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The IR/DR exam has 178 questions and runs 3 hours 13 minutes.
These 10 free IR/DR questions are organized by exam domain, so you can see how each part of the Interventional Radiology/Diagnostic Radiology blueprint is tested. Reveal the answer and explanation under each question.
An untreated 18-mm hepatic observation in a woman with hepatitis C cirrhosis shows nonrim arterial hyperenhancement on gadoxetate-enhanced MRI. There is no prior study. Before assigning LR-5, the radiologist reviews the remaining sequences. Which finding, combined with the arterial enhancement, would establish that category?
Correct answer: A - Nonperipheral washout in the portal venous phase
An 11-month-old with episodic crying, vomiting, and a blood-streaked stool has ileocolic intussusception on ultrasound. Mural perfusion is preserved. After fluids, the infant is alert and stable, with no peritoneal signs or pneumoperitoneum. How should the intussusception initially be treated?
Correct answer: A - Image-guided enema reduction with surgical backup available
Six hours after the sudden onset of left foot pain, a patient with atrial fibrillation has a cold foot, sensory loss extending beyond the toes, and mild weakness of ankle dorsiflexion. Arterial Doppler signals are absent, but a venous signal remains audible. There is no fixed mottling or muscle rigor. Intravenous unfractionated heparin has been started. Which pairing correctly describes limb viability and the required urgency?
Correct answer: D - Rutherford IIb: immediately threatened; immediate revascularization is required
Bleeding from a posterior duodenal-bulb ulcer recurs after proximal gastroduodenal artery coil embolization. Repeat celiac angiography confirms occlusion at the coil pack without extravasation. Which vessel should be interrogated next for collateral supply to the bleeding territory?
Correct answer: D - Superior mesenteric artery
A 61-year-old man with cirrhosis has a second fundal gastric-variceal hemorrhage despite prior endoscopic treatment. Bleeding is now controlled. He has also had recurrent overt encephalopathy despite lactulose and rifaximin. CT shows a large gastrorenal shunt communicating with the varices, patent portal and splenic veins, and no ascites. Endoscopy shows only small esophageal varices. Which intervention best addresses both the rebleeding risk and the shunt-associated encephalopathy?
Correct answer: C - Retrograde transvenous variceal obliteration
A 52-year-old woman with confirmed primary aldosteronism wishes to pursue surgery. CT shows a 1.6-cm right adrenal nodule and a normal-appearing left adrenal gland; overnight dexamethasone testing shows appropriate cortisol suppression. During cosyntropin-stimulated adrenal venous sampling, aldosterone (ng/dL) and cortisol (µg/dL), respectively, are: right adrenal vein 2,400 and 800; left adrenal vein 1,800 and 100; inferior vena cava 40 and 10. Using a selectivity index greater than 5 and a lateralization index of at least 4, what does this study support?
Correct answer: C - Left-sided secretion; left adrenalectomy is supported
Seven days after esophagectomy, a patient continues to drain 900 mL of cloudy pleural fluid daily. Enteral nutrition has been withheld for the preceding 72 hours. Pleural triglycerides are 82 mg/dL and cholesterol is 58 mg/dL. The team remains concerned about a lymphatic leak despite the triglyceride concentration being below 110 mg/dL. Which additional test would establish whether the fluid is chyle?
Correct answer: B - Pleural-fluid chylomicron analysis
A 67-year-old woman has fever, rigors, hypotension, and right hydronephrosis above an impacted 9-mm proximal ureteral stone. Broad-spectrum intravenous antibiotics and resuscitation have been initiated. Retrograde stent placement fails because the stone cannot be crossed. Platelets are 168,000/µL and INR is 1.1. Ultrasound identifies a safe posterior calyceal access route. What should the interventional radiologist do now?
Correct answer: B - Place a nephrostomy, then remove the stone after infection resolves
Metformin instructions are requested before an abdominal CT with intravenous iodinated contrast. The 59-year-old patient has a stable eGFR of 46 mL/min/1.73 m² and no acute kidney injury. No sedation or arterial catheterization is planned. Following ACR recommendations, what should the patient be told?
Correct answer: B - Continue metformin at the usual scheduled doses
A first radioembolization treatment for unresectable HCC is being planned with SIR-Spheres Y-90 resin microspheres under the U.S. prescribing information. The proposed activity is 3.2 GBq, the MAA lung shunt fraction is 18%, and the patient-specific lung mass is 0.75 kg. Other eligibility and nontarget-flow checks are satisfactory. Use lung dose (Gy) = 49.67 × activity reaching the lungs (GBq) / lung mass (kg). Which dose estimate and treatment decision follow from these data?
Correct answer: A - 38.1 Gy; revise the activity prescription before treatment
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