Post-Test Questions

This section provides a review. Mark each answer on the Post-Test Answer/Evaluation Form (see page C–5)

Article One (pp. 155–160)

1. What is the most commonly used embolic agent in the treatment of bronchial hemorrhage from a benign source?

   • Glue

   • Coils

   • Absolute alcohol

   • PVA particles (100 to 300 microns)

   • PVA particles (500 to 700 microns)

2. What is the most common anatomical arrangement of bronchial artery origins?

   • One right and one left bronchial artery

   • Two right and one left bronchial artery

   • One right and two left bronchial arteries

   • Two right and two left bronchial arteries

   • None of the above

3. The following are all common causes of hemoptysis from a bronchial artery source except:

   • Tuberculosis

   • Cystic fibrosis

   • Blunt trauma

   • Interstitial pulmonary fibrosis

   • Bronchiectasis

   Article Two (pp. 161–168)

4. Which of the following placental abnormalities account for the greatest risk of maternal death from hemorrhage?

   • Placenta previa

   • Placenta percreta

   • Placenta accreta

   • Placenta increta

5. Which of the following methods is not a method for managing placental abnormalities?

   • Balloon occlusion of the hypogastric arteries

   • Intraoperative ligation of the uterine of internal iliac arteries

   • Administration of methotrexate to aid in placental regression

   • Coil embolization of the common iliac arteries

6. In regard to the management of placental abnormalities, balloon occlusion of which of the following vessels runs a risk of causing ischemia to the lower extremities?

   • Aorta and common iliac arteries

   • Uterine arteries

   • Internal iliac veins

   • Hypogastric arteries

   Article Three (pp. 169–177)

7. Which of the following embolic agents is likely least efficacious in treating UGIB patients with underlying coagulopathy?

   • Coils

   • Gelfoam

   • Glue

   • Particles

8. Which of the following is true?

   • Rebleeding after endoscopic treatment of UGIB occurs in 5% of cases

   • UGIB accounts for 24% of all gastrointestinal bleeding events

   • Active extravasation on conventional angiography is seen in slightly more than half of cases

   • Rebleeding after transarterial embolization occurs in 12% of cases

9. Which of the following treatments is most appropriate in a patient presenting with bleeding gastroesophageal varices refractory to endoscopic therapy?

   • TIPS

   • TIPS with embolization of varices

   • BRTO

   • Transarterial embolization of left gastric artery

   Article Four (pp. 178–186)

10. What is one of the most common causes of lower gastrointestinal bleeding?

    • Diverticulosis

    • Neoplasm

    • Postoperative bleeding

    • Dieulafoy lesion

11. Which of the following is false regarding correction of any coagulopathy important in successful treatment and coil embolization of a lower gastrointestinal bleed?

    • Decrease bleeding risk from arterial puncture

    • Optimal function of coils requires adequate thrombogenesis

    • Coagulopathy is not a contraindication for emergent endovascular treatment

    • Lower gastrointestinal bleeding may resolve after correcting any coagulopathy

12. What is the appropriate size for a microcoil for lower gastrointestinal bleeding?

    • The normal vessel diameter, erring on the side of slightly oversizing the coil

    • 10% larger than the normal vessel diameter

    • The normal vessel diameter, erring on the size of slightly undersizing the coil

    • Grossly larger than the vessel to avoid distal embolization

    Article Five (pp. 187–191)

13. All of the following can be sources of bleeding that can result in life-threatening shock except:

    • Fractured cancellous bone surface

    • Venous lacerations

    • Arterial injuries

    • All of the above can be a source of life-threatening hemorrhage

14. Emergent pelvic angiography and embolization is indicated in patients with pelvic fractures and hemodynamic instability or signs of ongoing hemorrhage when other sources of bleeding have been ruled out. True or false?

15. Risk factors for recurrent hemorrhage following an initially successful embolization procedure include:

    • More than one bleeding vessels on the initial angiogram

    • Transfusion requirements of >1 unit of packed red blood cells per hour

    • Presence of intra-abdominal injuries

    • Persistent base deficit

    Article Six (pp. 192–196)

16. The incidence of bullet embolization after penetrating injury is reported to be:

    • 0.01%

    • 1%

    • 5%

    • 8%

    • No estimates are available

17. Potential complications of bullet embolization include all of the following except:

    • Limb-threatening ischemia

    • Cardiac valvular incompetence

    • Phlegmasia cerulean dolens

    • Pulmonary embolism

    • Death

18. Reported therapeutic options for bullet embolization include all of the following except:

    • Surgical extraction

    • Endovascular retrieval

    • Angioscopy

    • Combined surgical and endovascular approach

    • All of the above are therapeutic options

    Article Seven (pp. 197–200)

19. Active extravasation of the liver necessarily requires initial surgical management. True or false?

20. Using the “coil sandwich” technique for embolization means:

    • Using coils and particles together when embolizing an injured artery

    • Placing coils both distal to and proximal to the involved artery

    • Using alternating large and small coils to improve the coil pack occlusion of the involved artery

    • None of the above

21. Why is a portal venogram showing normal hepatopetal flow important?

    • If not present, there is higher risk of significant hepatic necrosis

    • Hepatopetal flow in the portal vein improves vascular occlusion during embolization procedures

    • Hepatopetal flow in the portal vein worsens the outcome of embolization

    • Portal vein hepatopetal flow confirms proper directional flow in the splenic vein excluding significant vascular injury to the spleen

    Article Eight (pp. 201–203)

22. Which of the following is a contraindication to thrombolysis?

    • Native bypass graft

    • Embolic occlusion

    • Coagulopathy

    • Nonviable limb

23. Which of the following is the most commonly used agent for thrombolysis in the United States?

    • tPA

    • Urokinase

    • Heparin

    • Streptokinase

24. Compared with surgery, which of the following is not a rationale for performing thrombolysis?

    • More complete clot removal

    • Ability to remove clot in very small vessels

    • Lower risk of hemorrhage

    • Minimizing damage to arterial endothelium

    Article Nine (pp. 204–217)

25. PE is the leading cause of preventable in-hospital mortality. True or false?

26. ACCP guidelines support the use of prophylactic IVC filters. True or false?

27. Which of the following statements is false?

    • Most symptomatic PE originates in the deep veins of the thigh

    • The PREPIC trial is the only randomized controlled trial evaluating the effectiveness of IVC filters

    • Postthrombotic syndrome is characterized by aching pain/heaviness on standing, pruritus, dependent edema, and sometimes lipodermatosclerosis and venous ulcers

    • Temporary filters are also known as retrievable filters

    Article Ten (pp. 218–225)

28. Which of the following technical aspects is not ideal during emergent PCN catheter placement?

    • Utilizing a subcostal approach

    • Deferring a diagnostic pyelogram at time of initial placement

    • Accessing an anterior calyx of the collecting system

    • Achieving adequate local anesthesia at the renal capsule

29. “Single-stick” and “double-stick” (first placing a needle in the collecting system to inject contrast and air to define a ideal access point for a second needle placement/final nephrostomy placement) techniques for percutaneous nephrostomy placement in adults have similar technical success rates, but the “doublestick” technique has a higher complication rate due to the additional punctures in the renal parenchyma. True or false?

30. Acceptable rate for complication of hemorrhage requiring transfusions as recommended by the Society of Interventional Radiology (SIR) Standards of Practice Committee is:

    • 2%

    • 4%

    • 10%

    • 15%

    Article Eleven (pp. 226–230)

31. What CT finding is highly suggestive of empyema in a patient presenting with fever?

    • “Pleural studding” sign

    • Air-fluid level

    • “Split pleura” sign

    • Calcified pleural plaques

32. Which laboratory value of a collected sample of pleural fluid would indicate the need for catheter drainage?

    • Glucose = 100 mg/dL

    • Glucose = 60 mg/dL

    • pH = 7.5

    • LDH = 900 units/L

33. In which clinical setting would fibrinolytics be most appropriate?

    • A 62-year-old man with pneumonia and small (<15 cc) pleural effusion seen on lateral chest x-ray

    • A 72-year-old woman with multiloculated effusion and extremely thick pleural peel (pleural fibrosis)

    • A 65-year-old woman with single loculated purulent draining collection

    • A 68-year-old man with persistent purulent effusion despite multiple attempts at tube thoracostomy

    Article Twelve (pp. 231–236)

34. In complicated appendicitis with signs of sepsis, emergent percutaneous placement of drainage catheter(s) using image guidance is preferred over urgent or delayed placement. True or false?

35. The following are necessary before considering periappendiceal drainage catheter removal except:

    • Normalization of leukocytosis

    • Reduction of drain output to <20 mL/day

    • Follow-up CT demonstrating near-complete resolution of the periappendiceal fluid collection

    • Resolution of fever

36. The sedation needs of a pediatric patient differ from those of an adult and are best managed by an anesthesiologist or nurses who have undergone a sedation competency process tailored for the pediatric population. True or false?

Emergency IR; Guest Editor, Thuong G. Van Ha, M.D.

© by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: [phone]. DOI http://dx.doi.org/10.1055/s-0032-1327468. ISSN 0739-9529.