absorbed Dose The most important factor in decreasing Xray exposure to a patient is to? To decrease time of exposure What is the MAX DOSE of radiation a worker can receive in one year 5 REM (...not RAD!!) What converts the X-rays to light rays? Image Intensifier What is the best choice of catheter to use on an LCA with a high take-off? Amplatz To view pulmonary stenosis, where do you inject the contrast? In the right ventricle Pulmonic stenosis is generally associated with what? Congenital abnormalities What is the normal PR interval? If the PR interval is .25 where is the delay? PR interval: .12-.20 AV node What is the normal amount of blood in the pericardium? 50cc When do the coronary perfuse? During ventricular diastole In what condition do you get the equalization of LVEDP and RVEDP? Constrictive pericarditis Where is the most common renal stenosis located? Ostial Greatest % of peripheral stenosis occurs where? Lower extremities What will cause failure to capture of a pacemaker in the RV? Lead dislodgement You have a 50 y/o admitted to the cath lab, HR 200, BP 90/50, what would you do? Synchronized cardioversion Vascular resistance is most greatly influenced by? The radius of the tube (vessel) What is the ACLS protocol for monophonic defibrillation How do you test a defibrillator? Discharging paddles into the dummy load If there is a valve with regurgitation, what CO method should you use? FICK