Semin intervent Radiol 2018; 35(03): C1-C5
DOI: 10.1055/s-0038-1661346
Post-Test Questions
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Post-Test Questions

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Publication History

Publication Date:
06 August 2018 (online)

Article 1 (153–159)

  1. Clinically significant portal hypertension is defined as hepatic venous pressure gradient (HVPG) of:

    • HVPG > 5 mm Hg.

    • HVPG > 10 mm Hg.

    • HVPG > 8 mm Hg.

    • HVPG > 0 mm Hg.

  2. Early re-bleeding after esophageal variceal bleed is associated with:

    • large esophageal varices seen on endoscopy.

    • HVPG > 20 mm Hg.

    • 'red whale' signs.

    • platelet count < 50.

  3. Median survival after an episode of hepatic encephalopathy is:

    • 2 years.

    • 6 months.

    • 5 years.

    • 1 year.

    Article 2 (160–164)

  4. What is the most common cause of portal hypertension in the pediatric population?

    • Chronic liver disease.

    • Budd-Chiari.

    • Extrahepatic portal vein occlusion (EHPVO).

    • Arterioportal istula.

  5. What is the curative treatment for EHPVO, reestablishing irst-pass portal perfusion?

    • Coronario-caval shunt.

    • Proximal splenorenal shunt.

    • Distal splenorenal (“Warren shunt”).

    • Mesenterico-LPV (Rex) shunt.

  6. Which of the following is false regarding preoperative planning prior to a Meso-Rex shunt?

    • A transjugular liver biopsy is often performed during the wedged hepatic venograms to exclude underlying liver disease.

    • Cross-sectional (CT/MR) imaging is superior to hepatic wedged venograms in delineating the intrahepatic portal venous system.

    • Direct puncture portal venography is not commonly performed to delineate the intrahepatic portal venous system.

    • Wedged venograms in the left and middle hepatic vein are most likely to show patency of the left portal vein.

    Article 3 (165–168)

  7. Compared to paracentesis, the placement of a TIPS for refractory ascites has been shown associated with all of the following except:

    • Improved control of ascites.

    • Improved post-transplant outcomes.

    • Improved transplant-free survival.

    • Increased incidence of hepatic encephalopathy.

  8. Current guidelines recommend which therapy as first line treatment for refractory ascites?

    • Denver (peritoneovenous) shunt.

    • Large volume paracentesis.

    • Transjugular intrahepatic portosystemic shunt.

    • Liver transplantation.

  9. Which of the following is not a mechanism by which TIPS placement helps to control ascites?

    • Alleviation of sinusoidal obstruction.

    • Decrease in the portal pressure.

    • Increase in right heart preload and cardiac output.

    • Upregulation of the renin-angiotensin system.

    Article 4 (169–184)

  10. Compared to esophageal varices, gastric varices are:

    • More likely drained “downhill” by a gastrorenal shunt.

    • More likely drained “uphill” by the azygos/ hemiazygos system.

    • More likely supplied by left gastric vein (coronary vein).

    • More likely to bleed.

  11. Which of the following is not a generally accepted indication for BRTO?

    • Secondary prevention recurrent of GV hemorrhage.

    • Patients with GVH and elevated MELD (>18) who are poor candidates for TIPS creation.

    • Primary prophylaxis of GV hemorrhage.

    • Patients with GVH and severe hepatic encephalopathy who are poor candidates for TIPS creation.

  12. Compared to BRTO alone, the proposed benefits of adding TIPS to BRTO include:

    • Reduced rates of new or worsening ascites following BRTO.

    • Reduced rates of esophageal variceal aggravation following BRTO.

    • Reduced rates of new or worsening hepatic hydrothorax following BRTO.

    • All of the above.

    Article 5 (185–193)

  13. In general, what types of bleeding varices are referred for RTO rather than endoscopic management?

    • Slow-flow esophageal varices.

    • High-flow esophageal varices.

    • Slow-low gastric varices

    • Large fundal or cardiac gastric varices with rapid flow.

  14. Which of the following is not a potential contraindication to shunt obliteration?

    • Uncompensated MPV thrombosis.

    • Large volume intractable ascites.

    • HCC > 5 cm.

    • Cirrhosis.

  15. Which of the following is not a potential advantage of RTO over TIPS?

    • Improved HE.

    • Performed in patients with compromised hepatic function.

    • Improved esophageal varices.

    • Less invasive.

    Article 6 (194–197)

  16. Which of the following meds are used in the United States in the treatment of hepatorenal syndrome?

    • Terlipressin.

    • Midodrine and octreotide.

    • Norepinephrine.

    • Vasopressin.

  17. What is the median survival for the patients diagnosed with hepatorenal syndrome type 2?

    • 3 months.

    • 6 months.

    • 12 months.

    • 18 months.

  18. What percent of patients with HRS will develop hepatic encephalopathy after Transjugular Intrahepatic Portosystemic Shunt creation?

    • 12%

    • 27%

    • 49%

    • 73%

    Article 7 (198–202)

  19. What is not an imaging feature of malignant thrombus?

    • Enhancing thrombus.

    • Evidence of portal vein invasion.

    • Calciication within the thrombus.

    • Doppler flow within the thrombus.

  20. What is the irst line treatment for acute portal vein thrombosis?

    • Observation.

    • Antiplatelet therapy.

    • Surgery.

    • Anticoagulation.

  21. What endovascular techniques have been described to treat acute portal vein thrombosis?

    • Catheter directed ibrinolytic therapy alone.

    • Mechanical thrombectomy alone.

    • Combination of mechanical thrombectomy and ibrinolytic therapy.

    • All of the above.

    Article 8 (203–205)

  22. Compared to patients without portal hypertension undergoing abdominal surgery, patients with portal hypertension have a relatively higher risk of all of the following EXCEPT:

    • Intra-abdominal hemorrhage.

    • Peritonitis.

    • Adhesions.

    • Liver failure.

  23. According to the authors, when should preoperative TIPS be placed in the setting of ascites?

    • Immediately before surgery as a reduction in the portosystemic gradient occurs immediately after TIPS placement.

    • The most appropriate timing for preoperative TIPS placement is difficult to definitively conclude, but based on the reviewed studies, TIPS should be 5 to 7 days before surgery.

    • The most appropriate timing for preoperative TIPS has not been studied.

    • At least several weeks before surgery.

  24. Since progressive liver failure was the most common cause of death among patients with preoperative TIPS in several studies reviewed in this article, the authors recommend preoperative TIPS should be limited to those:

    • Without ascites.

    • With a hepatic venous pressure gradient <30.

    • In Child class A or B.

    • In Child class C only.

    Article 9 (206–214)

  25. In comparison to TIPS performed without ICE guidance, TIPS performed with ICE has which of the following significant differences in procedure-related outcomes?

    • Increased radiation exposure.

    • Increased iodinated contrast volume usage.

    • Decreased risk of capsular perforation.

    • Decreased risk of vascular access complications.

    • All of the above.

  26. Placement of a controlled expansion TIPS should be considered in elective cases in patients with:

    • Age greater than 65 years.

    • Multiple comorbid conditions.

    • Elevated baseline ammonia levels.

    • Prior episodes of hepatic encephalopathy.

    • All of the above.

  27. Despite a high technical success rate and low risk of complications, transsplenic access for PVR-TIPS may not be feasible in:

    • Long segment chronic splenic vein thrombosis.

    • Diminutive portal veins.

    • Splenomegaly due to portal hypertension.

    • All of the above.