Interventional Radiological Anatomy — MCQs

10 questions

In which of the following locations should the incision be made for the saphenous cutdown procedure in an obese patient with no visible or palpable superficial veins, requiring intravenous fluids in shock?

Pringle's maneuver is mainly used to control bleeding from which site?

Which one of the following is the most preferred route to perform cerebral angiography?

Which of the following structures is not a boundary of Calot's triangle shown in the given image?

A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

A young man with tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment, which vascular structure should be evaluated first?

Which of the following is NOT a standard management option for fat embolism?

One of the risks of the endometrial biopsy that was performed on this patient is perforation of the uterus. The endometrial biopsy device is placed through the cervix and into the endometrial cavity. If complete perforation occurs, what is the sequence of layers that the biopsy device would penetrate prior to entering the peritoneal cavity?

Arrange the following according to good outcome a - zone of stasis b - zone of coagulation c - zone of hyperemia

Q10

Which of the following statements about articular cartilage is true?

Interventional Radiological Anatomy Indian Medical PG Practice Questions and MCQs

Question 1: In which of the following locations should the incision be made for the saphenous cutdown procedure in an obese patient with no visible or palpable superficial veins, requiring intravenous fluids in shock?

A. Anterior to the medial malleolus (Correct Answer)
B. Posterior to the lateral malleolus
C. Anterior to the lateral malleolus
D. On the dorsum of the foot

Explanation: ***Anterior to the medial malleolus*** - The **greater saphenous vein** consistently runs anterior, one finger breadth to the medial malleolus, making this a reliable site for incision even when veins are not visible or palpable, particularly in **obese patients** or those in shock. - This location allows for direct access to a relatively large vein, crucial for rapid **intravenous fluid administration** in an emergency. *Posterior to the lateral malleolus* - This location is typically associated with the **small saphenous vein**, which is generally smaller and more variable in its superficial course, making it less dependable for cutdown in an emergent situation. - Incision here carries a higher risk of damaging the **sural nerve**, leading to sensory deficits. *Anterior to the lateral malleolus* - The veins in this region are usually smaller and less surgically significant for a **saphenous cutdown** required for rapid fluid infusion. - Accessing a suitable vein here is often more challenging and time-consuming, especially in an obese patient. *On the dorsum of the foot* - While veins on the **dorsum of the foot** are commonly used for routine IV access, they are smaller and more prone to collapse during shock, making them inadequate for rapid, high-volume fluid resuscitation. - The superficial location also makes them more susceptible to accidental dislodgement during patient movement.

Question 2: Pringle's maneuver is mainly used to control bleeding from which site?

A. IVC
B. Cystic artery
C. Hepatic vein
D. Liver parenchyma (Correct Answer)

Explanation: ***Liver parenchyma*** - Pringle's maneuver involves **clamping the hepatoduodenal ligament**, which contains the portal triad (hepatic artery, portal vein, and bile duct), to temporarily **reduce blood flow to the liver**. - This maneuver is primarily performed during **liver surgery** to control bleeding from the liver parenchyma itself, allowing for safer resection or repair of liver injuries. *IVC* - Bleeding from the **inferior vena cava (IVC)** is not directly controlled by Pringle's maneuver. The IVC is located posterior to the liver parenchyma and is not part of the hepatoduodenal ligament. - Controlling IVC bleeding typically requires **direct repair** or other specific vascular control techniques, often involving clamps placed directly on the IVC. *Cystic artery* - While the **cystic artery** is a branch of the right hepatic artery (which is occluded during Pringle's maneuver), the maneuver is not *mainly* used to control isolated cystic artery bleeding. - **Cystic artery bleeding** is typically encountered during cholecystectomy and is controlled by ligating or clipping the artery directly, rather than relying on a general liver inflow occlusion. *Hepatic vein* - The **hepatic veins** drain directly into the IVC from the liver parenchyma and are not part of the hepatoduodenal ligament, thus their blood flow is not directly occluded by Pringle's maneuver. - Bleeding from the hepatic veins is a more challenging complication in liver surgery, often requiring **direct compression**, suture repair, or venovenous bypass to manage.

Question 3: Which one of the following is the most preferred route to perform cerebral angiography?

A. Direct carotid puncture
B. Transaxillary route
C. Transfemoral route (Correct Answer)
D. Transbrachial route

Explanation: **Transfemoral route (Correct Answer)** - The **transfemoral** route is the **most preferred** and widely used method for cerebral angiography due to its **safety**, ease of access, and lower complication rates. - It allows for the safe cannulation of **cerebral vessels** using a catheter inserted into the **femoral artery** and advanced up to the aortic arch. - This is the **gold standard approach** (Seldinger technique) for diagnostic and interventional cerebral angiography. *Direct carotid puncture (Incorrect)* - This method is more invasive and carries a higher risk of complications, such as **hematoma**, **stroke**, or **carotid artery dissection**. - It is typically reserved for cases where other routes are inaccessible or when very specific and localized imaging is required. - Largely of **historical significance** now that safer endovascular techniques are available. *Transaxillary route (Incorrect)* - The **transaxillary** route is an alternative but carries a higher risk of complications like **brachial plexus injury** and **bleeding** compared to the transfemoral approach. - It may be considered when the femoral access is not feasible, for example, in patients with severe peripheral vascular disease affecting the femoral arteries. *Transbrachial route (Incorrect)* - The **transbrachial** (or **transradial**) route is also an alternative but is generally less preferred due to the risk of **radial or brachial artery spasm** or damage, and it can be technically more challenging. - This route is typically avoided if possible, especially when the transfemoral route is readily available and safe. - May be considered in patients with severe aortoiliac disease or morbid obesity.

Question 4: Which of the following structures is not a boundary of Calot's triangle shown in the given image?

A. Common hepatic duct
B. Cystic duct
C. Inferior surface of the liver
D. Gallbladder (Correct Answer)

Explanation: ***Gallbladder*** - The image depicts **Calot's triangle**, which is an important anatomical landmark in gallbladder surgery. The gallbladder itself is located within this region, but it is not one of the defined boundaries of the triangle. - While central to the anatomy shown, the **gallbladder** is surrounded by the structures that form the triangle's boundaries rather than bounding it itself. *Common hepatic duct* - The **common hepatic duct** forms the medial boundary of Calot's triangle. - This duct is formed by the union of the right and left hepatic ducts and carries bile from the liver. *Cystic duct* - The **cystic duct** forms the lateral (or inferior) boundary of Calot's triangle. - This duct connects the gallbladder to the common hepatic duct. *Inferior surface of the liver* - The **inferior surface of the liver** forms the superior boundary of Calot's triangle. - Specifically, this refers to the edge of the right lobe of the liver at the base of the gallbladder fossa.

Question 5: A 55-year-old male, known smoker, complains of calf pain while walking. He experiences calf pain while walking but can continue walking with effort. Which grade of claudication does this patient fall under?

A. Grade I (Mild claudication)
B. Grade II (Moderate claudication) (Correct Answer)
C. Grade III (Severe claudication)
D. Grade IV (Ischemic rest pain)

Explanation: ***Grade II (Moderate claudication)*** - **Grade II claudication** is characterized by **intermittent claudication** where the patient experiences pain while walking but can **continue walking with effort**. - This level of claudication reflects a moderate degree of peripheral arterial disease, where blood flow is sufficiently compromised to cause pain with exertion but not severe enough to force immediate cessation of activity. - The patient in this scenario can continue ambulation despite discomfort, which is the defining feature of this grade. *Grade I (Mild claudication)* - **Grade I claudication** involves discomfort or pain that the patient can **tolerate without significantly altering their gait or pace**. - In this stage, the pain is minimal, and the patient may perceive it as a dull ache or mild fatigue rather than true pain. - Walking can continue without significant effort or limitation. *Grade III (Severe claudication)* - **Grade III claudication** is marked by pain that is **severe enough to stop the patient from walking within a short distance** (typically less than 200 meters). - The pain forces the patient to rest and recover before they can resume walking. - This represents significant functional limitation in daily activities. *Grade IV (Ischemic rest pain)* - **Grade IV**, also known as **critical limb ischemia**, involves **pain even at rest**, especially in the feet or toes, often worsening at night when the limb is elevated. - This stage indicates severe arterial obstruction and is frequently associated with **ulcers, non-healing wounds, or gangrene**. - This represents advanced peripheral arterial disease requiring urgent intervention. **Note:** This grading system is a simplified clinical classification. The standard medical classifications for peripheral arterial disease are the **Fontaine classification** (Stages I-IV) and **Rutherford classification** (Categories 0-6).

Question 6: A young man with tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment, which vascular structure should be evaluated first?

A. Superior vena cava
B. Pulmonary artery
C. Pulmonary vein
D. Bronchial artery (Correct Answer)

Explanation: ***Bronchial artery*** - The **bronchial arteries** are the primary source of blood supply to the conducting airways, and in conditions like **tuberculosis**, they often become hypertrophied and tortuous, leading to **massive hemoptysis**. - Angiographic embolization of these abnormal bronchial arteries is a common and effective treatment for persistent or massive hemoptysis, especially in patients with chronic inflammatory lung diseases. *Pulmonary artery* - The **pulmonary artery** carries deoxygenated blood to the lungs for gas exchange and is less commonly the source of hemoptysis, unless there is a **pulmonary artery aneurysm**, fistula, or erosion. - While pulmonary hemorrhage can occur, it typically presents differently and is not the primary source of massive recurrent hemoptysis in tuberculosis. *Pulmonary vein* - The **pulmonary veins** carry oxygenated blood from the lungs back to the left atrium and are almost never the source of hemoptysis. - Hemoptysis originates from the arterial system due to rupture of high-pressure vessels into the airways. *Superior vena cava* - The **superior vena cava** is a large vein that drains deoxygenated blood from the upper body into the right atrium and is not directly involved in the pulmonary circulation supplying the airways. - It would not be a source of hemoptysis; symptoms related to SVC obstruction would be **upper body edema** and plethora.

Question 7: Which of the following is NOT a standard management option for fat embolism?

A. Heparin administration
B. Low Molecular Weight Dextran
C. Oxygen therapy
D. Surgical intervention (Correct Answer)

Explanation: ***Surgical intervention*** - **Fat embolism syndrome (FES)** is a medical emergency primarily managed with **supportive care**, not surgery. - Surgical intervention is only indicated for the **initial injury**, such as stabilizing long bone fractures, which helps prevent fat emboli, but not for treating an already established FES [1]. *Oxygen therapy* - **Oxygen therapy** is a crucial component of FES management, as the syndrome often leads to **hypoxemia** due to lung involvement. - It helps maintain adequate **tissue oxygenation** and can be administered via nasal cannula, face mask, or mechanical ventilation in severe cases. *Heparin administration* - **Heparin administration** was historically used with the rationale of preventing thrombus formation and potentially breaking down fat globules. - However, its effectiveness is **unproven**, and it carries risks such as bleeding, so it is generally **not recommended** for FES. *Low Molecular Weight Dextran* - **Low Molecular Weight Dextran** has been investigated for its potential to improve blood flow, reduce fat globule aggregation, and expand plasma volume in FES. - While some studies showed promising results, it is **not a universally accepted standard treatment** due to conflicting evidence and potential side effects.

Question 8: One of the risks of the endometrial biopsy that was performed on this patient is perforation of the uterus. The endometrial biopsy device is placed through the cervix and into the endometrial cavity. If complete perforation occurs, what is the sequence of layers that the biopsy device would penetrate prior to entering the peritoneal cavity?

A. Ovary, fallopian tube, broad ligament
B. Endometrium, myometrium, serosa (Correct Answer)
C. Round ligament, cardinal ligament, uterosacral ligament
D. Serosa, myometrium, endometrium

Explanation: ***Endometrium, myometrium, serosa*** - The **endometrium** is the innermost lining layer of the uterus and is the first layer encountered by the biopsy device within the uterine cavity [1]. - The **myometrium** is the thick muscular middle layer of the uterine wall, which lies superficial to the endometrium and deep to the serosa [1]. - The **peritoneum** (also known as the serosa or perimetrium when referring to the uterus) is the outermost layer of the uterus that covers the myometrium, and once perforated, the device enters the peritoneal cavity [4]. *Ovary, fallopian tube, broad ligament* - The **ovaries** and **fallopian tubes** are located lateral to the uterus, and the **broad ligament** is a fold of peritoneum that supports the uterus, ovaries, and fallopian tubes [3]. - These structures are not directly superior or immediately adjacent to the uterine wall in such a way that they would be sequentially penetrated during a direct anterior-posterior perforation from the uterine cavity. *Round ligament, cardinal ligament, uterosacral ligament* - The **round, cardinal, and uterosacral ligaments** are supportive structures of the uterus located externally to the uterine wall. - They would not be encountered in a direct transmural penetration from within the uterine cavity into the peritoneal cavity. *Serosa, myometrium, endometrium* - This sequence describes penetration in the reverse direction, from the **peritoneal cavity** inward towards the uterine lumen. - An endometrial biopsy device starts within the **endometrial cavity**, so it would penetrate from inside out [2].

Question 9: Arrange the following according to good outcome a - zone of stasis b - zone of coagulation c - zone of hyperemia

A. a > b > c
B. a > c > b
C. c > a > b (Correct Answer)
D. a = c > b

Explanation: **Context:** This question refers to Jackson's burn wound model, which describes three concentric zones in a burn injury. ***c > a > b*** (Correct Answer) - The **zone of hyperemia (c)** has the **best prognosis** for recovery because tissue damage is minimal, involving primarily vasodilation and increased blood flow. This zone typically recovers completely within 7-10 days. - The **zone of stasis (a)** has an **intermediate prognosis**; tissue here is potentially salvageable but at risk of progression to necrosis within 24-48 hours if not properly managed (adequate fluid resuscitation, prevention of infection, avoiding vasoconstrictors). - The **zone of coagulation (b)** has the **worst prognosis**, as cellular damage is irreversible with immediate coagulative necrosis. This tissue will eventually slough off and requires debridement. *a > b > c* - Incorrectly suggests the **zone of stasis** has better outcome than **zone of hyperemia**, which contradicts the pathophysiology of burn injuries. - The **zone of coagulation** cannot have better outcome than **zone of hyperemia** as it represents dead tissue. *a > c > b* - Incorrectly places **zone of stasis** as having the best outcome when it has only intermediate prognosis. - The **zone of hyperemia** should be first as it has the highest probability of complete recovery without intervention. *a = c > b* - Incorrectly equates the prognosis of **zone of stasis** and **zone of hyperemia**, despite clear differences in severity and reversibility of tissue damage. - The **zone of hyperemia** has unequivocally better prognosis than the **zone of stasis**.

Question 10: Which of the following statements about articular cartilage is true?

A. Very vascular structure
B. Surrounded by thick perichondrium
C. Has no nerve supply (Correct Answer)
D. Fibrocartilage

Explanation: ***Has no nerve supply*** - Articular cartilage is **aneural**, meaning it lacks nerve endings, which is why damage to it doesn't immediately cause pain until underlying bone or surrounding tissues are affected [1]. - Its aneural nature contributes to its low metabolic activity and limited capacity for repair. *Very vascular structure* - Articular cartilage is **avascular**, meaning it lacks a direct blood supply [1]. - It receives nutrients primarily through diffusion from the synovial fluid [1]. *Surrounded by thick perichondrium* - Articular cartilage is typically **not covered by a perichondrium**, unlike most other types of cartilage. - The absence of perichondrium prevents potential ossification of the articular surface. *Fibrocartilage* - Articular cartilage is primarily composed of **hyaline cartilage**, not fibrocartilage [1]. - **Hyaline cartilage** provides a smooth, low-friction surface for joint movement and acts as a shock absorber [1].

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