VASCULAR INTERVENTIONAL
RADIOLOGY 2025 to 2026 COMPLETE
STUDY GUIDE KEY CONCEPTS
PRACTICE QUESTIONS and EXAM
PREPARATION
Vascular Interventional Radiology (VI) Registry Study Guide
Module 1: Patient Care & Pharmacology (Questions 1–15)
1. Which of the following laboratory values represents the most
critical contraindication for performing a high-risk arterial
intervention according to standard Society of Interventional
Radiology (SIR) guidelines?
A. Platelet count of 120,000/µL
B. Hemoglobin of 10.5 g/dL
C. International Normalized Ratio (INR) of 2.1
D. Serum creatinine of 1.1 mg/dL
Correct Answer: C
Rationale: An INR of 2.1 indicates significant anticoagulation or
coagulopathy. For high-risk vascular interventions (such as arterial
punctures, TIPS, or biliary drainage), SIR guidelines recommend correcting
the INR to less than 1.5 to minimize the risk of severe access-site or
systemic hemorrhage. A platelet count of 120,000/µL is adequate
(threshold is typically <50,000/µL), and mild anemia does not preclude a
procedure.
2. A patient experiences an immediate anaphylactoid reaction
with profound laryngospasm and a blood pressure drop to 70/40
mmHg following contrast injection. What is the immediate first-
line pharmacological treatment?
A. Diphenhydramine 50 mg IV push
B. Epinephrine 0.3 mg IM (1:1,000 concentration)
C. Hydrocortisone 100 mg IV push
D. Atropine 0.5 mg IV push
, Correct Answer: B
Rationale: Epinephrine is the primary drug of choice for severe, life-
threatening anaphylactic or anaphylactoid reactions presenting with airway
compromise (laryngospasm/bronchospasm) or hemodynamic collapse.
Giving it intramuscularly (IM) in the lateral thigh provides rapid, reliable
absorption. Antihistamines and corticosteroids are secondary medications
because they act too slowly to secure an airway or reverse acute distributive
shock. Atropine is used for vagal bradycardia, not anaphylaxis.
3. To minimize the risk of Contrast-Induced Nephropathy (CIN)
in a patient with a baseline eGFR of 35 mL/min/1.73m², which
pre-procedural management strategy is most effective?
A. Restricting all fluid intake for 12 hours prior to the procedure
B. Intravenous hydration with 0.9% Normal Saline prior to and
following the contrast exposure
C. Prophylactically administering high-dose loop diuretics immediately
before access
D. Switching the contrast agent from non-ionic iodinated contrast to
Gadolinium
Correct Answer: B
Rationale: Controlled intravenous hydration with isotonic fluids (0.9%
Normal Saline or Sodium Bicarbonate) remains the gold standard for
reducing the risk of CIN in patients with renal insufficiency. Fluid
restriction or volume depletion increases contrast concentration in the
renal tubules, exacerbating toxicity. Diuretics can worsen dehydration
unless the patient is in fluid overload. Gadolinium is not an acceptable or
safe substitute for high-volume arterial imaging due to the risk of
Nephrogenic Systemic Fibrosis (NSF) and poor spatial resolution.
4. A patient under moderate sedation becomes
uncommunicative, and their pulse oximeter reads 82% on room
air with a respiratory rate of 5 breaths per minute. If the patient
received Fentanyl and Midazolam, which reversal agent should
be administered first?
A. Flumazenil 0.2 mg IV
B. Naloxone 0.4 mg IV
C. Protamine Sulfate 50 mg IV
D. Neostigmine 1.0 mg IV
, Correct Answer: B
Rationale: Respiratory depression under moderate sedation is most
commonly driven by opioid analgesics like Fentanyl. Naloxone is a specific
opioid antagonist that rapidly reverses respiratory depression. Flumazenil
reverses benzodiazepines (like Midazolam) but can trigger withdrawal
seizures in chronic users; it should be used secondary to addressing the
primary opioid-induced respiratory threat. Protamine reverses heparin,
and neostigmine reverses paralytics.
5. Which medication must be withheld for 48 hours after an
intravascular contrast administration to prevent the
development of life-threatening lactic acidosis if renal failure
occurs?
A. Clopidogrel
B. Lisinopril
C. Warfarin
D. Metformin
Correct Answer: D
Rationale: Metformin is cleared exclusively by the kidneys. If a patient
experiences a drop in renal function or CIN following iodinated contrast
exposure, Metformin can accumulate in the body, leading to Metformin-
associated lactic acidosis (MALA), which carries a high mortality rate. It
must be held at the time of the procedure and for 48 hours post-procedure,
and only restarted after normal renal function is verified.
6. According to the Universal Protocol for preventing wrong-site
or wrong-procedure errors, when must the clinical "Time Out"
be executed?
A. Immediately upon the patient's arrival in the holding area
B. Before the patient is transferred from the stretcher to the angiographic
table
C. Immediately prior to skin incision or needle puncture with all
active team members participating
D. Right after the first diagnostic digital subtraction angiography (DSA) run
is acquired
Correct Answer: C
Rationale: The "Time Out" must be conducted immediately before the
start of the invasive portion of the procedure (incision or initial needle
, stick). It requires active verbal agreement from all team members
(physician, technologist, nurse) to confirm the correct patient identity,
correct procedure, correct side/site, and availability of required implants.
7. What is the classic clinical triad of symptoms that defines
Post-Embolization Syndrome (PES) following a solid organ or
tumor embolization?
A. Hypotension, bradycardia, and skin rash
B. Pain, low-grade fever, and nausea/vomiting
C. Hematuria, flank pain, and hypertension
D. Dyspnea, chest tightess, and hemoptysis
Correct Answer: B
Rationale: Post-embolization syndrome is a common, localized
inflammatory response resulting from tissue ischemia, cellular death, and
tumor necrosis after an embolization procedure. It is characterized by
localized pain, low-grade fever, and gastrointestinal distress
(nausea/vomiting). It is managed supportively with analgesics and
antiemetics, and should not be confused with systemic infection.
8. A patient on continuous unfractionated heparin requires an
urgent intervention. If their Activated Clotting Time (ACT) is 350
seconds, what medication can be administered to directly
neutralize the heparin effect?
A. Vitamin K
B. Protamine Sulfate
C. Idarucizumab
D. Aminocaproic Acid
Correct Answer: B
Rationale: Protamine sulfate is the specific reversal agent for
unfractionated heparin. It binds ionically to heparin molecules to form a
stable, inactive salt complex, neutralizing its anticoagulant properties
within minutes. Vitamin K reverses Warfarin; Idarucizumab reverses
dabigatran; Aminocaproic acid is an antifibrinolytic used to stop clot
breakdown.
9. Which clinical condition represents an absolute
contraindication to the placement of an indwelling Inferior Vena
Cava (IVC) filter?
RADIOLOGY 2025 to 2026 COMPLETE
STUDY GUIDE KEY CONCEPTS
PRACTICE QUESTIONS and EXAM
PREPARATION
Vascular Interventional Radiology (VI) Registry Study Guide
Module 1: Patient Care & Pharmacology (Questions 1–15)
1. Which of the following laboratory values represents the most
critical contraindication for performing a high-risk arterial
intervention according to standard Society of Interventional
Radiology (SIR) guidelines?
A. Platelet count of 120,000/µL
B. Hemoglobin of 10.5 g/dL
C. International Normalized Ratio (INR) of 2.1
D. Serum creatinine of 1.1 mg/dL
Correct Answer: C
Rationale: An INR of 2.1 indicates significant anticoagulation or
coagulopathy. For high-risk vascular interventions (such as arterial
punctures, TIPS, or biliary drainage), SIR guidelines recommend correcting
the INR to less than 1.5 to minimize the risk of severe access-site or
systemic hemorrhage. A platelet count of 120,000/µL is adequate
(threshold is typically <50,000/µL), and mild anemia does not preclude a
procedure.
2. A patient experiences an immediate anaphylactoid reaction
with profound laryngospasm and a blood pressure drop to 70/40
mmHg following contrast injection. What is the immediate first-
line pharmacological treatment?
A. Diphenhydramine 50 mg IV push
B. Epinephrine 0.3 mg IM (1:1,000 concentration)
C. Hydrocortisone 100 mg IV push
D. Atropine 0.5 mg IV push
, Correct Answer: B
Rationale: Epinephrine is the primary drug of choice for severe, life-
threatening anaphylactic or anaphylactoid reactions presenting with airway
compromise (laryngospasm/bronchospasm) or hemodynamic collapse.
Giving it intramuscularly (IM) in the lateral thigh provides rapid, reliable
absorption. Antihistamines and corticosteroids are secondary medications
because they act too slowly to secure an airway or reverse acute distributive
shock. Atropine is used for vagal bradycardia, not anaphylaxis.
3. To minimize the risk of Contrast-Induced Nephropathy (CIN)
in a patient with a baseline eGFR of 35 mL/min/1.73m², which
pre-procedural management strategy is most effective?
A. Restricting all fluid intake for 12 hours prior to the procedure
B. Intravenous hydration with 0.9% Normal Saline prior to and
following the contrast exposure
C. Prophylactically administering high-dose loop diuretics immediately
before access
D. Switching the contrast agent from non-ionic iodinated contrast to
Gadolinium
Correct Answer: B
Rationale: Controlled intravenous hydration with isotonic fluids (0.9%
Normal Saline or Sodium Bicarbonate) remains the gold standard for
reducing the risk of CIN in patients with renal insufficiency. Fluid
restriction or volume depletion increases contrast concentration in the
renal tubules, exacerbating toxicity. Diuretics can worsen dehydration
unless the patient is in fluid overload. Gadolinium is not an acceptable or
safe substitute for high-volume arterial imaging due to the risk of
Nephrogenic Systemic Fibrosis (NSF) and poor spatial resolution.
4. A patient under moderate sedation becomes
uncommunicative, and their pulse oximeter reads 82% on room
air with a respiratory rate of 5 breaths per minute. If the patient
received Fentanyl and Midazolam, which reversal agent should
be administered first?
A. Flumazenil 0.2 mg IV
B. Naloxone 0.4 mg IV
C. Protamine Sulfate 50 mg IV
D. Neostigmine 1.0 mg IV
, Correct Answer: B
Rationale: Respiratory depression under moderate sedation is most
commonly driven by opioid analgesics like Fentanyl. Naloxone is a specific
opioid antagonist that rapidly reverses respiratory depression. Flumazenil
reverses benzodiazepines (like Midazolam) but can trigger withdrawal
seizures in chronic users; it should be used secondary to addressing the
primary opioid-induced respiratory threat. Protamine reverses heparin,
and neostigmine reverses paralytics.
5. Which medication must be withheld for 48 hours after an
intravascular contrast administration to prevent the
development of life-threatening lactic acidosis if renal failure
occurs?
A. Clopidogrel
B. Lisinopril
C. Warfarin
D. Metformin
Correct Answer: D
Rationale: Metformin is cleared exclusively by the kidneys. If a patient
experiences a drop in renal function or CIN following iodinated contrast
exposure, Metformin can accumulate in the body, leading to Metformin-
associated lactic acidosis (MALA), which carries a high mortality rate. It
must be held at the time of the procedure and for 48 hours post-procedure,
and only restarted after normal renal function is verified.
6. According to the Universal Protocol for preventing wrong-site
or wrong-procedure errors, when must the clinical "Time Out"
be executed?
A. Immediately upon the patient's arrival in the holding area
B. Before the patient is transferred from the stretcher to the angiographic
table
C. Immediately prior to skin incision or needle puncture with all
active team members participating
D. Right after the first diagnostic digital subtraction angiography (DSA) run
is acquired
Correct Answer: C
Rationale: The "Time Out" must be conducted immediately before the
start of the invasive portion of the procedure (incision or initial needle
, stick). It requires active verbal agreement from all team members
(physician, technologist, nurse) to confirm the correct patient identity,
correct procedure, correct side/site, and availability of required implants.
7. What is the classic clinical triad of symptoms that defines
Post-Embolization Syndrome (PES) following a solid organ or
tumor embolization?
A. Hypotension, bradycardia, and skin rash
B. Pain, low-grade fever, and nausea/vomiting
C. Hematuria, flank pain, and hypertension
D. Dyspnea, chest tightess, and hemoptysis
Correct Answer: B
Rationale: Post-embolization syndrome is a common, localized
inflammatory response resulting from tissue ischemia, cellular death, and
tumor necrosis after an embolization procedure. It is characterized by
localized pain, low-grade fever, and gastrointestinal distress
(nausea/vomiting). It is managed supportively with analgesics and
antiemetics, and should not be confused with systemic infection.
8. A patient on continuous unfractionated heparin requires an
urgent intervention. If their Activated Clotting Time (ACT) is 350
seconds, what medication can be administered to directly
neutralize the heparin effect?
A. Vitamin K
B. Protamine Sulfate
C. Idarucizumab
D. Aminocaproic Acid
Correct Answer: B
Rationale: Protamine sulfate is the specific reversal agent for
unfractionated heparin. It binds ionically to heparin molecules to form a
stable, inactive salt complex, neutralizing its anticoagulant properties
within minutes. Vitamin K reverses Warfarin; Idarucizumab reverses
dabigatran; Aminocaproic acid is an antifibrinolytic used to stop clot
breakdown.
9. Which clinical condition represents an absolute
contraindication to the placement of an indwelling Inferior Vena
Cava (IVC) filter?
