Interventional Radiology Practice Questions

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

Omentum. **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.

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

Ballon embolization. **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).

Q: Who is considered the father of Interventional Radiology?

Charles Dotter. **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.

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

Arteriography. **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.

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

Portal vein and hepatic vein. **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.

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

All of the above. **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).

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

Age of patient >= 50 years. **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.

Q: Which of the following is an embolization agent?

All of the above. **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 1

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

Accepted Answer

Omentum

Answer

Blood clot

Answer

Ethyl alcohol

Answer

Wool

Question 2

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

Accepted Answer

Ballon embolization

Answer

Ligation of internal artery

Answer

No treatment available

Answer

Fistulectomy

Question 3

TIPS is a type of?

Accepted Answer

Non selective shunt

Answer

Selective shunt

Answer

Both selective and non selective shunt

Answer

Systemic shunt

Question 4

Who is considered the father of Interventional Radiology?

Accepted Answer

Charles Dotter

Answer

Henry Bacquerel

Answer

Marie Curie

Answer

W.C. Roentgen

Question 5

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

Accepted Answer

Arteriography

Answer

Suturing muscles

Answer

Pulmonary biopsy

Answer

Lymphangiography

Question 6

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

Accepted Answer

Portal vein and hepatic vein

Answer

Portal vein and hepatic artery

Answer

Portal vein and IVC

Answer

Hepatic vein and hepatic artery

Question 7

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

Accepted Answer

All of the above

Answer

Large fibroids

Answer

Uterine arteriovenous malformation (AVM)

Answer

Intractable uterine bleeding

Question 8

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

Accepted Answer

Age of patient >= 50 years

Answer

Pregnancy

Answer

Uterine infection

Answer

Endometrial cancer

Question 9

Which of the following is an embolization agent?

Accepted Answer

All of the above

Answer

Gelfoam

Answer

Polyvinyl alcohol (PVA)

Answer

Autologous blood clot

Question 10

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

Accepted Answer

Inferior mesenteric artery

Answer

Celiac trunk

Answer

Superior mesenteric artery

Answer

Gastroduodenal artery

Interventional Radiology — MCQs

Interventional Radiology — MCQs

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