Post-Test Questions

This section provides a review. Mark each answer on the Post-Test Answer/Evaluation Form (see page C–5)

Article One (pp. 247–255)

1. Based on the Light criteria, fluid is considered exudative if one of the following criteria is present:

   • Pleural fluid to serum protein ratio <0.5

   • Pleural fluid to serum LDH ratio <0.6

   • Pleural fluid LDN concentration <200 U/L

   • Pleural fluid LDH concentration more than two thirds the upper limit of normal for serum LDH

2. Theoretical advantages of large-bore chest drains include which of the following?

   • Less painful to insert

   • Lower incidence of empyema

   • Better tolerated once placed

   • Lower incidence of drain blockage

3. Indications for removal of a chest drain includes which of the following?

   • Persistent air leak after chest drain insertion for pneumothorax

   • Persistent pneumothorax on chest X-ray

   • Persistent pleural effusion of chest X-ray

   • Output <30 mL/24 hours after chest drain insertion for exudative pleural effusion

   Article Two (pp. 256–263)

4. Organs considered safe to transverse during percutaneous catheter drainage include which of the following?

   • Pancreas

   • Liver

   • Spleen

   • Small bowel

5. For a transgluteal approach, the catheter should be placed:

   • As far from the sacrum as possible

   • At the level of or below the sacrospinous ligament

   • Above the sacrospinous ligament

   • At the level of the piriformis

6. Regarding the revised Atlanta classification of pancreatitis, which of the following is true?

   • Acute peripancreatic fluid collections occur after 4 weeks of the onset of pancreatitis

   • Pseudocysts occur within 4 weeks of the onset of pancreatitis

   • Acute necrotic collections occur within 4 weeks of the onset of pancreatitis

   • Walled-off necrosis occurs within 4 weeks of the onset of the pancreatitis

   Article Three (pp. 264–269)

7. The major goal of using intracavitary lytic therapy following percutaneous catheter placement is:

   • To improve the healing of a fistula

   • To improve the underlying function of a solid organ obtaining an abscess

   • To avoid surgery

   • None of the above

8. A reasonable formula for the instillation of tPA into an empyema includes:

   • 50 mg of tPA in 50 cc 0.9% NS

   • 4 to 6 mg tPA in 25 to 50 cc 0.9% NS

   • 2 to 8 mg tPA in 10 cc 0.9% NS

   • 5 mg tPA in 20 cc hypertonic saline

   • All of the above

9. Giving intracavitary tPA into either the pleural or abdominal space is contraindicated in patients receiving full systemic anticoagulation. True or false?

   Article Four (pp. 270–285)

10. The indications for arthrocentesis include:

    • Diagnosis of septic arthritis or crystal-based arthritides

    • Diagnosis of bone or ligamentous injury by confirmation of blood within a joint

    • Relief of pain via decompression of an acute effusion or hemarthrosis

    • All of the above

11. The advantages of using ultrasound for image-guided aspiration include all of the following, except:

    • No ionizing radiation exposure for patients and operator

    • Successful demonstration of fluid collections is user independent

    • Identification of vascular structures in real time

    • Ability to evaluate the contralateral side for symmetry

12. Which of the following statements is true when considering a sarcoma mimicking a benign fluid collection in the extremities?

    • The preferred approach for accessing the fluid collection should always be the shortest route

    • Magnetic resonance imaging is always sufficient in differentiating benign collections such as hematomas and abscesses from sarcomas

    • Aspiration should be performed in close consultation with an orthopedic surgeon who would remove the sarcoma because the needle track will need to be resected along with the tumor and hence will affect the surgeon's approach

    • A history of trauma excludes neoplasm when a hemorrhagic soft tissue mass is encountered on MRI

    Article Five (pp. 286–294)

13. Which of the following is not a recognized form of pancreatic infections in children?

    • Walled-off pancreatic necrosis

    • Infected pancreatic pseudocyst

    • Pancreatic macrocyst

    • Infected necrosis

    • All of the above

14. Which of the following should prompt follow-up imaging for patients with abdominal or pelvic drains in place?

    • Persistent fever

    • Continued drain output significantly beyond what is expected

    • Lack of clinical improvement

    • All of the above

    • None of the above

15. Which of the following is not a known risk for pyogenic liver abscesses in children?

    • Chronic granulomatous disease

    • Lymphoma

    • Diabetes mellitus

    • Portal sepsis from gastrointestinal sources

    • All of the above are known to be risk factors

    Article Six (pp. 295–300)

16. When may percutaneous drainage of cystic lesions be most appropriate?

    • When they enlarge

    • When they become symptomatic

    • When they bleed

    • When they undergo torsion

    • All of the above

17. Which of the following answers describing alcohol sclerosis of cystic lesions is correct?

    • Patients should roll on all sides for 3 to 4 hours to better allow diffusion of the alcohol

    • Fevers up to 39°C are typical

    • Care should be taken to be certain that the catheter is alcohol compatible

    • The total amount of alcohol instilled should equal the amount of cystic fluid initially aspirated

    • All of the above are correct

18. Which of the following have been used for renal cyst sclerosis?

    • Povidine-iodine

    • Hypertonic saline

    • Ethanolamine oleate

    • Sodium tetradecyl

    • All of the above

    Article Seven (pp. 301–310)

19. Common primary malignancies that metastasize to the spleen include all of the following except:

    • Renal

    • Ovary

    • Breast

    • Colon

    • Lung

20. Which of the following are absolute contraindications to splenic biopsy?

    • Uncorrectable coagulopathy

    • Cardiopulmonary compromise

    • Uncooperative patient

    • Hemodynamic instability

    • None of the above

21. Core needle biopsies provide a more accurate diagnosis than fine-needle aspiration alone. True or false?

    Article Eight (pp. 311–313)

22. When feasible, percutaneous drainage procedures should precede surgery for abscesses involving all of the following disease states except:

    • Crohn disease

    • Colon cancer

    • Appendicitis

    • Diverticulitis

    • None of the above

23. What is the interval between percutaneous drainage of abscesses and definitive surgery for patients?

    • For patients with Crohn disease, intervals vary from 8 days to 1 year

    • For patients with diverticulitis, intervals are 10 days to 6 weeks

    • For patients with appendicitis, intervals are 6 weeks to 3 months

    • All of the above

    • None of the above

24. Advantages of percutaneous drainage procedures prior to surgery include:

    • Allowing surgeons to perform a one-stage instead of a two-stage procedure more frequently

    • Reduced morbidity and mortality

    • Avoidance of surgery altogether

    • Maximizing medical comorbidities to improve surgical outcomes

    • All of the above

    Article Nine (pp. 314–318)

25. Drainage of pancreatic fluid collections are not indicated in which of the following?

    • Mass effect from the collection

    • Uncomplicated 4-cm fluid collection

    • Pancreatic abscess in an otherwise healthy individual

    • Painful hemorrhagic fluid collections

    • All should be drained

26. Which of the following is true regarding pseudoaneurysms (PSAs) associated with the pancreas?

    • CT imaging is generally not helpful in differentiating PSAs from other fluid collections

    • Because the PSA is deep within the structure of the pancreas, interventional radiologic techniques have no role in their management

    • They are generally incidentally noted, and treatment is not indicated

    • They are almost always due to pancreatitis

    • None of the above

27. Possible access windows for percutaneous placement of drainage catheters include all of the following except:

    • Transgastric

    • Transduodenal

    • Transperitoneal

    • Transhepatic

    • None of the above because all are potential pathways

    Article Ten (pp. 319–328)

28. Combined FNA and core biopsy yields a diagnosis in what percentage of patients?

    • 75%

    • 80%

    • 85%

    • 90%

    • 95%

29. In the setting of nondiagnostic biopsy, what percentage of repeat biopsies will yield a diagnosis?

    • 25%

    • 33%

    • 50%

    • 75%

    • None of the above

30. Regarding ground-glass opacities (GGO), all of the following are true except:

    • Diagnostic yield for percutaneous biopsy is lower than for solid pulmonary nodules

    • Of the subtypes, minimally invasive adenocarcinoma (MIA) typically has the greatest solid component

    • Core biopsies yield better diagnosis rates than FNA alone

    • The length of the needle path does not appear to be contributory to the overall diagnostic accuracy rate

    • All of the above are true