Post-Test Questions

Article One (3–9)

1. The following treatments are indicated after the diagnosis of tumor lysis syndrome has been made EXCEPT:

   • Allopurinol

   • Correction of serum potassium levels

   • Treatment of hypocalcemia

   • Hemodialysis for patients with fluid overload and renal insufficiency

   • None of the above

2. Which of the following are risk factors for tumor lysis syndrome?

   • Preexisting renal insufficiency

   • Elevated baseline lactate dehydrogenase serum levels

   • Large tumor bulk

   • Tumors with rapid cell turnover and proliferation

   • All of the above

3. Regarding tumor lysis syndrome in primary liver malignancies, which of the following is CORRECT?

   • Liver malignancies are the most common malignancy to cause tumor lysis syndrome

   • Tumor lysis syndrome has been reported to occur with metastatic colorectal cancer, hepatoma, cholangiocarcinoma, and neuroendocrine tumors

   • Tumor lysis syndrome has only been shown to occur following transarterial therapies

   • Most cases occur within 72 hours after treatment

   • None of the above

   Article Two (10–13)

4. Benefits of intranodal lymphangiography over pedal lymphangiography include the following:

   • Iodinated contrast is used instead of oily contrast

   • About half the amount of contrast is used

   • It is technically easier

   • Embolization with oily contrast is not possible

   • None of the above

5. Contraindications to lymphangiography include all of the following EXCEPT:

   • Known right-to-left shunt

   • Allergy to lipiodol

   • Thoracic duct rupture

   • Significant pulmonary insufficiency

   • None of the above

6. True or false? Lymphangiography for thoracic duct embolization predates vascular catheter-directed embolization?

   • True

   • False

   Article Three (14–17)

7. Initial concern for access hemorrhage workup should include:

   • Tc99m-RBC nuclear medicine scan

   • MRI pelvis with gadolinium

   • Noncontrast CT pelvis

   • Catheter angiogram

8. Groin access hemorrhage following stent-assisted intracranial aneurysm embolization can be treated with all of the following EXCEPT:

   • Cessation of anticoagulation and antiplatelet therapy without risk for thrombosis

   • Endovascular embolization if CT is positive

   • Temporary balloon occlusion until surgical repair

   • Stent graft if located in external iliac artery

9. Catheter angiogram of groin access during investigation for active hemorrhage should include:

   • Common femoral artery

   • External iliac artery

   • Inferior epigastric artery

   • Closure device site

   • All of the above

   Article Four (18–21)

10. What percentage of patients will develop elevated serum pancreatic enzymes following lobar TACE?

    • 0%

    • 5%

    • 10%

    • 20%

    • 40%

11. True or False? Treatment of pancreatitis post-TACE is largely conservative?

    • True

    • False

12. Nontarget embolization resulting in pancreatitis is known to occur only in the following:

    • Treatment with drug-eluting bead therapy

    • Treatment with glass (not resin) radioembolization beads

    • Treatment of the left hepatic lobe arterial distribution only

    • Treatment (infusion) proximal to the cystic arterial origin

    • None of the above

    Article Five (22–25)

13. Of the following options, the falciform artery most typically arises from the:

    • Right hepatic artery

    • Proper hepatic artery

    • Left hepatic artery

    • Left gastric artery

    • None of the above

14. Preventative measures taken to preclude nontarget embolization of the falciform artery include:

    • Placement of ice packs on the periumbilical area during embolization

    • Bland particle embolization (100–300 μm particles) of the falciform artery

    • Gentle embolization just proximal to the falciform artery origin

    • Surgical skeletonization of the falciform artery

    • All of the above

15. True or false? The falciform artery is noted in up to 2/3 of autopsy specimens, but only ¼ of all angiograms?

    • True

    • False

    Article Six (26–33)

16. Which of the following parameters accurately predicts bleeding following percutaneous biopsy?

    • INR

    • aPTT

    • Platelet count

    • None of the above

17. What percentage of major complications, including bleeding, are detected at 24 hours post–renal biopsy?

    • 50%

    • 75%

    • 90%

    • 100%

18. According to the Society of Interventional Radiology guidelines, which of the following patients do not require an INR level prebiopsy?

    • Suspected thyroid cancer

    • Suspected liver metastasis

    • Suspected lung cancer

    • Suspected spinal metastasis

    Article Seven (34–41)

19. Which of the following statements is correct?

    • In practice, almost all retrievable IVC filters are removed

    • All IVC filters should be removed

    • Retrievable IVC filters have a very high rate of successful removal

    • None of the above

20. Which of the following statements is correct?

    • Filter-related IVC perforation is rare

    • CT is less accurate than cavogram in diagnosing filter-related IVC perforation

    • Filter-related IVC perforation has been reported to involved adjacent organs in over 10% of cases

    • Filter-related IVC perforation typically presents with hemodynamic instability

21. All major societal guidelines (SIR, ACCP, EAST, and BSH/BCSH) endorse the use of IVC filters for which indication?

    • Absolute or relative contraindication to anticoagulation

    • Complications resulting from anticoagulation treatment

    • Severe trauma without documented PE or DVT

    • Recurrent PE in patients with adequate anticoagulation therapy

    Article Eight (42–48)

22. Regarding transjugular renal biopsies, which of the following is CORRECT?

    • The left kidney is typically chosen because of the more favorable angle

    • The incidence of AVF following renal biopsy is 0.5 to 1.0%

    • The biopsy cannula should not be advanced distally into the parenchyma due to the increased risk of capsular puncture

    • The increased number of needle passes increases the risk of bleeding

    • None of the above

23. Regarding transjugular liver biopsies, which of the following is CORRECT?

    • Overall complication rate exceeds 10%

    • Parenchymal hematomas are very common on postprocedural imaging

    • Major complications are less common in pediatric patients

    • Embolization for postbiopsy bleeds in transplant patients carries an added risk for biliary necrosis

    • None of the above

24. True or False? Transvenous biopsies decrease the risk of bleeding complications but require dedicated equipment and operators familiar with the techniques and tools.

    • True

    • False

    Article Nine (49–53)

25. What are the risk factors associated with rupture of HCC following TACE?

    • Large tumor size

    • Capsular location of the tumor

    • Contour protrusion and exophytic tumoral growth

    • Thrombosis of the portal venous system

    • All of the above

26. What is the treatment of choice for spontaneously ruptured hepatocellular carcinoma?

    • Emergent surgery with packing

    • Conservative management

    • Transarterial embolization

    • Definitive surgery

27. What is the particle of choice for embolization of spontaneous HCC rupture?

    • Microcoils

    • Particles

    • Gelatin sponge

    • Liquid embolics

    • There is no consensus on which material to use for embolization

    Article Ten (54–56)

28. In what percentage of cases is sepsis a major complication of percutaneous transhepatic biliary drainage?

    • Near zero

    • 2.5%

    • 10%

    • 25%

29. With which approach to biliary drainage are pleural complications more likely?

    • Endoscopic retrograde biliary drainage

    • Right-sided percutaneous biliary drainage

    • Left-sided percutaneous biliary drainage

30. What are the clinical ramifications of a bilothorax following PTBD?

    • It is typically asymptomatic

    • It is well tolerated and typically managed conservatively

    • It typically requires antibiotic treatment and drainage