Interventional Radiology — MCQs

Interventional Radiology Indian Medical PG Practice Questions and MCQs

Question 21: Which of the following is NOT a material used for therapeutic embolisation?

A. Blood clot
B. Ethyl alcohol
C. Wool
D. Omentum (Correct Answer)

Explanation: **Explanation:** Therapeutic embolization involves the intentional occlusion of a blood vessel using various agents to control hemorrhage, devascularize tumors, or treat vascular malformations. **Why Omentum is the correct answer:** The **Omentum** is a large, fatty fold of peritoneal tissue. While it is highly vascular and used in "omental transposition" surgeries to promote healing or provide a blood supply to ischemic areas, it is **not** an embolic agent. It cannot be injected or delivered through a catheter into a vessel to cause occlusion. **Analysis of incorrect options:** * **Blood Clot:** This is a **temporary** embolic agent. Autologous blood clots were among the first materials used for embolization. They are eventually lysed by the body’s fibrinolytic system, making them useful when only short-term occlusion is required. * **Ethyl Alcohol (Absolute Alcohol):** This is a **permanent** liquid sclerosing agent. It causes rapid protein denaturation and endothelial destruction, leading to total and permanent vascular occlusion. It is commonly used for arteriovenous malformations (AVMs) and renal ablation. * **Wool:** While less common today, wool (specifically **Dacron or cotton fibers** attached to stainless steel coils) is used to increase the thrombogenicity of the device. The fibers induce rapid local thrombosis to ensure complete vessel occlusion. **High-Yield Clinical Pearls for NEET-PG:** * **Classification of Embolic Agents:** * **Temporary:** Gelfoam (absorbable gelatin sponge), Autologous blood clot. * **Permanent:** Coils (Stainless steel/Platinum), PVA (Polyvinyl Alcohol) particles, Cyanoacrylate (Glue), and Absolute Alcohol. * **Gelfoam** is the most commonly used temporary agent (lasts 2–6 weeks). * **Absolute Alcohol** is the most potent and carries a higher risk of tissue necrosis if it refluxes into non-target vessels.

Question 22: What is the most commonly employed treatment for carotid-cavernous fistula nowadays?

A. Ballon embolization (Correct Answer)
B. Ligation of internal artery
C. No treatment available
D. Fistulectomy

Explanation: **Explanation:** **Carotid-Cavernous Fistula (CCF)** is an abnormal communication between the carotid arterial system and the cavernous sinus. It is categorized into Direct (high-flow, usually traumatic) and Indirect (low-flow, spontaneous). **Why Option A is Correct:** **Endovascular embolization** is the current gold standard and most commonly employed treatment. Specifically, **detachable balloon embolization** is the preferred technique for direct CCFs. The goal is to navigate a balloon into the cavernous sinus via the internal carotid artery (ICA) and inflate it to seal the fistula while maintaining the patency of the ICA. If balloons are unavailable or technically difficult, **platinum coils** or liquid embolic agents (like Onyx) are used. **Why Other Options are Incorrect:** * **Option B (Ligation of ICA):** This was a historical surgical approach. It is rarely performed now because it carries a high risk of ischemic stroke and does not always close the fistula due to collateral flow. * **Option C (No treatment available):** This is incorrect. Untreated CCFs can lead to progressive vision loss, intracranial hemorrhage, and debilitating proptosis. * **Option D (Fistulectomy):** Direct surgical excision (fistulectomy) of a CCF is technically extremely difficult and hazardous due to the complex anatomy of the cavernous sinus and the risk of massive hemorrhage. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Pulsatile exophthalmos (proptosis), conjunctival chemosis, and an orbital bruit. * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the definitive diagnostic tool to characterize the fistula. * **Classification:** The **Barrow Classification** divides CCFs into Types A (Direct), and B, C, D (Indirect/Dural). * **Treatment Goal:** To occlude the fistula while preserving the parent artery (ICA).

Question 23: TIPS is a type of?

A. Non selective shunt (Correct Answer)
B. Selective shunt
C. Both selective and non selective shunt
D. Systemic shunt

Explanation: **Explanation:** **TIPS (Transjugular Intrahepatic Portosystemic Shunt)** is a procedure used to manage complications of portal hypertension (like refractory ascites and variceal bleeding). It involves creating an artificial channel within the liver, using a stent, to connect the **portal vein** (high pressure) directly to the **hepatic vein** (low pressure). 1. **Why it is a Non-selective Shunt (Correct):** A shunt is "non-selective" if it diverts the **entire** portal venous flow away from the liver and into the systemic circulation. TIPS acts as a total shunt because it decompresses the entire portal venous system indiscriminately. This reduces portal pressure effectively but increases the risk of hepatic encephalopathy because toxic metabolites (like ammonia) bypass the liver's detoxification process entirely. 2. **Why other options are incorrect:** * **Selective Shunt:** These shunts (e.g., **Distal Splenorenal Shunt/Warren Shunt**) divert only a portion of the portal flow (specifically from the gastroesophageal varices via the splenic vein) while maintaining portal blood flow to the liver (prograde flow). This preserves liver function better than TIPS. * **Systemic Shunt:** While TIPS connects the portal to the systemic system, the term "systemic shunt" is too broad. In the context of portal hypertension classification, the distinction between "selective" and "non-selective" is the standard nomenclature. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** Internal Jugular Vein → Superior Vena Cava → Right Atrium → Inferior Vena Cava → Hepatic Vein → Portal Vein. * **Indications:** Secondary prophylaxis of variceal bleed, refractory ascites, Budd-Chiari syndrome, and Hepatorenal syndrome. * **Absolute Contraindications:** Severe congestive heart failure (due to sudden increase in preload), severe pulmonary hypertension, and multiple hepatic cysts/polycystic liver disease. * **Most Common Complication:** Hepatic Encephalopathy (due to bypass of nitrogenous waste).

Question 24: Who is considered the father of Interventional Radiology?

A. Henry Bacquerel
B. Marie Curie
C. Charles Dotter (Correct Answer)
D. W.C. Roentgen

Explanation: **Explanation:** **Correct Answer: C. Charles Dotter** Charles Dotter is widely recognized as the **"Father of Interventional Radiology."** In 1964, he performed the first percutaneous transluminal angioplasty (PTA) by using a series of catheters to dilate a stenosed superficial femoral artery in an elderly patient, successfully avoiding an amputation. He famously advocated for the "catheter as a surgical tool," shifting radiology from a purely diagnostic field to a therapeutic one. **Analysis of Incorrect Options:** * **A. Henry Becquerel:** A physicist who discovered **spontaneous radioactivity** (alongside the Curies). He is not associated with interventional procedures. * **B. Marie Curie:** Renowned for her pioneering research on **radioactivity** and the discovery of Polonium and Radium. While she advanced medical X-rays during WWI, she did not develop interventional techniques. * **D. W.C. Roentgen:** Discovered **X-rays** in 1895. He is considered the "Father of Diagnostic Radiology," but not Interventional Radiology. **High-Yield Clinical Pearls for NEET-PG:** * **Seldinger Technique:** Developed by Sven-Ivar Seldinger (1953), this is the fundamental method for gaining vascular access using a needle, guidewire, and sheath. * **Andreas Gruentzig:** He expanded on Dotter’s work by developing the first **balloon catheter**, leading to modern coronary angioplasty. * **Image Guidance:** Interventional Radiology (IR) utilizes Fluoroscopy, CT, and Ultrasound to perform minimally invasive procedures like embolization, biopsies, and drainage.

Question 25: The Seldinger needle is primarily used for which of the following procedures?

A. Suturing muscles
B. Arteriography (Correct Answer)
C. Pulmonary biopsy
D. Lymphangiography

Explanation: **Explanation:** The **Seldinger technique**, described by Sven-Ivar Seldinger in 1953, is the gold standard method for obtaining percutaneous access to hollow organs or blood vessels. The **Seldinger needle** is a hollow, large-bore needle used as the initial step to puncture a vessel (most commonly the femoral artery). Once blood flashback is observed, a guide wire is inserted through the needle, the needle is withdrawn, and a catheter is advanced over the wire. This makes it the fundamental tool for **Arteriography** and other endovascular procedures. **Analysis of Options:** * **B. Arteriography (Correct):** It is the primary application. The technique allows for safe, large-bore catheterization of arteries for diagnostic imaging or therapeutic interventions (like stenting). * **A. Suturing muscles:** Seldinger needles are rigid and hollow, designed for vascular access, not for passing suture material through muscular tissue. * **C. Pulmonary biopsy:** While some percutaneous biopsies use coaxial systems, a standard Seldinger needle is specifically designed for vascular entry, not for harvesting tissue cores from the lung. * **D. Lymphangiography:** This procedure typically requires direct surgical cut-down and cannulation of a lymphatic vessel using a very fine-gauge needle or cannula, as lymphatics are too small and low-pressure for the standard Seldinger technique. **High-Yield Clinical Pearls for NEET-PG:** * **Steps of Seldinger Technique:** Puncture → Guidewire insertion → Needle removal → Dilatation (optional) → Catheter insertion over the wire. * **Modified Seldinger Technique:** Uses a needle with a stylet (to prevent tissue plugging) or a "single-wall" puncture to reduce hematoma risk. * **Common Sites:** Common Femoral Artery (most common), Radial Artery, and Internal Jugular Vein (for Central Venous Lines). * **Complications:** Hematoma, pseudoaneurysm, and arterial dissection.

Question 26: TIPS refers to the creation of an anastomosis between which of the following?

A. Portal vein and hepatic artery
B. Portal vein and IVC
C. Portal vein and hepatic vein (Correct Answer)
D. Hepatic vein and hepatic artery

Explanation: **Explanation:** **TIPS (Transjugular Intrahepatic Portosystemic Shunt)** is a high-yield interventional radiology procedure used primarily to treat complications of portal hypertension, such as refractory ascites and variceal bleeding. **Why Option C is Correct:** The procedure involves creating an artificial channel within the liver parenchyma that connects the **Portal Vein** (high-pressure system) to the **Hepatic Vein** (low-pressure system). By bypassing the congested liver sinusoidal bed, the portal venous pressure is effectively decompressed as blood flows directly into the systemic circulation via the Inferior Vena Cava (IVC). **Analysis of Incorrect Options:** * **Option A & D:** The **Hepatic Artery** supplies oxygenated blood to the liver. Connecting it to the portal or hepatic veins would create an arteriovenous fistula, which does not address portal hypertension and could lead to high-output heart failure. * **Option B:** While the goal is to reach the systemic circulation, the shunt is anatomically created between the portal vein and the hepatic vein (usually the right hepatic vein). A direct portal vein to **IVC** shunt is a surgical procedure (Portacaval shunt), not the standard radiologic TIPS. **NEET-PG High-Yield Pearls:** * **Access Route:** Internal Jugular Vein (usually the right side) → Superior Vena Cava → Right Atrium → IVC → Hepatic Vein. * **Indications:** Refractory variceal bleeding (most common), refractory ascites, and Budd-Chiari syndrome. * **Contraindications:** Severe congestive heart failure (due to sudden increase in venous return), severe pulmonary hypertension, and multiple hepatic cysts. * **Major Complication:** **Hepatic Encephalopathy** (due to nitrogenous wastes bypassing liver detoxification) and shunt stenosis.

Question 27: Uterine artery embolization can be employed in which of the following conditions?

A. Large fibroids
B. Uterine arteriovenous malformation (AVM)
C. Intractable uterine bleeding
D. All of the above (Correct Answer)

Explanation: **Explanation:** Uterine Artery Embolization (UAE) is a minimally invasive interventional radiology procedure that involves the occlusion of the uterine arteries using embolic agents (such as polyvinyl alcohol particles or coils). The primary goal is to devascularize targeted pathology while preserving the uterus. **Why "All of the Above" is Correct:** * **Large Fibroids (Option A):** UAE is a well-established alternative to hysterectomy or myomectomy. By cutting off the blood supply, the fibroids undergo ischemic necrosis and shrink, significantly reducing symptoms like menorrhagia and pelvic pressure. * **Uterine Arteriovenous Malformation (Option B):** AVMs are abnormal communications between arteries and veins. UAE is the **treatment of choice** for symptomatic AVMs, as it allows for targeted occlusion of the nidus, preventing life-threatening hemorrhage. * **Intractable Uterine Bleeding (Option C):** UAE is a critical emergency intervention for severe postpartum hemorrhage (PPH) or bleeding secondary to malignancy when conservative measures fail and the patient is hemodynamically stable enough for the procedure. **Clinical Pearls for NEET-PG:** * **Access Site:** Usually the common femoral artery (unilateral or bilateral approach). * **Contraindications:** Pregnancy, active pelvic infection, and suspected uterine malignancy (relative). * **Post-Embolization Syndrome:** The most common complication, characterized by pain, low-grade fever, and nausea due to tissue ischemia. * **High-Yield Fact:** For fibroids, UAE is specifically indicated for those who wish to avoid surgery but may not be the first choice for those desiring future fertility (though it is not an absolute contraindication).

Question 28: All of the following are absolute contraindications to uterine artery embolization except?

A. Pregnancy
B. Uterine infection
C. Endometrial cancer
D. Age of patient >= 50 years (Correct Answer)

Explanation: **Explanation:** Uterine Artery Embolization (UAE) is a minimally invasive procedure primarily used for the management of symptomatic uterine fibroids and adenomyosis. Understanding the contraindications is high-yield for NEET-PG. **Why Option D is the Correct Answer:** **Age ≥ 50 years** is **not** a contraindication. While UAE is often preferred by women wishing to preserve their uterus or avoid major surgery in their 30s and 40s, there is no upper age limit for the procedure. In perimenopausal women (around age 50), UAE can effectively bridge the gap to natural menopause by resolving symptoms like menorrhagia. **Analysis of Incorrect Options (Absolute Contraindications):** * **A. Pregnancy:** UAE is strictly contraindicated as it can lead to placental insufficiency, fetal growth restriction, or fetal demise due to compromised uterine blood flow. * **B. Uterine Infection:** Active pelvic inflammatory disease (PID) or uterine sepsis is an absolute contraindication. Embolizing an infected organ can lead to abscess formation, necrosis, and septic shock. * **C. Endometrial Cancer:** UAE is contraindicated in the presence of suspected or confirmed gynecological malignancy (endometrial, cervical, or uterine sarcoma). These conditions require definitive surgical staging and oncological management; embolization may delay diagnosis or mask symptoms. **Clinical Pearls for NEET-PG:** * **Most common indication:** Symptomatic uterine fibroids (Leiomyomas). * **Agent of choice:** Polyvinyl Alcohol (PVA) particles or Tris-acryl gelatin microspheres. * **Post-Embolization Syndrome:** The most common complication, characterized by pain, low-grade fever, nausea, and leukocytosis (managed conservatively). * **Relative Contraindications:** Renal insufficiency (due to contrast), uncorrected coagulopathy, and prior pelvic radiation.

Question 29: Which of the following is an embolization agent?

A. Gelfoam
B. Polyvinyl alcohol (PVA)
C. Autologous blood clot
D. All of the above (Correct Answer)

Explanation: **Explanation:** Embolization is an interventional radiology procedure where substances are introduced into the circulatory system to deliberately occlude a blood vessel. This is used to stop hemorrhage, devascularize tumors, or treat aneurysms and arteriovenous malformations (AVMs). The correct answer is **D (All of the above)** because embolization agents are classified based on their duration of action, and all three options represent different categories: 1. **Gelfoam (Absorbable Gelatin Sponge):** A **temporary** particulate agent. It provides occlusion for roughly 2 to 6 weeks before being resorbed. It is commonly used in trauma or preoperative embolization where permanent occlusion is not required. 2. **Polyvinyl Alcohol (PVA):** A **permanent** particulate agent. These non-absorbable particles cause inflammatory endarteritis leading to permanent vascular occlusion. They are frequently used for uterine artery embolization (fibroids) and bronchial artery embolization. 3. **Autologous Blood Clot:** A **temporary** agent (the shortest acting). While rarely used today due to rapid lysis (within hours), it was historically the first embolic agent used. **High-Yield Facts for NEET-PG:** * **Classification by Duration:** * *Temporary:* Gelfoam, Autologous blood clot, Oxidized cellulose. * *Permanent:* PVA, Coils (mechanical), Glue (Cyanoacrylate), Onyx (Ethylene vinyl alcohol copolymer), Absolute Alcohol (Sclerosant). * **Absolute Alcohol:** Considered the most potent and permanent embolic agent; it causes immediate protein denaturation and capillary bed destruction. * **Coils:** Best for high-flow vessels (e.g., aneurysms) to induce mechanical thrombosis. * **Onyx:** A liquid embolic agent often used in the treatment of brain AVMs because it solidifies slowly, allowing for controlled delivery.

Question 30: Which artery is dissected most frequently following arteriography by the femoral route?

A. Celiac trunk
B. Superior mesenteric artery
C. Inferior mesenteric artery (Correct Answer)
D. Gastroduodenal artery

Explanation: **Explanation:** The **Inferior Mesenteric Artery (IMA)** is the most frequently dissected artery during femoral route arteriography due to its unique anatomical orientation and small caliber. **Why the IMA is the correct answer:** 1. **Anatomical Angle:** The IMA originates from the anterolateral aspect of the abdominal aorta at an acute, downward angle (around the L3 level). When advancing catheters or guide wires superiorly from the femoral artery, the tip often inadvertently enters the IMA orifice. 2. **Vessel Size:** Compared to the Celiac trunk or SMA, the IMA has a significantly smaller diameter. This makes it more prone to intimal injury and subsequent dissection when a standard-sized catheter is manipulated near its origin. 3. **Catheter Mechanics:** During retrograde femoral access, the "hooking" motion used to select visceral vessels often puts undue stress on the IMA's ostium if the catheter is not carefully managed. **Analysis of Incorrect Options:** * **Celiac Trunk (A) & Superior Mesenteric Artery (B):** These are much larger vessels with higher flow rates. While they are frequently catheterized, their larger diameter makes them more resilient to mechanical dissection compared to the IMA. * **Gastroduodenal Artery (D):** This is a branch of the common hepatic artery. It is a distal target rather than a primary aortic branch encountered during the initial ascent of the catheter, making it a less common site for primary iatrogenic dissection during the approach. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of iatrogenic injury** during abdominal aortography: **IMA**. * **Most common complication of femoral artery puncture:** Hematoma at the puncture site. * **IMA Landmark:** It typically originates 3-4 cm above the aortic bifurcation (at the level of the L3 vertebra). * **Management:** Most iatrogenic dissections are asymptomatic and managed conservatively unless they cause distal ischemia.

Practice by Chapter

Vascular Access Techniques

Practice Questions

Angiography and Angioplasty

Practice Questions

Embolization Procedures

Practice Questions

Thrombolysis and Thrombectomy

Practice Questions

Transjugular Intrahepatic Portosystemic Shunt

Practice Questions

Biliary Interventions

Practice Questions

Genitourinary Interventions

Practice Questions

Gastrointestinal Interventions

Practice Questions

Percutaneous Biopsy Techniques

Practice Questions

Drainage Procedures

Practice Questions

Tumor Ablation Techniques

Practice Questions

Venous Interventions

Practice Questions

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