RSS-Feed abonnieren
DOI: 10.1055/s-0035-1550095
Post-Test Questions
Publikationsverlauf
Publikationsdatum:
28. Mai 2015 (online)
![](https://www.thieme-connect.de/media/sir/201502/lookinside/thumbnails/10-1055-s-0035-1550095_cme-1.jpg)
Article One (67–77)
-
Three months after percutaneous catheter nephrostomy insertion, which of the following is the most appropriate treatment for pericatheter leakage of urine?
-
Initiation of oral antibiotics
-
Angiography
-
Tractogram
-
Catheter exchange
-
-
Which of the following is the most common reason for catheter dysfunction occurring 6 months after central venous catheter insertion?
-
Catheter kinking
-
Fibrin sheath formation
-
Catheter obstruction with debris
-
Catheter tip malposition
-
-
After percutaneous gastrojejunostomy insertion, a patient experiences bloating and pericatheter leakage of tube feeds during infusions. What is the most likely etiology?
-
Retrograde migration of the jejunal port tip into the stomach
-
Gastroparesis
-
Tube obstruction with pills
-
Buried bumper syndrome
Article Two (78–88)
-
-
All of the following are important risk factors for the development of an abscess following thermal ablation in the liver EXCEPT:
-
Biliary-enteric anastomosis
-
Endoscopic biliary drainage catheter
-
Prior liver transplant
-
Pneumobilia
-
-
The eff ectiveness of preprocedural prophylactic antibiotics is established by level 1 data for which of the following procedures in interventional radiology?
-
Thermal ablation of liver malignancy
-
Transarterial embolization of liver malignancy
-
Percutaneous nephrostomy
-
Placement of a central venous catheter
-
None of the above
-
-
All of the following are established means to decrease the rate of catheter-related blood stream infections EXCEPT:
-
Standard hand hygiene
-
Avoid femoral vein access for tunneled central venous lines
-
Use of >0.5% chlorhexidine skin cleansing agent
-
Maximum sterile barriers (i.e., cap, mask, sterile gown, sterile gloves, sterile body drape)
Article Three (89–97)
-
-
Regarding hemorrhage following percutaneous biliary catheter placement, which of the following is INCORRECT?
-
CT scans may be helpful to determine the location and specific source of bleeding.
-
Patients may present with melena.
-
Bleeding may occur secondary to side holes malposition in the biliary tree.
-
Upsizing the catheter may be eff ective in treating the bleeding.
-
If initial angiography is negative, the catheter should be removed entirely and angiography repeated. If biliary access is still needed, a new puncture should be performed.
-
-
Regarding bleeding from percutaneous renal interventions, which of the following is CORRECT?
-
The rate of vascular injuries requiring arterial intervention or nephrectomy is 1–4%.
-
Embolization must be performed proximal and distal to the vessel injury to prevent backbleeding from collateral channels.
-
Bleeding may occur from nonrenal arteries, such as intercostal or renal capsular arteries.
-
Even in the setting of mildly symptomatic bleeding, angiography and embolization should be performed to prevent catastrophic bleeding.
-
All of the above are incorrect.
-
-
Regarding bleeding following percutaneous biopsy, which of the following is INCORRECT?
-
Significant bleeding is expected to occur in between 1 and 4% of biopsies, depending on the organ.
-
Biopsy by using a coaxial system is theoretically beneficial in that it allows embolization of the tract.
-
Contrast-enhanced CT may be helpful in the postbiopsy hemorrhagic patient, to determine the site of bleeding and the need for intervention.
-
Nontarget embolization during biopsy tract embolization has been demonstrated.
-
All of the above are correct.
Article Four (98–107)
-
-
For diagnostic cerebral angiograms, quality improvement guidelines recommend that transient neurologic deficits should occur in no more than X% of patients, and permanent neurologic deficits should occur in no more than Y% of patients.
-
X = 0.06%, Y = 0.02%
-
X = 0.7%, Y = 0.5%
-
X = 2.5%, Y = 1%
-
X = 12%, Y = 7%
-
-
Aneurysm perforation with a microcatheter or coil during embolization requires prompt recognition and careful intervention. In addition to heparin reversal with protamine, the following should be performed:
-
Leave the microcatheter and guide catheter in place, perform an immediate CT scan, and aggressively treat hypertension to a systolic blood pressure goal <140 mm Hg.
-
Remove the microcatheter, perform an immediate guide catheter angiogram, and undertake endovascular occlusion of the parent artery.
-
Advance the guide catheter to occlude the perforation with a larger diameter device.
-
Leave the perforating microcatheter in place and deploy additional coils until the aneurysm is protected.
-
-
Following intra-arterial thrombectomy for internal carotid artery occlusion and acute ischemic stroke, a patient develops a moderate headache without a new neurologic deficit. A CT scan of the head reveals areas of contrast extravasation in the left basal ganglia without overt hemorrhage. Management of this condition should consist of:
-
Reversal of heparin with protamine, and reverse antiplatelet agents with platelet transfusion
-
Aggressive blood pressure control to a systolic blood pressure goal <140 mm Hg
-
Mannitol 1 g/kg IV, perform frequent neurological examinations, keep the patient in the NICU, and consider ventriculostomy or craniotomy for evacuation of clot
-
Analgesics for headache and blood pressure control
Article Five (108–122)
-
-
What anatomic landmark is used to locate the ideal arteriotomy site for femoral arterial access?
-
Greater trochanter
-
Cranial margin of femoral head
-
Equator of femoral head
-
Caudal margin of femoral head
-
Equator of acetabulum
-
-
Which of the following is a common theme for the endovascular treatment of iatrogenic vascular injury during arterial or venous procedures?
-
Maintain wire access across the injury
-
Remove wire and catheters and hold manual pressure
-
Coil or Gelfoam is used to thrombose the injured vessel
-
Obtain a surgical consult
-
None of the above
-
-
When is revascularization indicated for patient with peripheral artery disease?
-
Limb threatening ischemia
-
Lifestyle limiting claudication
-
Mild neuropathy
-
Choices A and B
-
All of the above
-
-
In patients with retrievable IVC filters, what is an indication for filter removal?
-
Fractured filter with embolized strut
-
Large thrombus burden in filter despite medical anticoagulation
-
Filter penetration with postprandial abdominal pain
-
All the above
-
A and C only
-
-
Compared to surgical bypass grafting, femoropopliteal angioplasty's primary patency rate is:
-
Greater than that of surgical bypass
-
Less than that of surgical bypass
-
The same as surgical bypass
-
Unknown
Article Six (123–132)
-
-
During TIPS insertion, multiple needle passes were performed. The patient has developed hemodynamic instability and increasing abdominal distention. Which of the following is NOT an appropriate action?
-
Perform urgent hepatic arteriography
-
Perform inferior venacavography
-
Perform portal venography if portal venous access has been obtained
-
Perform a cone-beam CT
-
-
Three days after TIPS insertion, a patient develops severe encephalopathy, a total serum bilirubin level of 9.8, and an INR of 4.9. That patient is likely suff ering from what complication as the underlying cause:
-
Acute arterial hemorrhage
-
Acute hepatic failure
-
Transgression of the liver capsule with puncture of the kidney
-
Radiation injury
-
-
In a patient who has developed severe encephalopathy after TIPS insertion, which of the following is an appropriate next action?
-
Hepatic arteriography
-
Administration of fresh frozen plasma
-
Insert a parallel TIPS
-
A TIPS narrowing procedure for flow reduction
Article Seven (133–155)
-
-
Which of the following regarding transplant renal artery stenosis (TRAS) is INCORRECT?
-
It most commonly occurs at the anastomotic site.
-
Diagnostic findings on Doppler ultrasound include a peak systolic velocity (PSV) of >200 cm/s and a ratio of >2 in the PSVs of the stenotic to prestenotic segment.
-
Percutaneous transluminal angioplasty (PTA) and stenting play little role in management, as essentially all cases must be managed surgically.
-
Hemodynamically significant TRAS is defined as narrowing of the luminal diameter >50% or pressure gradient >10 mm Hg across the stenosis.
-
-
Regarding liver transplant complications, which of the following is CORRECT?
-
Retransplantation is always necessary in cases of early hepatic arterial thrombosis.
-
In cases of upper caval anastomotic stenosis, flow reversal in the hepatic veins and absence of phasicity in the hepatic venous Doppler waveform may be seen.
-
Portal venous complications are common.
-
Biliary leaks are rarely seen at the T-tube site.
-
-
Which of the following is INCORRECT in regard to lung transplant?
-
Posttransplant complications are relatively rare in comparison to the incidence of complications seen with other solid organ transplants.
-
Pulmonary artery anastomotic complications are more common than complications involving the pulmonary venous anastomosis.
-
Self-expanding uncovered metallic stents are currently favored by most interventional radiologists and pulmonologists.
-
MDCT may define the extent and degree of a vascular stenosis.
Article Eight (156–162)
-
-
A radiation-induced tissue reaction is best predicted by which of the following measures of radiation dose?
-
Fluoroscopic beam-on time
-
Air kerma at the interventional reference plane (Ka,r)
-
Peak skin dose (Dskin, max)
-
Eff ective dose (HE)
-
-
What is a temporal separation between multiple high radiation FGIs that may significantly decrease the risk of a tissue reaction, if clinically feasible?
-
24 hours
-
14 days
-
8 weeks
-
3 months
-
-
According to the Joint Commission, a single field skin dose of more than ___ constitutes a sentinel event.
-
3 Gy
-
5 Gy
-
10 Gy
-
15 Gy
Article Nine (163–173)
-
-
Which of the following patients has had a major complication as defined by the Society of Interventional Radiology (SIR) Classification System for Complications by Outcome?
-
A 65-year-old man with end-stage liver disease and refractory ascites who dies 6 months after placement of a tunneled peritoneal drain
-
A 26-year-old woman with cystic fibrosis who presents with a small groin hematoma 6 hours after femoral puncture for pulmonary angiography who is discharged the next day
-
A 75-year-old man who is taken to the operating room for repair of a dominant large caliber left vertebral artery following return of pulsatile blood flow during placement of a central venous catheter
-
A 68-year- old man with end-stage renal disease on hemodialysis who presents with a thrombosed upper arm arteriovenous loop graft 5 days after declot procedure that included angioplasty
-
-
Which of the following agents should be held prior to elective arthrography and steroid injection of the knee?
-
Clopidogrel
-
Aspirin
-
Warfarin in a patient with INR of 3.5
-
None of the above
-
-
According to the Joint Practice Guideline for Sterile Technique during Vascular and Interventional Radiology Procedures published by the SIR, the majority of musculoskeletal procedures would generally be classified as:
-
Clean
-
Clean-contaminated
-
Contaminated
-
Dirty
Article Ten (174–181)
-
-
In the pathophysiology of iatrogenic systemic air embolism, what is the final common step in the introduction of air into the systemic vasculature?
-
Access to pulmonary vein lumen
-
Access to the right atrium
-
Access to the coronary circulation
-
The establishment of a bronchovenous fistula
-
-
Which of the following is a reported risk factor for pneumothorax following thoracic interventions?
-
Multiple pleural punctures
-
Deeper lesions
-
Traversal of fissures
-
All of the above
-
-
Which of the following is associated with higher incidence of hemorrhagic complications?
-
Biopsy of large lesions (>1.5 cm)
-
Use of coaxial technique
-
Use of multi-tined ablative electrodes
-
All of the above
Article Eleven (182–194)
-
-
All of the following are true of hepatic arterial injury EXCEPT:
-
This injury may result in ischemic cholangiopathy.
-
Transection is best treated by surgical intervention.
-
This injury may result in biliary anastomosis failure.
-
This injury has decreased in prevalence since the advent of laparoscopic surgeries.
-
-
Which of the following statements regarding pseudoaneurysms is INCORRECT?
-
Pseudoaneurysms result in dilatation of the vessel from injury to one or more vascular wall layers.
-
Minimally invasive techniques such as arterial embolization or placement of a covered stent are the first line of treatment for a pseudoaneurysm.
-
Pseudoaneurysms can be complicated by rupture and hemorrhage.
-
Pseudoaneurysms can be monitored without treatment until the patient is symptomatic.
-
-
All of the following are indications for percutaneous transhepatic cholangiography/drainage except
-
Redirection of bile flow for healing of bilomas
-
Treatment of primary sclerosing cholangitis
-
Anastomotic dehiscence
-
Permanent treatment of common hepatic duct injury from cholecystectomy
Article Twelve (195–208)
-
-
During percutaneous nephrostomy tube placement, interventional radiologists traditionally attempt to target a dorsolateral calyx because
-
As this most likely represents a relatively avascular watershed zone known as Brödel's line resulting in less likelihood of vascular injuries
-
Central access can result in injury to the major vascular structure
-
Central punctures may be associated with urinary leakage due to incomplete sealing of the catheter tract, as the renal pelvis may not be completely surrounded by renal parenchymal tissue
-
All of the above
-
-
Which of the following is true CORRECT regarding symptomatic iatrogenic renal vascular injuries
-
Symptomatic iatrogenic renal vascular injuries are typically managed by minimally invasive techniques such as coil embolization, stent graft placement and/or thrombin injection
-
Symptomatic iatrogenic renal vascular injuries typically require only conservative management
-
Traditional open surgery is the standard of care for iatrogenic renal vascular injuries
-
None of the above.
-
-
What is the most common cause of iatrogenic urinoma?
-
Renal injuries
-
Ureteric injuries
-
Bladder injuries
-
None of the above
Article Thirteen (209–216)
-
-
What is the mainstay of therapy for adult patients with tumor lysis syndrome?
-
Aggressive hydration
-
Immediate correction of metabolic derangement
-
Treatment of renal failure
-
All of the above
-
-
When converting to a new opiate, what is the purpose of reducing the new drug dose by 25 to 50%?
-
Allows for better pain control
-
Accounts for incomplete cross-tolerance between opiates
-
Reduces tolerance to the old medication
-
Allows for rapid escalation of dose
-
-
What is the recommended use of echocardiogram in the diagnosis of pulmonary embolism?
-
Evaluating chronicity of pulmonary embolism
-
Diff erentiating between myocardial injury and pulmonary embolism
-
Evaluating for right volume overload while stratifying treatment options in high-risk patients
-
Confirmation of pulmonary embolism after positive D-dimer in low-risk patients
-