Several hours after a femoral puncture, a patient develops back and flank pain, hypotension and a falling haemoglobin, with no visible groin swelling. The most likely diagnosis is:

Pseudoaneurysm of the radial artery

A DSA run of the lower limb shows blurred bone edges around the vessels. The most likely cause is:

Patient movement between mask and contrast

A faulty collimator limiting the beam field

Excessive kilovoltage chosen for the whole run

An empty contrast syringe during the injection

During a coronary or peripheral intervention given with heparin, the activated clotting time (ACT) is 280 seconds when the operator wants to remove the sheath. The usual practice is to:

Wait until ACT is under about 180 s, or reverse heparin

Remove the sheath and then give vitamin K to stop bleeding

Remove the sheath at once as the procedure is finished

Double the heparin dose before removing the sheath

After a femoral angiogram, the nurse reports that the patient's foot is pale and cool, and the pedal pulses are weaker than before the procedure. This suggests:

Arterial occlusion or embolus needing urgent review

A vasovagal reaction to the groin pressure

An allergic reaction to the contrast medium

A normal finding that needs no further action at all

Angiography and interventional procedures

40 Gulf Prometric Radiographer (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Angiography and interventional procedures, part of Angiography and Fluoroscopy. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Several hours after a femoral puncture, a patient develops back and flank pain, hypotension and a falling haemoglobin, with no visible groin swelling. The most likely diagnosis is:
1. AContrast allergy
2. BSimple groin bruising
3. CRetroperitoneal haemorrhage
4. DPseudoaneurysm of the radial artery
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Answer: C · Retroperitoneal haemorrhage
A puncture above the inguinal ligament lets blood escape into the retroperitoneal space, where it can hide a large volume without visible swelling. Flank or back pain with hypotension and a falling haemoglobin should prompt urgent imaging and resuscitation.
- A: Contrast allergy does not cause a falling haemoglobin.
- B: Simple bruising does not produce shock.
- D: A radial artery lesion is not related to a femoral access.
Remember this
Back or flank pain with hypotension after femoral puncture suggests retroperitoneal bleeding.
Question 2 · Medium
Carbon dioxide is used as an angiographic contrast agent in patients with renal impairment. It should be injected only:
1. AInto the coronary arteries
2. BInto the vertebral arteries
3. CBelow the diaphragm
4. DInto the carotid arteries
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Answer: C · Below the diaphragm
CO2 is not nephrotoxic and not allergenic, but it is a gas that can embolise and cause neurological injury if it reaches the brain, and it can cause cardiac or coronary effects. It is therefore confined to vessels below the diaphragm.
- A: Coronary injection risks arrhythmia and ischaemia.
- B: Vertebral injection risks posterior circulation infarction.
- D: Carotid injection risks air embolism in the brain.
Remember this
CO2 angiography is limited to arteries below the diaphragm because of cerebral and cardiac risk.
Question 3 · Medium
A DSA run of the lower limb shows blurred bone edges around the vessels. The most likely cause is:
1. AA faulty collimator limiting the beam field
2. BExcessive kilovoltage chosen for the whole run
3. CPatient movement between mask and contrast
4. DAn empty contrast syringe during the injection
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Answer: C · Patient movement between mask and contrast
Misregistration between the mask and later frames leaves bone and soft-tissue edges unsubtracted, which gives ghost artefacts that hide vessels. Clear breath-holding or limb immobilisation instructions reduce it, and the mask can be reselected or pixel-shifted afterwards.
- A: A faulty collimator would alter the field and not the registration.
- B: Kilovoltage does not create subtraction artefacts of this type.
- D: An empty syringe would give no vessel opacification at all.
Remember this
Motion between mask and contrast frames causes misregistration artefacts in DSA.
Question 4 · Hard
During a coronary or peripheral intervention given with heparin, the activated clotting time (ACT) is 280 seconds when the operator wants to remove the sheath. The usual practice is to:
1. ARemove the sheath and then give vitamin K to stop bleeding
2. BWait until ACT is under about 180 s, or reverse heparin
3. CRemove the sheath at once as the procedure is finished
4. DDouble the heparin dose before removing the sheath
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Answer: B · Wait until ACT is under about 180 s, or reverse heparin
Procedural heparin keeps ACT above about 250 seconds, which would cause bleeding at the arteriotomy if the sheath were removed. The sheath stays until ACT has fallen to a safer level, typically 150 to 180 seconds, or the heparin is reversed with protamine as ordered.
- A: Vitamin K does not reverse heparin.
- C: Removing the sheath at a high ACT risks haemorrhage.
- D: More heparin would further increase bleeding risk.
Remember this
Remove sheaths only after ACT falls to about 150 to 180 seconds, or after protamine reversal.
Question 5 · Medium
After a femoral angiogram, the nurse reports that the patient's foot is pale and cool, and the pedal pulses are weaker than before the procedure. This suggests:
1. AA vasovagal reaction to the groin pressure
2. BAn allergic reaction to the contrast medium
3. CA normal finding that needs no further action at all
4. DArterial occlusion or embolus needing urgent review
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Answer: D · Arterial occlusion or embolus needing urgent review
A pale, cool foot with reduced pulses after arterial puncture points to arterial thrombosis, dissection or embolism downstream. Limb perfusion is at risk, and the interventional radiologist is called urgently. Baseline pulses are recorded before the procedure for comparison.
- A: A vasovagal reaction gives bradycardia and hypotension, not a cold limb.
- B: Contrast allergy does not cause a localised cold, pulseless limb.
- C: Reduced perfusion is never a normal finding.
Remember this
A cold, pale limb with weak pulses after arterial puncture is an emergency requiring urgent review.
Question 6 · Medium
A pulsatile groin mass with an audible bruit appears two days after a femoral angiogram. This is most consistent with:
1. AAn inguinal hernia
2. BA reactive lymph node
3. CA femoral pseudoaneurysm
4. DA simple, non-pulsatile haematoma
Answer and explanation in LearnFree account
Question 7 · Easy
The most common minor complication at a femoral puncture site is:
1. ARenal artery occlusion
2. BHaematoma
3. CInfection of the brain
4. DPulmonary embolism
Answer and explanation in LearnFree account
Question 8 · Medium
Gelatin sponge (Gelfoam) used in embolisation is classed as:
1. AA contrast medium
2. BA permanent liquid embolic
3. CA temporary embolic agent
4. DA permanent metallic coil
Answer and explanation in LearnFree account
Question 9 · Easy
In digital subtraction angiography, the mask image is:
1. AAn image taken after the catheter is removed
2. BA reduced-resolution copy of the contrast image
3. CA pre-contrast image subtracted from the contrast images
4. DAn image with the contrast diluted
Answer and explanation in LearnFree account
Question 10 · Medium
Compared with fluoroscopy, cine or DSA acquisition runs in angiography usually deliver:
1. ANo ionising radiation, as it uses stored images
2. BExactly the same dose rate as fluoroscopy
3. CA slightly lower dose rate than fluoroscopy alone
4. DA much higher dose rate to the patient
Answer and explanation in LearnFree account
Question 11 · Medium
Protamine sulfate is given after some interventional procedures to:
1. AReverse the effect of heparin
2. BReverse the effect of warfarin
3. CTreat an allergic contrast reaction
4. DDissolve an existing thrombus
Answer and explanation in LearnFree account
Question 12 · Medium
Which skin preparation is generally recommended before arterial puncture for interventional procedures?
1. ADry shaving the area with no antiseptic at all
2. BPlain soap and water with no antiseptic agent
3. CChlorhexidine in alcohol, allowed to dry
4. DPlain tap water only, applied with sterile gauze
Answer and explanation in LearnFree account
Question 13 · Hard
An hour after sheath removal, a patient's groin swells rapidly and tenses. Blood pressure is falling. After calling the doctor, the first action is to:
1. AApply firm manual pressure above the puncture site
2. BPlace an ice pack on the groin and keep observing it
3. CGive oral analgesia and review the groin in an hour
4. DSit the patient up to ease the breathing, then reassess
Answer and explanation in LearnFree account
Question 14 · Medium
Before an elective diagnostic angiogram by femoral puncture, a patient on warfarin has an INR of 3.6. The department follows SIR 2019 guidance, which accepts an INR of up to about 2.0 to 3.0 for this low-bleeding-risk procedure. The radiographer should:
1. AGive vitamin K at once without waiting for an order
2. BTell the radiologist, as the INR is above the threshold
3. CStart the procedure and watch the groin afterwards
4. DProceed, because the INR is not relevant to this study
Answer and explanation in LearnFree account
Question 15 · Medium
A vascular closure device is used after femoral arterial puncture mainly to:
1. AIncrease the patient's blood pressure to aid flow
2. BRemove residual contrast from the circulation
3. CDilate the artery to ease catheter exchange
4. DSeal the puncture and allow earlier mobilisation
Answer and explanation in LearnFree account
Question 16 · Hard
A 70 kg patient has a serum creatinine of 2.0 mg/dL. Using the maximum acceptable contrast dose formula of 5 mL x weight (kg) / creatinine (mg/dL), with a cap of 300 mL, the limit for this procedure is:
1. A300 mL
2. B140 mL
3. C350 mL
4. D175 mL
Answer and explanation in LearnFree account
Question 17 · Easy
A pigtail catheter is typically chosen for aortography because its:
1. ASide holes allow a fast, large injection safely
2. BClosed end prevents any flow of contrast out
3. CStraight tip allows entry into small branches
4. DBalloon tip occludes the aorta during injection
Answer and explanation in LearnFree account
Question 18 · Easy
After removal of a femoral arterial sheath, the standard way to achieve haemostasis is:
1. AFirm manual pressure over the puncture for 10 to 15 minutes
2. BApplication of a cold pack to the groin for an hour
3. CElevation of the leg alone, without any local pressure
4. DA tight elastic bandage wrapped around the entire thigh
Answer and explanation in LearnFree account
Question 19 · Medium
A patient presents for a cerebral angiogram. During the procedure and recovery, the staff must pay particular attention to:
1. ABlood glucose measurements and nothing else
2. BRegular neurological checks for new deficits
3. CHourly urine output measurement and nothing else
4. DNothing specific beyond the routine observations
Answer and explanation in LearnFree account
Question 20 · Medium
Judkins left and right catheters are designed mainly for:
1. ASelective coronary artery catheterisation
2. BCerebral venography through the jugular vein
3. CBiliary drainage through the liver
4. DLymphangiography of the lower limbs
Answer and explanation in LearnFree account
Question 21 · Hard
A DSA run of the pelvic arteries shows misregistration because the patient moved shortly after the mask was taken. Which correction can often recover the study without repeating the injection?
1. ASelect a different mask or use pixel shifting
2. BDelete the affected contrast frames from the run
3. CReduce the image matrix size of the stored run
4. DRaise the kilovoltage on the stored images
Answer and explanation in LearnFree account
Question 22 · Medium
A soft J-tipped guide wire is preferred for initial vessel entry because it:
1. ADilates the artery while it is being advanced
2. BReduces the risk of vessel wall damage on entry
3. CIs much easier to see on the fluoroscopy monitor
4. DIs stiffer than a straight wire, giving support
Answer and explanation in LearnFree account
Question 23 · Medium
An angiography team prevents air embolism mainly by:
1. AInjecting very quickly to push any bubbles through
2. BRemoving the guide wire as early as possible
3. CKeeping the patient's head raised during every injection
4. DFlushing and de-airing syringes and lines before use
Answer and explanation in LearnFree account
Question 24 · Hard
A patient with a history of heparin-induced thrombocytopenia (HIT) is being prepared for angiography. Which change to the routine is needed?
1. AUse saline flushes and avoid all heparin products
2. BGive an extra bolus of heparin to prevent thrombosis
3. CIgnore the history if the platelet count is normal
4. DUse double-strength heparinised saline for flushing
Answer and explanation in LearnFree account
Question 25 · Medium
The operator can lower scatter exposure to the team during an angiographic procedure with a steep oblique C-arm angle by:
1. AIncreasing the field of view to the maximum available
2. BMoving the detector well away from the patient to widen the air gap
3. CStanding on the tube side, close to the beam entry point
4. DKeeping the detector near the patient and standing on its side
Answer and explanation in LearnFree account

15 more Angiography and interventional procedures questions

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Study Angiography and Fluoroscopy

Angiography and interventional procedures

Several hours after a femoral puncture, a patient develops back and flank pain, hypotension and a falling haemoglobin, with no visible groin swelling. The most likely diagnosis is:

Carbon dioxide is used as an angiographic contrast agent in patients with renal impairment. It should be injected only:

A DSA run of the lower limb shows blurred bone edges around the vessels. The most likely cause is:

During a coronary or peripheral intervention given with heparin, the activated clotting time (ACT) is 280 seconds when the operator wants to remove the sheath. The usual practice is to:

After a femoral angiogram, the nurse reports that the patient's foot is pale and cool, and the pedal pulses are weaker than before the procedure. This suggests:

A pulsatile groin mass with an audible bruit appears two days after a femoral angiogram. This is most consistent with:

The most common minor complication at a femoral puncture site is:

Gelatin sponge (Gelfoam) used in embolisation is classed as:

In digital subtraction angiography, the mask image is:

Compared with fluoroscopy, cine or DSA acquisition runs in angiography usually deliver:

Protamine sulfate is given after some interventional procedures to:

Which skin preparation is generally recommended before arterial puncture for interventional procedures?

An hour after sheath removal, a patient's groin swells rapidly and tenses. Blood pressure is falling. After calling the doctor, the first action is to:

Before an elective diagnostic angiogram by femoral puncture, a patient on warfarin has an INR of 3.6. The department follows SIR 2019 guidance, which accepts an INR of up to about 2.0 to 3.0 for this low-bleeding-risk procedure. The radiographer should:

A vascular closure device is used after femoral arterial puncture mainly to:

A 70 kg patient has a serum creatinine of 2.0 mg/dL. Using the maximum acceptable contrast dose formula of 5 mL x weight (kg) / creatinine (mg/dL), with a cap of 300 mL, the limit for this procedure is:

A pigtail catheter is typically chosen for aortography because its:

After removal of a femoral arterial sheath, the standard way to achieve haemostasis is:

A patient presents for a cerebral angiogram. During the procedure and recovery, the staff must pay particular attention to:

Judkins left and right catheters are designed mainly for:

A DSA run of the pelvic arteries shows misregistration because the patient moved shortly after the mask was taken. Which correction can often recover the study without repeating the injection?

A soft J-tipped guide wire is preferred for initial vessel entry because it:

An angiography team prevents air embolism mainly by:

A patient with a history of heparin-induced thrombocytopenia (HIT) is being prepared for angiography. Which change to the routine is needed?

The operator can lower scatter exposure to the team during an angiographic procedure with a steep oblique C-arm angle by: