About the Challenge Scenarios question bank
This is the hardest bank on the site and the closest to how the RCIS actually thinks. Each item gives you a clinical picture — a rhythm, a set of pressures, a complication mid-case — and asks for the correct next action. There is usually more than one defensible thing to do, and exactly one best thing to do first.
Scenario questions integrate every other domain. To answer them you have to read the waveform, recognise the rhythm, know the drug, and understand the procedure, all at once. If you can work this bank comfortably, you are ready.
What this bank covers
- Cardiogenic shock — recognition, hemodynamic profile, and support
- Cardiac tamponade and emergency pericardiocentesis
- Coronary perforation and its immediate management
- Acute stent thrombosis during and after the case
- Vagal reaction and the hypotensive, bradycardic patient
- Access-site bleeding and retroperitoneal haemorrhage
- Contrast anaphylaxis and airway emergencies
- Peri-procedural arrhythmia, arrest, and defibrillation
How to use it
- Read the stem for what is being asked. "What is the next step" and "what is the diagnosis" have different answers to the same scenario.
- When the patient is unstable, the answer is almost always the intervention that restores perfusion, not the test that confirms the diagnosis.
- Do this bank last, after the others. It assumes everything they teach.
Frequently asked questions
What is the hemodynamic signature of cardiogenic shock?
A low cardiac index — below about 2.2 L/min/m² — with a raised wedge pressure above roughly 15 mmHg and hypotension despite adequate filling. High filling pressures with low output is the pattern to recognise.
How is a coronary perforation managed in the moment?
Immediately reinflate a balloon proximally to seal the leak, reverse anticoagulation as directed, and prepare for a covered stent and possible pericardiocentesis. Echo early — tamponade can develop within minutes.
A patient becomes bradycardic and hypotensive during sheath removal. What is happening?
A vasovagal reaction. Stop the stimulus, lay the patient flat with legs raised, give fluid, and give atropine for the bradycardia. It is common, it is treatable, and the exam expects you to recognise it instantly.