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EBIR practice questions

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Question 1Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

According to the European Curriculum and Syllabus for IR, which parameter is used to describe the dose of ionizing radiation absorbed by an organ or tissue?

  1. Equivalent dose, expressed in sieverts
  2. Air kerma rate, expressed in becquerels
  3. Absorbed dose, expressed in grays Correct answer.
  4. Effective dose, expressed in coulombs per kilogram

Explanation

Absorbed dose quantifies energy deposited per unit mass of tissue and is expressed in grays (1 Gy = 1 J/kg). Equivalent and effective dose weight absorbed dose by radiation and tissue factors and are used for stochastic risk estimation. Air kerma describes radiation in air, not tissue deposition.

Question 2Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

During a fluoroscopically guided procedure, which action most directly reduces patient skin dose when magnification is not clinically required?

  1. Selecting a larger focal spot
  2. Using continuous rather than pulsed fluoroscopy
  3. Increasing the detector-to-patient distance
  4. Keeping the image intensifier or flat detector as close to the patient as possible Correct answer.

Explanation

Minimizing the patient-to-detector distance reduces the required tube output and scatter while improving image quality, so it lowers entrance skin dose. Magnification and continuous fluoroscopy both increase dose. A larger focal spot does not reduce dose.

Question 3Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which imaging modality is the primary workhorse for planning and guiding percutaneous transhepatic biliary drainage?

  1. Positron emission tomography
  2. Magnetic resonance cholangiopancreatography
  3. Fluoroscopy with iodinated contrast Correct answer.
  4. Computed tomography without contrast

Explanation

Fluoroscopy with contrast injection allows real-time visualization of the biliary tree and needle or catheter placement during transhepatic puncture and drainage. MRCP and CT depict anatomy but do not provide real-time guidance. PET has no role in procedural guidance.

Question 4Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which vessel is most commonly used for arterial access in peripheral endovascular procedures?

  1. Axillary artery
  2. Popliteal artery
  3. Radial artery
  4. Common femoral artery Correct answer.

Explanation

The common femoral artery remains the most widely used access site because of its caliber, compressibility against the femoral head, and suitability for large sheaths. Radial access is increasingly used but is not the default for peripheral work. Axillary and popliteal access are reserved for specific indications.

Question 5Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a bleeding gastric varix is referred for a transjugular intrahepatic portosystemic shunt. Which structure is punctured to create the shunt tract?

  1. Hepatic vein to portal vein Correct answer.
  2. Splenic vein to left renal vein
  3. Hepatic artery to portal vein
  4. Portal vein to inferior vena cava

Explanation

TIPS is created by passing a needle from a hepatic vein through liver parenchyma into a portal vein branch, then deploying a stent-graft to decompress the portal system. Portosystemic shunting lowers portal pressure and reduces variceal bleeding. The other pairings describe different procedures or anatomy.

Question 6Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which finding on pre-procedural imaging is a contraindication to percutaneous renal biopsy?

  1. A simple cortical cyst of 3 cm
  2. Mild hydronephrosis
  3. An uncorrected bleeding diathesis Correct answer.
  4. A single kidney

Explanation

Uncorrected coagulopathy or thrombocytopenia substantially increases the risk of major hemorrhage after renal biopsy and must be corrected before puncture. A simple cyst, mild hydronephrosis, and a solitary kidney are not absolute contraindications, though a solitary kidney warrants extra caution.

Question 7Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which periprocedural medication strategy is standard for a patient undergoing elective arterial embolization who has normal renal function?

  1. Withholding all analgesia
  2. Prophylactic dialysis after the procedure
  3. Adequate hydration and minimization of contrast volume Correct answer.
  4. Routine full anticoagulation with therapeutic heparin throughout

Explanation

Contrast-associated acute kidney injury risk is reduced by adequate hydration and using the lowest contrast volume consistent with the procedure. Routine therapeutic anticoagulation is not standard for embolization. Prophylactic dialysis is unnecessary and analgesia should be provided as needed.

Question 8Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In the European Curriculum and Syllabus for IR, which competency domain covers obtaining informed consent and communicating risk to patients?

  1. Research and quality improvement
  2. Technical and procedural skills
  3. Medical expertise and clinical reasoning
  4. Professionalism, communication, and interpersonal skills Correct answer.

Explanation

Consent, shared decision-making, and risk communication are grouped under professionalism and communication competencies. Technical skills cover the procedure itself, while clinical reasoning and research are separate domains. This reflects the curriculum's emphasis on non-technical competencies.

Question 9Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient develops sudden hypotension, tachycardia, and flank pain during percutaneous nephrostomy. Which complication should be suspected first?

  1. Contrast anaphylaxis
  2. Vasovagal syncope
  3. Septic shock from pyelonephritis
  4. Significant periprocedural hemorrhage Correct answer.

Explanation

The combination of hypotension, tachycardia, and flank pain during renal puncture strongly suggests significant bleeding, such as arterial injury or subcapsular hematoma. Immediate assessment of hemoglobin, hemodynamic resuscitation, and imaging are required. Anaphylaxis usually includes urticaria or bronchospasm, and vasovagal reactions typically cause bradycardia.

Question 10Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which feature distinguishes a covered stent-graft from a bare metal stent when treating a bleeding pseudoaneurysm?

  1. The covered device is always balloon-expandable
  2. The bare metal stent provides a physical barrier to flow
  3. The covered device excludes flow from the aneurysm sac Correct answer.
  4. The bare metal stent dissolves over time

Explanation

A covered stent-graft has a fabric or polymer layer that excludes the aneurysm or pseudoaneurysm from the circulation while preserving the parent vessel lumen. Bare metal stents maintain vessel patency but do not seal the sac. Both may be balloon- or self-expanding, and neither dissolves.

Question 11Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a failing hemodialysis arteriovenous fistula is found to have a short-segment venous stenosis. Which endovascular treatment is first-line?

  1. Balloon angioplasty of the stenotic segment Correct answer.
  2. Surgical ligation of the fistula
  3. Thrombolysis of the entire fistula
  4. Placement of a covered stent across the anastomosis

Explanation

Balloon angioplasty is the first-line endovascular treatment for a focal venous stenosis in a failing fistula and can restore flow. Stent-grafts are reserved for recurrent or elastic lesions. Ligation would destroy access, and thrombolysis addresses thrombosis rather than stenosis.

Question 12Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which technique best reduces the risk of nontarget embolization during bland embolization of a hypervascular liver tumor?

  1. Superselective catheterization with flow control and sizing of embolic particles Correct answer.
  2. Embolizing the main portal vein first
  3. Using large particles alone
  4. Injecting embolic material under high pressure

Explanation

Superselective catheter placement, controlled injection, and appropriately sized particles reduce reflux and nontarget embolization. Large particles or high-pressure injection increase the risk of proximal or collateral occlusion. Embolizing the main portal vein would cause hepatic decompensation.

Question 13Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In a patient with acute limb ischemia, which finding on duplex ultrasound suggests an immediately threatened limb requiring urgent revascularization?

  1. Mild intimal thickening without flow limitation
  2. Absent arterial flow with monophasic or no distal Doppler signal Correct answer.
  3. Peak systolic velocity of 80 cm/s in a patent segment
  4. A small collateral vessel with low resistance flow

Explanation

Absent or monophasic arterial flow distal to an occlusion indicates a threatened limb and mandates urgent revascularization. Normal peak systolic velocities, mild intimal thickening, and low-resistance collateral flow do not indicate critical ischemia. Clinical assessment of motor and sensory function complements imaging.

Question 14Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which parameter is most important to monitor to prevent contrast-induced nephropathy in a patient with chronic kidney disease undergoing angiography?

  1. Intravascular volume status and contrast volume Correct answer.
  2. Platelet count
  3. Serum potassium
  4. White blood cell count

Explanation

Adequate intravascular volume and limiting contrast volume are the main modifiable factors that reduce contrast-induced nephropathy. Potassium, white cell count, and platelet count do not directly predict contrast nephrotoxicity. Renal function should be checked before and after the procedure.

Question 15Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a large, symptomatic simple hepatic cyst is treated with sclerotherapy. Which agent is commonly instilled after aspiration to destroy the cyst epithelium?

  1. Iodinated contrast
  2. Heparinized saline
  3. Absolute ethanol Correct answer.
  4. Isotonic saline

Explanation

Absolute ethanol is a widely used sclerosant that denatures proteins and destroys the epithelial lining of the cyst after aspiration. Saline and contrast do not sclerose, and heparinized saline is used to prevent clotting in catheters rather than to treat cysts.

Question 16Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which factor most strongly predicts technical success of percutaneous vertebroplasty for an osteoporotic compression fracture?

  1. The patient's body mass index
  2. The age of the fracture and residual vertebral body height Correct answer.
  3. The side of the approach
  4. The presence of a fluid-filled cleft within the vertebral body

Explanation

Acute or subacute fractures with preserved vertebral body height and edema on MRI respond best to vertebroplasty. Chronic fractures with collapse have lower success. Body mass index and approach side are less important determinants.

Question 17Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which measure best protects the operator from occupational radiation exposure during complex embolization?

  1. Standing on the tube side of the patient
  2. Using continuous fluoroscopy at high frame rate
  3. Removing the table-mounted lead drape to improve access
  4. Increasing the distance from the radiation source and using ceiling-suspended shielding Correct answer.

Explanation

Occupational dose falls with distance and with appropriate shielding, including ceiling-suspended lead screens, table drapes, and personal dosimeters. Removing drapes, increasing frame rate, or standing on the tube side all raise exposure. Dose monitoring and collimation further reduce risk.

Question 18Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In a patient with a bleeding duodenal ulcer refractory to endoscopic therapy, which endovascular approach is most appropriate when the gastroduodenal artery is the bleeding source?

  1. Embolization of the gastroduodenal artery with coils or particles Correct answer.
  2. Balloon angioplasty of the gastroduodenal artery
  3. Placement of a covered stent across the pylorus
  4. Thrombolysis of the gastroduodenal artery

Explanation

Transcatheter embolization of the bleeding gastroduodenal artery is the standard endovascular rescue after failed endoscopic treatment. Angioplasty and stenting do not address hemorrhage, and thrombolysis would worsen bleeding. Collateral supply through the pancreaticoduodenal arcades should be considered.

Question 19Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which statement about the role of a multidisciplinary team in interventional radiology is most accurate according to the European curriculum?

  1. Multidisciplinary meetings are only required for oncological cases
  2. The team replaces the need for informed consent
  3. Interventional radiologists should make all treatment decisions independently
  4. Case discussion with referring clinicians improves appropriate patient selection and outcomes Correct answer.

Explanation

The curriculum emphasizes multidisciplinary collaboration for appropriate patient selection, shared decision-making, and safe periprocedural care across all IR domains. Independence in decision-making and restricting meetings to oncology are contrary to this principle. Informed consent remains the responsibility of the treating physician.

Question 20Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which finding on CT angiography indicates a type II endoleak after endovascular aortic aneurysm repair?

  1. Contrast from a fabric defect in the stent-graft
  2. Contrast within the aneurysm sac supplied by a lumbar artery Correct answer.
  3. Contrast at the proximal attachment site
  4. Contrast at the distal attachment site

Explanation

Type II endoleak arises from retrograde flow through branch vessels such as lumbar or inferior mesenteric arteries into the sac. Proximal and distal attachment leaks are type I, and fabric defects are type III. Management depends on sac growth and type.

Question 21Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which patient factor most increases the risk of contrast extravasation and local tissue injury during power injection for CT or angiography?

  1. A history of well-controlled hypertension
  2. Poor peripheral venous access with a fragile small vein Correct answer.
  3. Mild obesity
  4. Use of a 20-gauge cannula in a large forearm vein

Explanation

Fragile or small veins and difficult access increase the risk of cannula dislodgement and contrast extravasation during power injection. Adequate cannula size in a good vein, controlled hypertension, and obesity are less important. Extravasation requires prompt recognition and management.

Question 22Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a malignant biliary obstruction and a metal stent in situ develops recurrent jaundice. Which endovascular or percutaneous option is most appropriate when the stent is occluded by tumor ingrowth?

  1. Endoscopic sphincterotomy without drainage
  2. Systemic chemotherapy alone
  3. Oral ursodeoxycholic acid
  4. Percutaneous transhepatic placement of a covered stent or drainage catheter Correct answer.

Explanation

Recurrent obstruction from tumor ingrowth can be managed by percutaneous or endoscopic placement of a covered stent or a drainage catheter to restore bile flow. Chemotherapy alone does not relieve acute obstruction, and ursodeoxycholic acid or sphincterotomy alone does not bypass the occlusion.

Question 23Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient is scheduled for percutaneous cryoablation of a small renal tumor. Which consideration is most specific to cryoablation compared with radiofrequency ablation?

  1. Real-time visualization of the ice ball allows monitoring of the ablation margin Correct answer.
  2. It is only effective for tumors larger than 5 cm
  3. It cannot be used near the bowel
  4. It requires no imaging guidance

Explanation

Cryoablation produces an ice ball that is visible on CT or MRI, allowing real-time monitoring of the ablation zone and its relationship to adjacent structures. It still requires imaging guidance, can be used near bowel with hydrodissection, and is suitable for small tumors.

Question 24Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In transjugular intrahepatic portosystemic shunt creation, which factor most increases the risk of post-procedural hepatic encephalopathy?

  1. Use of a covered stent-graft
  2. A high pre-procedural MELD score with prior encephalopathy Correct answer.
  3. A large-diameter shunt with a low portosystemic pressure gradient
  4. Preserved hepatic synthetic function

Explanation

Advanced liver dysfunction and a history of encephalopathy are the strongest predictors of post-TIPS encephalopathy because shunting diverts portal blood from the liver. Larger shunts and lower gradients also increase risk, but the pre-procedural clinical status is most predictive. Covered stent-grafts improve patency rather than causing encephalopathy.

Question 25Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which mechanism best explains the antirestenotic effect of drug-coated balloons in peripheral arterial disease?

  1. Systemic anticoagulation
  2. Thermal ablation of the vessel wall
  3. Mechanical debulking of the plaque
  4. Local delivery of an antiproliferative drug to inhibit neointimal hyperplasia Correct answer.

Explanation

Drug-coated balloons transfer an antiproliferative agent such as paclitaxel to the vessel wall during balloon inflation, suppressing neointimal hyperplasia. They do not debulk plaque, provide systemic anticoagulation, or use thermal energy. Vessel preparation often precedes their use.

Question 26Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

During ultrasound-guided percutaneous drainage of a deep abdominal abscess, which needle guidance technique allows continuous real-time visualization of the needle tip along its entire length?

  1. Needle guide bracket fixed to the probe with the needle entering in-plane Correct answer.
  2. Blind landmark-based insertion followed by fluoroscopic confirmation
  3. Out-of-plane approach with the needle entering at the center of the probe face
  4. Freehand technique with the probe oriented perpendicular to the needle path

Explanation

An in-plane approach keeps the entire needle shaft and tip within the thin ultrasound slice, so the operator can track the tip continuously as it advances. A fixed needle guide maintains this alignment mechanically and improves precision for deep targets. Out-of-plane and freehand perpendicular approaches show only a dot where the needle crosses the plane, so tip position is uncertain during advancement.

Question 27Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which access route is preferred for percutaneous transluminal angioplasty of a short stenosis in the proximal superficial femoral artery when a contralateral approach would require a long catheter course?

  1. Ipsilateral antegrade common femoral artery puncture Correct answer.
  2. Direct puncture of the superficial femoral artery at the stenosis
  3. Retrograde popliteal puncture
  4. Contralateral retrograde common femoral artery puncture

Explanation

An ipsilateral antegrade common femoral puncture gives a short, straight working distance to the proximal superficial femoral artery and improves pushability and control. Contralateral access is useful for flush iliac occlusions or when antegrade puncture is unfavorable, but it demands a long crossover course. Popliteal access is generally reserved for distal lesions or failed antegrade attempts.

Question 28Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which catheter shape is most appropriate for selective catheterization of the left gastric artery arising from the celiac trunk?

  1. A straight flush catheter with multiple side holes
  2. A reverse-curve catheter such as a Simmons or Cobra shape Correct answer.
  3. A microcatheter advanced without a guiding catheter
  4. A balloon occlusion catheter

Explanation

The left gastric artery often arises with a sharp superior and sometimes posterior origin from the celiac trunk, so a reverse-curve or hook-shaped catheter provides the needed angle and support. Flush catheters are for angiography and cannot select sharply angulated branches. A microcatheter requires a parent catheter for support and cannot itself perform the initial selection.

Question 29Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which embolic agent is most suitable for occluding a large high-flow arteriovenous malformation nidus after flow reduction?

  1. Coils placed in the feeding artery proximal to the nidus
  2. Autologous blood clot
  3. Gelatin sponge slurry alone
  4. Liquid embolic agent such as ethylene vinyl alcohol copolymer Correct answer.

Explanation

A liquid embolic agent penetrates and fills the nidus itself, which is the target in arteriovenous malformation treatment; proximal occlusion alone leaves the nidus recruitable and can worsen the lesion. Flow reduction before injection allows the liquid agent to remain in the nidus rather than washing into venous outflow. Gelatin sponge and blood clot are temporary and unsuitable for definitive nidus occlusion.

Question 30Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In the Seldinger technique for gaining arterial access, what is the correct sequence of steps after the vessel is punctured and pulsatile backflow is confirmed?

  1. Advance the sheath over the needle, then pass the guidewire through the sheath
  2. Dilate the tract before passing the guidewire
  3. Pass the guidewire through the needle, remove the needle, then advance the catheter or sheath over the wire Correct answer.
  4. Remove the needle first, then pass the guidewire through the skin tract

Explanation

The guidewire is passed through the needle while the needle tip remains intravascular, confirming intraluminal position by smooth wire passage. The needle is then removed and the tract dilated before the catheter or sheath is advanced over the wire. Removing the needle before wire passage risks losing access and causing hemorrhage.

Question 31Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which imaging modality is the first-line noninvasive test for suspected deep vein thrombosis in a symptomatic leg?

  1. Compression duplex ultrasound Correct answer.
  2. Radionuclide venography
  3. Plain radiography of the leg
  4. Non-contrast CT of the pelvis and thighs

Explanation

Compression duplex ultrasound is accurate, rapid, and noninvasive, and it is the accepted first-line test for suspected lower-limb deep vein thrombosis. Failure of the vein to compress and absent flow augmentation support the diagnosis. CT and radionuclide venography are reserved for specific situations such as suspected pelvic or inferior vena cava extension.

Question 32Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which periprocedural precaution is most important before image-guided biopsy of a solid organ in a patient taking a direct oral anticoagulant?

  1. Withholding the anticoagulant for an interval appropriate to the drug and renal function, following local protocol Correct answer.
  2. Replacing the anticoagulant with aspirin on the day of biopsy
  3. Performing the biopsy without interruption because the agent has a short half-life
  4. Doubling the usual dose on the morning of the procedure

Explanation

Direct oral anticoagulants must be withheld for a drug- and renal-function-dependent interval before procedures with meaningful bleeding risk, and the decision should follow local or societal protocols. Simply continuing therapy or substituting aspirin does not restore adequate hemostatic competence. Restart timing after the procedure must also be planned.

Question 33Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which feature on pre-procedural imaging most strongly suggests that a liver lesion is suitable for percutaneous thermal ablation rather than surgery?

  1. A lesion abutting the common bile duct and main portal vein
  2. A solitary lesion smaller than 3 cm with no macrovascular invasion and accessible window Correct answer.
  3. A lesion larger than 8 cm with capsular rupture
  4. Multiple bilobar lesions with portal vein tumor thrombus

Explanation

Thermal ablation achieves reliable local control for small lesions, generally up to about 3 cm, when a safe percutaneous window exists and there is no macrovascular invasion. Larger lesions, biliary or major vascular abutment, and tumor thrombus increase the risk of incomplete ablation or collateral injury. Such features favor other treatments or a different approach.

Question 34Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

During fluoroscopically guided intervention, which practice most effectively reduces the absorbed dose to the operator's hands and lens?

  1. Using pulsed fluoroscopy with the last-image-hold and collimating to the region of interest Correct answer.
  2. Standing closer to the patient to improve manual dexterity
  3. Increasing the detector-to-patient distance
  4. Increasing magnification to improve image detail

Explanation

Pulsed fluoroscopy, last-image-hold, and tight collimation all reduce the number of frames and the volume of tissue irradiated, lowering scatter and operator dose. Distance is the most powerful protective factor, so stepping back when possible also helps. Magnification and proximity to the patient both increase dose.

Question 35Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a bleeding gastroduodenal artery pseudoaneurysm is treated by coil embolization. Which technical step is essential to prevent retrograde collateral refilling of the pseudoaneurysm?

  1. Occluding the feeding artery both proximal and distal to the pseudoaneurysm (sandwich technique) Correct answer.
  2. Injecting vasopressin into the feeding artery after coiling
  3. Placing coils only in the pseudoaneurysm sac
  4. Using a single coil in the most proximal gastroduodenal artery segment

Explanation

The gastroduodenal artery has a rich collateral supply through pancreaticoduodenal arcades, so proximal occlusion alone permits retrograde flow into the pseudoaneurysm. Placing coils both proximal and distal to the lesion isolates it from both directions. Coils confined to the sac or only proximally leave a route for refilling.

Question 36Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which finding on a fluoroscopically guided barium study most strongly suggests a malignant esophageal stricture rather than a benign peptic stricture?

  1. An irregular, asymmetric stricture with mucosal nodularity and shouldering Correct answer.
  2. A long smooth narrowing that resolves after intravenous glucagon
  3. A smooth, tapered, concentric narrowing at the distal esophagus
  4. A short web-like narrowing in the cervical esophagus

Explanation

Malignant strictures typically show irregular, asymmetric narrowing with mucosal destruction, nodularity, and abrupt shouldered margins. Benign peptic strictures are usually smooth, concentric, and tapered and occur near the gastroesophageal junction. Webs and glucagon-responsive narrowing reflect other benign processes.

Question 37Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

In a patient with acute massive hemoptysis, which endovascular approach is most appropriate when bronchoscopy localizes bleeding to the right lower lobe and the right bronchial artery is identified?

  1. Pulmonary artery balloon occlusion without bronchial artery embolization
  2. Embolization of the left bronchial artery
  3. Systemic thrombolysis
  4. Embolization of the right bronchial artery with particles or coils after identifying the artery of Adamkiewicz Correct answer.

Explanation

Bronchial artery embolization is the endovascular treatment of choice for massive hemoptysis after airway protection. The critical step is identifying the spinal cord supply, especially the artery of Adamkiewicz, before embolization to avoid paraplegia. Treating the contralateral side or giving thrombolysis would not address the bleeding source.

Question 38Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which parameter on a contrast-enhanced CT most reliably identifies a ruptured abdominal aortic aneurysm requiring emergent repair?

  1. Retroperitoneal hematoma with contrast extravasation beyond the aortic wall Correct answer.
  2. Mural thrombus thickness greater than 1 cm
  3. Maximal aneurysm diameter of 4.5 cm
  4. Presence of a calcified aneurysm neck

Explanation

Contrast extravasation beyond the aortic wall with periaortic or retroperitoneal hematoma is the direct sign of contained or free rupture. Diameter alone predicts rupture risk but does not establish rupture. Mural thrombus and calcified neck are morphological features relevant to repair planning, not rupture.

Question 39Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which factor most increases the technical difficulty and radiation dose during transjugular liver biopsy in a patient with cirrhosis?

  1. Ascites decompressed by paracentesis before the procedure
  2. Mild elevation of transaminases
  3. A small shrunken liver with a steeply angled hepatic vein Correct answer.
  4. Capsular thickening on prior imaging

Explanation

A small cirrhotic liver with a sharply angled hepatic vein makes catheterization and needle passage harder, prolonging fluoroscopy and increasing the number of passes. Pre-procedural paracentesis can actually improve respiratory excursion and access. Capsular thickening and mild enzyme elevation do not substantially affect technical difficulty.

Question 40Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which statement best describes the purpose of a covered metallic stent when placed for malignant dysphagia in esophageal cancer?

  1. It restores luminal patency and seals the tumor surface to reduce ingrowth and fistula risk Correct answer.
  2. It provides local antitumor effect through drug elution
  3. It permanently ablates the tumor by thermal conduction
  4. It replaces the need for nutritional support in all patients

Explanation

Covered esophageal stents palliate dysphagia by holding the lumen open, and the covering limits tumor ingrowth and can seal malignant fistulas. They do not deliver drug therapy or ablate tumor. Nutritional support still requires individual assessment, including feeding route and diet texture.

Question 41Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient develops severe back pain and lower limb weakness hours after percutaneous vertebroplasty. Which complication should be suspected first?

  1. Pneumothorax
  2. Cement leakage into the epidural or paraspinal venous plexus with cord or nerve root compression Correct answer.
  3. Contrast-induced nephropathy
  4. Retroperitoneal hemorrhage from the contralateral groin puncture

Explanation

Epidural or foraminal cement leakage can compress the spinal cord or nerve roots, producing new back pain, radicular symptoms, or weakness shortly after vertebroplasty. Urgent imaging and neurosurgical or interventional review are required. Nephropathy, pneumothorax, and groin hemorrhage do not typically present with acute myelopathic or radicular signs.

Question 42Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which feature makes a renal artery aneurysm amenable to endovascular coil embolization rather than surgical repair?

  1. A fusiform aneurysm involving the entire main renal artery bifurcation
  2. A saccular aneurysm with a narrow neck in a patient with preserved renal function Correct answer.
  3. An aneurysm with active extravasation and hemodynamic instability
  4. An aneurysm in a patient with a solitary kidney and renal insufficiency

Explanation

A saccular aneurysm with a narrow neck allows selective coil packing while preserving the parent artery and distal renal perfusion. Fusiform bifurcation involvement and solitary-kidney insufficiency favor surgical reconstruction or careful stent-graft planning to preserve renal mass. Active instability with extravasation requires urgent hemorrhage control rather than elective coiling.

Question 43Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which instruction should be given to a patient after uncomplicated percutaneous image-guided core biopsy of a liver lesion?

  1. Resume full anticoagulation immediately and return to heavy lifting the same day
  2. Avoid all oral fluids for 48 hours
  3. Remain on bed rest with observation for bleeding and report worsening pain, dizziness, or hematemesis Correct answer.
  4. Fast for 24 hours to reduce biliary leakage

Explanation

Post-biopsy care centers on detecting bleeding: a period of rest and observation with clear instructions to report pain, dizziness, or hematemesis. Anticoagulation should be resumed only according to protocol after hemostasis is confirmed. Prolonged fasting or fluid restriction has no protective role and may cause harm.

Question 44Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which feature on magnetic resonance imaging is most characteristic of a spinal hemangioma that can be safely treated with percutaneous vertebroplasty?

  1. Low T1 and low T2 signal with destruction of the posterior vertebral body wall
  2. Enhancing epidural mass with cord compression
  3. Multiple vertebral levels with pathologic fracture and marrow replacement
  4. High T1 and high T2 signal with a striated appearance and no epidural soft tissue mass Correct answer.

Explanation

Typical vertebral hemangiomas show high signal on both T1- and T2-weighted images with a striated or polka-dot pattern and no aggressive features. This appearance supports a benign diagnosis suitable for cement augmentation when symptomatic. Posterior wall destruction, epidural mass, and multilevel marrow replacement suggest malignancy or aggressive hemangioma requiring different management.

Question 45Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which strategy best minimizes the risk of biliary sepsis during percutaneous transhepatic cholangiography and drainage in an obstructed, infected system?

  1. Complete the diagnostic cholangiogram before any drainage and delay catheter placement
  2. Perform drainage promptly with antibiotic coverage and avoid excessive contrast injection pressure Correct answer.
  3. Remove the drainage catheter as soon as bile flow is seen
  4. Use large-volume high-pressure contrast injection to opacify all ducts

Explanation

In an infected obstructed biliary system, prompt decompression with adequate antibiotic cover is the priority; excessive contrast volume or pressure can force bacteria into the bloodstream and precipitate septic shock. Diagnostic imaging should not delay drainage. Early catheter removal would risk recurrent obstruction and sepsis.

Question 46Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which mechanism explains why a drug-eluting stent reduces in-stent restenosis in the superficial femoral artery?

  1. Mechanical radial force alone exceeding that of bare metal stents
  2. Local release of an antiproliferative agent that limits neointimal hyperplasia Correct answer.
  3. Coverage of the vessel wall that prevents all plaque progression
  4. Systemic anticoagulation induced by the stent coating

Explanation

Drug-eluting stents release an antiproliferative drug locally into the vessel wall, suppressing smooth muscle proliferation and neointimal hyperplasia, which is the dominant cause of in-stent restenosis. Radial force and stent geometry matter for acute results but do not explain the durable reduction in restenosis. The coating does not provide systemic anticoagulation.

Question 47Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which factor most strongly increases the risk of nontarget embolization during particle embolization of a hypervascular liver tumor?

  1. Use of small particles with a low-flow injection technique
  2. Prior transarterial chemoembolization
  3. Presence of a patent extrahepatic collateral such as the right inferior phrenic artery supplying the tumor Correct answer.
  4. Superselective catheter placement beyond the tumor-feeding branch

Explanation

Extrahepatic collaterals recruited by a tumor can carry particles to the lung, stomach, or other organs if they are not recognized and controlled. Superselective positioning and careful low-flow injection reduce, rather than increase, nontarget risk. Prior chemoembolization may alter vascularity but is not itself the main determinant of collateral shunting.

Question 48Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

A patient with a type II endoleak after endovascular aortic aneurysm repair has a stable sac diameter at 12 months. Which management approach is most appropriate?

  1. Immediate coil embolization of the inferior mesenteric artery in all cases
  2. Percutaneous thrombin injection into the aneurysm sac regardless of sac growth
  3. Immediate open conversion to prevent rupture
  4. Continued imaging surveillance because many type II endoleaks spontaneously thrombose and sac size is stable Correct answer.

Explanation

Type II endoleaks from lumbar or inferior mesenteric artery backflow are common and often benign; intervention is generally reserved for progressive sac enlargement or persistent leak with rising sac size. With a stable sac at 12 months, surveillance is appropriate. Open conversion and routine embolization expose the patient to unnecessary risk.

Question 49Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which hemodynamic feature most favors creation of a transjugular intrahepatic portosystemic shunt rather than large-volume paracentesis for refractory ascites?

  1. A portosystemic pressure gradient above 12 mmHg with preserved hepatic reserve Correct answer.
  2. Severe hepatic encephalopathy refractory to lactulose
  3. Right heart failure with elevated pulmonary artery pressure
  4. A portosystemic pressure gradient of 8 mmHg

Explanation

A portosystemic gradient above about 12 mmHg identifies patients whose ascites is driven by portal hypertension and who may benefit from a shunt, provided hepatic reserve is adequate. A gradient of 8 mmHg is not significantly elevated. Refractory encephalopathy and right heart failure are contraindications because a shunt would worsen them.

Question 50Interventional Radiology (per the European Curriculum and Syllabus for IR, third edition)

Which finding on CT angiography most reliably distinguishes a type I endoleak from a type II endoleak after endovascular aortic aneurysm repair?

  1. Contrast within the sac communicating directly with the stent-graft attachment site or a graft defect Correct answer.
  2. A stable sac diameter over 12 months
  3. A calcified aneurysm neck without sac contrast
  4. Contrast confined to the sac with a patent lumbar artery but no communication with the graft

Explanation

Type I endoleak results from incomplete sealing at a graft attachment site or a defect in the fabric, so contrast tracks directly from the graft lumen into the sac at that location. Type II endoleak fills the sac retrogradely from branch vessels without direct graft communication. Sac stability and neck calcification do not distinguish the leak type.