Interventional Radiology — MCQs

Interventional Radiology Indian Medical PG Practice Questions and MCQs

Question 31: Percutaneous vertebroplasty is indicated in all except:

A. Tuberculosis (Correct Answer)
B. Metastasis
C. Osteoporosis
D. Hemangioma

Explanation: **Explanation:** Percutaneous Vertebroplasty (PVP) is a minimally invasive procedure involving the injection of bone cement (Polymethylmethacrylate - PMMA) into a vertebral body to provide structural stability and pain relief. **Why Tuberculosis is the Correct Answer (Contraindication):** Active infection, such as **Tuberculous spondylitis (Pott’s spine)** or pyogenic osteomyelitis, is an **absolute contraindication** for vertebroplasty. Injecting foreign material like PMMA into an infected site can exacerbate the infection, prevent effective antibiotic penetration, and lead to the formation of a persistent nidus for bacteria/mycobacteria. Surgical debridement and antitubercular therapy (ATT) are the mainstays of treatment for TB. **Analysis of Incorrect Options (Indications):** * **Osteoporosis:** The most common indication. It is used for painful osteoporotic vertebral compression fractures (VCFs) that do not respond to conservative management. * **Metastasis:** Indicated for painful osteolytic lesions or multiple myeloma to prevent pathological fractures and provide rapid pain relief. * **Hemangioma:** Specifically indicated for symptomatic aggressive vertebral hemangiomas that cause debilitating pain or risk of collapse. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Active systemic or local infection, uncorrected coagulopathy, and asymptomatic fractures. * **Relative Contraindication:** Retropulsion of a bone fragment into the spinal canal (risk of cord compression). * **Kyphoplasty vs. Vertebroplasty:** Kyphoplasty involves inflating a balloon first to restore vertebral height before injecting cement, whereas vertebroplasty is a high-pressure injection without height restoration. * **Most common complication:** Cement leakage (usually asymptomatic, but can cause pulmonary embolism or nerve root compression).

Question 32: Tolazoline is used as:

A. A thrombin inhibitor in peripheral angiography
B. A vasodilator in treating coronary artery stenosis during angio procedures (Correct Answer)
C. A vasoconstrictor in treatment of varices
D. An antispasmodic during biliary spasm

Explanation: **Explanation:** **Tolazoline** is a non-selective **alpha-adrenergic receptor antagonist** (alpha-blocker) that acts as a potent direct peripheral **vasodilator**. In the context of interventional radiology and cardiology, it is primarily used to counteract vasospasm and improve blood flow. **Why Option B is Correct:** During angiographic procedures, mechanical irritation from catheters or wires can trigger arterial spasms. Tolazoline is administered intra-arterially to induce vasodilation, particularly in coronary or peripheral vessels, to improve visualization of the distal vasculature and facilitate the passage of interventional tools. **Analysis of Incorrect Options:** * **Option A:** Thrombin inhibitors (like Heparin or Bivalirudin) are anticoagulants used to prevent clot formation. Tolazoline has no effect on the coagulation cascade. * **Option C:** Vasoconstrictors (like Vasopressin or Terlipressin) are used to treat variceal bleeding by reducing portal pressure. Tolazoline, being a vasodilator, would be contraindicated as it would worsen the condition. * **Option D:** Antispasmodics for biliary or GI spasms typically include anticholinergics (like Hyoscine) or Glucagon. Tolazoline acts on vascular smooth muscle rather than the biliary tree. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Competitive alpha-1 and alpha-2 blockade + direct histamine-like effect on vessels. * **Other Uses:** Historically used to treat **Persistent Pulmonary Hypertension of the Newborn (PPHN)**, though largely replaced by Nitric Oxide. * **Angiography Tip:** It is often used in **Superior Mesenteric Artery (SMA) arteriography** to improve the opacification of the portal venous system (indirect portography). * **Side Effects:** Tachycardia (due to alpha-2 blockade) and GI stimulation (increased gastric acid secretion).

Question 33: The MOST commonly used chemotherapeutic agent in transarterial chemoembolization for hepatocellular carcinoma is:

A. Doxorubicin (Correct Answer)
B. Cisplatin
C. Mitomycin C
D. 5-Fluorouracil

Explanation: **Explanation:** **Transarterial Chemoembolization (TACE)** is the standard of care for intermediate-stage Hepatocellular Carcinoma (HCC) (BCLC Stage B). The procedure involves the delivery of a concentrated dose of chemotherapy directly into the hepatic artery supplying the tumor, followed by embolization to induce ischemia and prolong drug retention. **Why Doxorubicin is the Correct Answer:** **Doxorubicin** (an anthracycline) is the most widely used and studied chemotherapeutic agent for TACE. It is highly effective against HCC cells and has a high binding affinity for **Lipiodol** (ethiodized oil), which acts as a carrier. When used in **DEB-TACE** (Drug-Eluting Bead TACE), doxorubicin is loaded into microspheres, allowing for a slow, sustained release that maximizes local tumor necrosis while minimizing systemic toxicity. **Analysis of Incorrect Options:** * **B. Cisplatin:** While used in some protocols (especially in Asia or as part of a "triple-drug cocktail"), it is generally considered a second-line choice compared to doxorubicin due to a higher risk of systemic side effects like nephrotoxicity. * **C. Mitomycin C:** Historically used in combination with other drugs, its use has declined because it is less effective as a monotherapy for HCC compared to doxorubicin. * **D. 5-Fluorouracil:** Primarily used for gastrointestinal malignancies and colorectal liver metastases; it has limited efficacy as a primary agent for HCC in the TACE setting. **High-Yield Clinical Pearls for NEET-PG:** * **Dual Blood Supply:** TACE exploits the fact that HCC receives 90-100% of its blood supply from the **hepatic artery**, while normal liver parenchyma receives 75% from the **portal vein**. * **Lipiodol:** This is a radio-opaque contrast agent that is selectively retained by HCC cells, making it both a drug carrier and a marker for post-procedure imaging. * **Post-Embolization Syndrome:** The most common complication of TACE, characterized by fever, abdominal pain, and nausea/vomiting. * **Contraindication:** TACE is generally contraindicated in patients with **main portal vein thrombosis** (due to risk of liver failure) and Child-Pugh Class C cirrhosis.

Question 34: Stereotactic radiosurgery is used in which of the following conditions?

A. Metastatic brain tumors
B. Arteriovenous malformations
C. Trigeminal neuralgia
D. All of the above (Correct Answer)

Explanation: **Explanation:** Stereotactic Radiosurgery (SRS) is a highly precise form of radiation therapy that delivers a single, high dose of ionizing radiation to a specific target within the brain or spine, while sparing the surrounding healthy tissue. Despite the name, it is a non-invasive procedure and does not involve traditional surgery. **Why "All of the Above" is Correct:** SRS is indicated for various intracranial pathologies where surgical access is difficult or high precision is required: * **Metastatic Brain Tumors (Option A):** SRS is a gold-standard treatment for brain metastases (especially if <3-4 cm in size). It offers excellent local control and is often preferred over whole-brain radiation to avoid cognitive decline. * **Arteriovenous Malformations (AVMs) (Option B):** SRS is used for small-to-medium-sized AVMs, particularly those located in eloquent areas (speech or motor cortex) where surgical resection carries high risk. It induces endothelial proliferation and eventual obliteration of the nidus over 1–3 years. * **Trigeminal Neuralgia (Option C):** It is a recognized treatment for refractory trigeminal neuralgia. The radiation is targeted at the trigeminal nerve root entry zone to disrupt pain signaling. **High-Yield Clinical Pearls for NEET-PG:** * **Modalities:** Common SRS systems include **Gamma Knife** (uses Cobalt-60 sources), **CyberKnife** (robotic linear accelerator), and modified **LINAC** systems. * **Benign Tumors:** SRS is also highly effective for **Acoustic Neuromas** (Vestibular Schwannomas) and **Meningiomas**. * **Dose Gradient:** The hallmark of SRS is a "steep dose fall-off," ensuring that the high-dose zone is strictly confined to the lesion. * **Contraindication:** It is generally not suitable for very large tumors (>3-4 cm) due to the risk of radiation-induced edema in surrounding brain tissue.

Question 35: Which of these can be used for uterine artery embolization for fibroid uterus?

A. Polyvinyl alcohol (Correct Answer)
B. Methylene blue
C. Ethacridine lactate
D. Polyglactin

Explanation: **Polyvinyl alcohol** - **Polyvinyl alcohol (PVA)** particles are commonly used as embolization material in **uterine artery embolization (UAE)** for fibroids. - These particles create **permanent occlusion** of the small arteries supplying the fibroids, leading to their shrinkage. *Methylene blue* - **Methylene blue** is a dye used for diagnostic purposes (e.g., to identify fistulas) and as an **antiseptic**, not for embolization. - It does not have the physical properties required to achieve arterial occlusion. *Ethacridine lactate* - **Ethacridine lactate** is an **antiseptic** and **abortifacient**, primarily used in second-trimester abortions. - It is not used as an embolization agent for fibroids. *Polyglactin* - **Polyglactin** is a commonly used material for **absorbable sutures** (e.g., Vicryl). - It is designed to be absorbed by the body over time and is not suitable for **permanent arterial occlusion** in embolization procedures.

Question 36: A Seldinger needle is used for:

A. Breast biopsy
B. Lymphangiography
C. Liver biopsy
D. Arteriography (Correct Answer)

Explanation: ***Arteriography*** - The **Seldinger technique** involves using a needle to puncture a blood vessel, typically an artery, after which a guidewire is threaded through the needle. - This method is fundamental for inserting catheters for procedures like **arteriography**, which visualizes arteries using contrast. *Breast biopsy* - Breast biopsies typically use specialized biopsy needles (e.g., **core needle biopsy** or vacuum-assisted biopsy needles) designed to extract tissue samples. - These are distinct from the Seldinger needle, which is primarily for accessing blood vessels. *Lymphangiography* - Lymphangiography involves injecting contrast into **lymphatic vessels**, which are typically very fine and superficial. - This procedure usually employs fine-gauge needles or direct cannulation of lymphatic vessels, not the Seldinger needle which is designed for larger vessels. *Liver biopsy* - Liver biopsies are usually performed with a **Menghini needle** or other types of cutting needles that can obtain a core sample from the liver parenchyma. - The Seldinger needle is not designed for obtaining solid tissue biopsies from organs like the liver.

Question 37: Procedure of choice for control of massive hemoptysis?

A. Rigid bronchoscopy and Photocoagulation
B. Bronchial artery embolization (Correct Answer)
C. Balloon catheter tamponade
D. Flexible bronchoscopy and cautery

Explanation: ***Bronchial artery embolization*** - **Bronchial artery embolization (BAE)** is the preferred initial treatment for **massive hemoptysis** due to its high success rate and minimally invasive nature. - It works by identifying and occluding the bleeding bronchial arteries, which are the most common source of massive hemoptysis. *Rigid bronchoscopy and Photocoagulation* - **Rigid bronchoscopy** is primarily used for **airway control**, foreign body removal, and occasionally for direct visualization and tamponade in massive hemoptysis. - While **photocoagulation** can be used to treat small bleeds, it is generally ineffective for massive or widespread hemorrhage. *Balloon catheter tamponade* - **Balloon catheter tamponade** can provide temporary control of bleeding by compressing the bleeding site but is not a definitive long-term solution. - It carries risks of tracheal injury and can obstruct the airway, making it a bridging measure until a more definitive treatment can be performed. *Flexible bronchoscopy and cautery* - **Flexible bronchoscopy** is useful for localizing the bleeding site but is **less effective** for controlling massive hemoptysis due to limited suction and instrument channels. - **Cautery** applied through a flexible bronchoscope is generally insufficient for significant bleeding and carries a risk of worsening the hemorrhage.

Question 38: The major disadvantage of mesenteric angiography in the setting of GI bleeding is:

A. Transient ischemic attacks
B. High radiation exposure to patient
C. Requires active bleeding for detection (Correct Answer)
D. It does not identify the specific cause of the bleeding

Explanation: ***Requires active bleeding for detection*** - This is the **major disadvantage** of mesenteric angiography in the setting of GI bleeding. - It requires bleeding at a rate of at least **0.5-1 mL/min** to visualize contrast extravasation, which means it will **miss intermittent or slow bleeding** (the most common pattern in GI hemorrhage). - This significant limitation often makes **CT angiography or nuclear medicine scans** more suitable for detecting slower or intermittent bleeds. - The need for active bleeding at the time of the procedure **directly limits its clinical utility** and is why the study may be negative even when bleeding is ongoing at a slower rate. *It does not identify the specific cause of the bleeding* - While mesenteric angiography primarily localizes the bleeding site rather than identifying the underlying pathology, this is a **secondary limitation**. - The angiographic appearance can sometimes **suggest the etiology** (e.g., vascular malformations show characteristic patterns, tumors may show a blush). - The primary goal of the procedure is **localization for therapeutic intervention**, not definitive diagnosis, so this is less of a disadvantage. *High radiation exposure to patient* - Although mesenteric angiography involves **ionizing radiation**, this is a general concern with fluoroscopy-guided procedures, not its major specific disadvantage in GI bleeding. - The diagnostic and therapeutic benefit typically **outweighs the radiation risk** when active bleeding is appropriately suspected. *Transient ischemic attacks* - This is **not a recognized complication** of mesenteric angiography. - TIAs are **neurological events** related to cerebrovascular circulation, not the mesenteric (abdominal) circulation. - This option is medically inaccurate in the context of mesenteric angiography.

Question 39: Which of the following agents can be used for the embolisation of tumors?

A. Autologous blood clots
B. Absolute ethanol
C. Polyvinyl alcohol
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **All three agents can be used for tumor embolization** in clinical practice, though they differ in their properties, applications, and duration of effect. - The choice depends on the specific clinical scenario, tumor type, desired duration of occlusion, and available resources. **Polyvinyl alcohol (PVA)** - **Most commonly used particulate embolic agent** with particles ranging from 45-1200 micrometers in size. - Causes **permanent occlusion** as it is non-biodegradable and induces foreign body reaction. - Widely used for **pre-operative embolization** of hypervascular tumors (renal cell carcinoma, meningiomas, bone metastases). - Excellent safety profile with predictable occlusion patterns. **Autologous blood clots** - Can be used for **temporary embolization** as they undergo fibrinolysis and recanalization within days to weeks. - Useful in **emergency situations** or when temporary devascularization is desired. - **Cost-effective option** in resource-limited settings. - Main limitation: unpredictable lysis rate and short duration of effect. **Absolute ethanol** - Potent **sclerosing agent** that causes immediate protein denaturation, endothelial destruction, and vessel thrombosis. - Used for **permanent ablation** in hepatocellular carcinoma (via TACE), renal tumors, and vascular malformations. - Requires **precise delivery technique** due to risks of non-target embolization, severe pain, and potential systemic toxicity. - More technically demanding but highly effective when properly administered.

Question 40: What is the principle behind radiofrequency ablation?

A. Separates tissues using heat.
B. Operates within the radiofrequency range.
C. Destroys nerve tissue for pain relief.
D. Uses alternating current (AC) to generate heat. (Correct Answer)

Explanation: ***Uses alternating current (AC) to generate heat.*** - **Radiofrequency ablation (RFA)** works by delivering a **high-frequency alternating electrical current** (typically 350-500 kHz) through an electrode inserted into the tissue. - This current causes nearby ions to oscillate rapidly, generating **frictional heat** that causes coagulative necrosis and destroys the target tissue. - This is the fundamental **physical principle** underlying all RFA applications. *Separates tissues using heat.* - While heat is generated during RFA, the primary goal is **tissue destruction (ablation)** through thermal coagulation, not mechanical separation. - Tissue separation is more characteristic of electrosurgical cutting tools, which use different waveforms and current densities for dissection. *Operates within the radiofrequency range.* - This statement is technically true, as RFA uses alternating current in the **radiofrequency spectrum** (350-500 kHz). - However, this merely describes a characteristic of the current type and does not explain the **mechanism of action** or how tissue ablation occurs. - This is descriptive, not explanatory of the principle. *Destroys nerve tissue for pain relief.* - This describes a **specific clinical application** of RFA (e.g., for chronic pain management by ablating sensory nerves) rather than the underlying physical principle. - RFA can ablate various tissue types including tumors (liver, lung, kidney), cardiac tissue (for arrhythmias), and nerves, making this option too narrow and application-specific.

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

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Venous Interventions

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