CCI RCIS Exam Flashcards

Q: How many questions are on the RCIS exam?

The current CCI RCIS exam has 170 items: 150 scored and 20 unscored. It includes traditional multiple choice plus multiple-response, hot-spot, and drag-and-place formats.

Q: How much time is provided for the RCIS exam?

Total seat time is three hours. CCI allocates 2 hours 50 minutes to the exam questions and 10 minutes to the tutorial and post-exam survey.

Q: What is the current RCIS pass rate?

CCI reports a 75% first-time RCIS pass rate for 2025. Separately, a total scaled score of 650 is required to pass; the scaled score is not a percentage correct.

Q: What is the RCIS retake policy?

A candidate may submit a new application after failing, but must wait 45 days from the failed test date before testing again. The same waiting period applies to later failures.

Q: How do these flashcards match the RCIS matrix?

The 50 cards follow CCI's official task weights: 4 pre-procedure, 20 diagnostic, 17 interventional, 6 emergency, and 3 post-procedure cards. The final whole-card remainder is tied between the 13% emergency and 5% post-procedure domains, so this set assigns it to post-procedure.

Question 1

What must be confirmed during the pre-procedure time-out?

Accepted Answer

Correct patient, planned procedure and site, consent, allergies, relevant imaging or implants, and readiness of the team and required equipment.

Question 2

Why review renal function before iodinated contrast?

Accepted Answer

Impaired kidney function increases risk from contrast exposure and may change hydration, contrast-volume, medication, or procedural planning.

Question 3

What is the purpose of a radial collateral-circulation assessment?

Accepted Answer

To evaluate hand perfusion pathways before radial access and identify findings that require operator review or an alternate plan.

Question 4

What should a baseline cath-lab assessment establish?

Accepted Answer

The patient's usual rhythm, vital signs, symptoms, pulses, neurovascular status, labs, allergies, medications, and level of consciousness.

Question 5

What does the aortic pressure waveform represent?

Accepted Answer

Left-ventricular ejection creates the systolic rise; aortic valve closure produces the dicrotic notch before diastolic runoff.

Question 6

What creates the right-atrial a wave?

Accepted Answer

Atrial contraction. It is absent in atrial fibrillation and may become prominent when the atrium contracts against increased resistance.

Question 7

What creates the right-atrial v wave?

Accepted Answer

Venous filling of the right atrium while the tricuspid valve is closed during ventricular systole.

Question 8

How is cardiac output calculated by the Fick principle?

Accepted Answer

Oxygen consumption divided by the arterial-minus-mixed-venous oxygen content difference.

Question 9

What can an oxygen-saturation step-up indicate?

Accepted Answer

A left-to-right shunt entering at or before the chamber where a reproducible rise in oxygen saturation first appears.

Question 10

What does pulmonary capillary wedge pressure approximate?

Accepted Answer

Left-atrial pressure when the catheter is correctly wedged and there is no important obstruction between pulmonary capillaries and the left atrium.

Question 11

What pressure finding suggests aortic stenosis?

Accepted Answer

A systolic pressure gradient between the left ventricle and aorta during pullback, interpreted with waveform quality and flow conditions.

Question 12

What does FFR compare?

Accepted Answer

Distal coronary pressure with aortic pressure during maximal hyperemia to estimate the physiologic effect of a coronary stenosis.

Question 13

How does iFR differ from FFR?

Accepted Answer

iFR uses a specific diastolic wave-free period without routine pharmacologic hyperemia; FFR is measured during maximal hyperemia.

Question 14

What is the main difference between IVUS and OCT?

Accepted Answer

IVUS uses ultrasound and penetrates deeper; OCT uses light, provides higher surface resolution, and requires blood clearance for imaging.

Question 15

What does TIMI flow grade describe?

Accepted Answer

The degree of antegrade coronary blood flow beyond a lesion, from no perfusion to normal flow.

Question 16

What coronary territory is usually supplied by the LAD?

Accepted Answer

The anterior wall and septum, with exact territory depending on anatomy and branch distribution.

Question 17

What coronary territory is usually supplied by the circumflex?

Accepted Answer

The lateral left-ventricular wall through obtuse marginal branches; contribution to the inferior wall depends on dominance.

Question 18

What determines coronary dominance?

Accepted Answer

Which coronary artery gives rise to the posterior descending artery, not which vessel is physically largest.

Question 19

What does ST-segment elevation suggest in the cath-lab context?

Accepted Answer

Acute transmural injury or another ST-elevation cause; correlate immediately with symptoms, leads involved, hemodynamics, and angiographic findings.

Question 20

What is the purpose of the square-wave test?

Accepted Answer

To assess the dynamic response of a fluid-filled pressure system and identify underdamping or overdamping.

Question 21

How does an overdamped pressure system affect a waveform?

Accepted Answer

It blunts detail, tends to underestimate systolic pressure, and can overestimate diastolic pressure.

Question 22

Why must the pressure transducer be leveled and zeroed?

Accepted Answer

Leveling establishes the reference height; zeroing removes atmospheric pressure so displayed values reflect intravascular pressure.

Question 23

How does distance reduce radiation exposure?

Accepted Answer

Increasing distance from the radiation source and scatter field sharply reduces exposure; maximize distance whenever the task permits.

Question 24

What does ALARA require in fluoroscopy?

Accepted Answer

Keep radiation as low as reasonably achievable through time, distance, shielding, collimation, positioning, and appropriate imaging settings.

Question 25

Why is meticulous manifold preparation essential?

Accepted Answer

Air or clot introduced through the system can embolize; all connections must be secure, flushed, and continuously observed.

Question 26

What is balloon angioplasty intended to do?

Accepted Answer

Enlarge a narrowed vessel lumen by controlled balloon expansion, often as preparation for or optimization of stent placement.

Question 27

What is the purpose of a coronary stent?

Accepted Answer

To scaffold the vessel and maintain lumen gain after lesion preparation or balloon dilation.

Question 28

What does atherectomy accomplish?

Accepted Answer

It modifies or removes selected plaque, often calcified tissue, to improve device delivery and lesion expansion.

Question 29

What is no-reflow?

Accepted Answer

Inadequate microvascular perfusion despite opening the epicardial vessel, often associated with distal embolization or microvascular injury.

Question 30

What is coronary dissection?

Accepted Answer

A tear separating layers of the vessel wall that may create a false lumen and compromise flow.

Question 31

What finding raises concern for coronary perforation?

Accepted Answer

Contrast exiting the vessel or collecting outside its expected lumen, especially with new hypotension or pericardial effusion.

Question 32

What does activated clotting time monitor?

Accepted Answer

The anticoagulant effect of procedural therapy at the point of care; targets depend on the procedure, device, and medication strategy.

Question 33

Why is dual antiplatelet therapy important after many coronary stents?

Accepted Answer

It reduces platelet-mediated stent thrombosis risk; regimen and duration are determined by the clinical and bleeding-risk context.

Question 34

What is the purpose of a distal protection device?

Accepted Answer

To capture or limit embolic debris traveling downstream during selected vascular interventions.

Question 35

What does an intra-aortic balloon pump do?

Accepted Answer

It inflates in diastole to augment coronary perfusion and deflates before systole to reduce afterload.

Question 36

What is the basic role of an Impella device?

Accepted Answer

It provides temporary mechanical circulatory support by moving blood from the left ventricle into the aorta.

Question 37

What is the purpose of a temporary transvenous pacemaker?

Accepted Answer

To provide short-term ventricular stimulation when clinically significant bradycardia or conduction failure requires support.

Question 38

What does pericardiocentesis treat?

Accepted Answer

Hemodynamically significant pericardial fluid, including tamponade, by draining fluid from the pericardial space.

Question 39

What is TAVR?

Accepted Answer

Transcatheter aortic valve replacement: catheter-based implantation of a prosthetic valve for selected patients with aortic valve disease.

Question 40

What does a left-atrial-appendage closure device target?

Accepted Answer

The appendage where thrombus commonly forms in atrial fibrillation, reducing embolic risk in appropriately selected patients.

Question 41

Why is vascular-access imaging or ultrasound useful?

Accepted Answer

It helps select an appropriate entry site and avoid adjacent structures, reducing failed access and complication risk.

Question 42

What are classic signs of cardiac tamponade?

Accepted Answer

Falling blood pressure, rising filling pressures, tachycardia, and worsening perfusion; confirm rapidly with hemodynamics and imaging.

Question 43

What is the first priority in ventricular fibrillation?

Accepted Answer

Recognize pulseless arrest, activate the emergency response, begin high-quality CPR, and deliver prompt defibrillation per protocol.

Question 44

What should be suspected with sudden hypotension after femoral access?

Accepted Answer

Bleeding, including retroperitoneal hemorrhage, along with tamponade, arrhythmia, ischemia, reaction, or other procedural causes.

Question 45

What is an anaphylactic contrast reaction?

Accepted Answer

A rapid systemic hypersensitivity reaction with airway, breathing, or circulatory compromise requiring immediate emergency treatment.

Question 46

What is cardiogenic shock?

Accepted Answer

Critical tissue hypoperfusion caused primarily by inadequate cardiac pump function despite sufficient circulating volume.

Question 47

What must a cath lab emergency role assignment achieve?

Accepted Answer

Clear leadership and simultaneous coverage of compressions, airway, defibrillation, medications, procedure support, documentation, and communication.

Question 48

What should be assessed after radial hemostasis is applied?

Accepted Answer

Bleeding control plus hand perfusion, sensation, movement, pain, and device pressure, with gradual adjustment per protocol.

Question 49

What finding suggests a femoral pseudoaneurysm?

Accepted Answer

A painful pulsatile access-site mass or bruit after arterial access; protect the site and obtain prompt clinical evaluation.

Question 50

What makes a safe post-procedure handoff?

Accepted Answer

Procedure and access details, medications and contrast, hemostasis plan, pulses, complications, vital trends, restrictions, and required monitoring.

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