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angiogram

Practice targeted AMC-style multiple-choice questions on angiogram.

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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysm coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening neurological deficits. What is the MOST likely cause?

A. Meningitis
B. Coil migration
C. Hemorrhagic conversion
D. Hydrocephalus
E. Vasospasm
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 62-year-old patient presented with a subarachnoid haemorrhage secondary to a ruptured cerebral aneurysm and underwent endovascular coiling. They have recovered well and are on routine follow-up. The image shows a recent angiogram performed as part of their surveillance. Considering the findings, what is the MOST appropriate next step in this patient's management?

A. Continue routine clinical follow-up and discharge from neurosurgical care
B. Initiate long-term anticoagulant therapy
C. Schedule a follow-up CT angiogram in 2 years
D. Refer for psychiatric evaluation for anxiety
E. Plan for repeat endovascular intervention
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening confusion. What is the MOST appropriate next step?

A. Obtain blood cultures and start broad-spectrum antibiotics
B. Increase the dose of her antihypertensive medication
C. Repeat CT angiogram of the head
D. Initiate nimodipine
E. Administer intravenous mannitol
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A. Hydrocephalus
B. Post-operative delirium
C. Re-rupture of the aneurysm
D. Vasospasm
E. Cerebral salt wasting
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old presents with worsening headaches post-aneurysm coiling. The image shows a follow-up angiogram. What is the MOST appropriate next step?

A. Conservative management with analgesia
B. Initiate nimodipine
C. Repeat coiling
D. Start warfarin
E. Prescribe aspirin
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals intact language function and no cognitive deficits. A CT angiogram was performed, followed by endovascular coiling. The provided image shows a post-operative angiogram. Despite the intervention, the patient's hemianopia persists, and her weakness has slightly worsened. What is the MOST appropriate next step in the management of this patient?

A. Administer intravenous thrombolysis with alteplase
B. Prescribe a course of high-dose corticosteroids to reduce cerebral edema
C. Repeat angiography to assess for recanalization or further aneurysm growth
D. Start the patient on nimodipine to prevent vasospasm
E. Initiate dual antiplatelet therapy with aspirin and clopidogrel
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 55-year-old patient presented with a subarachnoid haemorrhage from a ruptured cerebral aneurysm, which was successfully treated with endovascular coiling. They have made a good recovery. The image shows a routine follow-up angiogram performed 6 months post-procedure. Based on the findings demonstrated in the image, what is the MOST appropriate next step in this patient's management?

A. Continue routine clinical follow-up with no further imaging.
B. Discharge home with aspirin and statin.
C. Plan for repeat endovascular intervention.
D. Schedule surgical clipping of the aneurysm.
E. Initiate dual antiplatelet therapy indefinitely.
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A patient with severe lower GI bleeding refractory to colonoscopy requires further management. Which intervention is most appropriate if the bleeding source is suspected in the small bowel or inaccessible colon?

A. Repeat colonoscopy
B. Increased dose of proton pump inhibitor
C. Angiography with potential embolization
D. Capsule endoscopy
E. Surgical resection
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 72-year-old male with a history of atrial fibrillation and well-controlled hypertension presents with acute onset expressive aphasia and right-sided facial droop. A CT angiogram reveals a posterior cerebral artery aneurysm, which was promptly treated with endovascular coiling. The provided image shows the post-operative angiogram. Despite the intervention, the patient's aphasia persists, and the facial droop has worsened. What is the MOST likely cause of the patient's continued and worsening symptoms?

A. Intracranial pressure elevation due to edema
B. Reperfusion injury following aneurysm coiling
C. Underlying progressive neurodegenerative disease
D. Thromboembolic complication during the coiling procedure
E. Vasospasm of the posterior cerebral artery
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A 70-year-old man with a history of atrial fibrillation presents with sudden onset of severe pain, pallor, and coldness in his left leg, extending below the knee. On examination, the leg is cool to touch, pale, and distal pulses (popliteal, dorsalis pedis, posterior tibial) are absent. Sensation is diminished below the ankle, but he can still move his toes slightly. Capillary refill is delayed. Which of the following is the most appropriate initial diagnostic investigation?

A. Arterial duplex ultrasound of the affected limb
B. Venous duplex ultrasound of the affected limb
C. CT angiography of the affected limb
D. Plain film X-ray of the affected limb
E. ECG and cardiac enzymes
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 55-year-old patient presents with a subarachnoid haemorrhage from a ruptured posterior cerebral artery aneurysm. Endovascular coiling is performed without immediate complications. The image shows the post-procedure angiogram obtained before leaving the angiography suite. Based on this finding, what is the MOST appropriate next step in management?

A. Discharge with outpatient follow-up.
B. Proceed to surgical clipping.
C. Schedule repeat digital subtraction angiography in 12 months.
D. Plan for further endovascular intervention.
E. Initiate dual antiplatelet therapy immediately.
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination reveals a left homonymous hemianopia, mild right hemiparesis (4/5 strength), and intact sensation. A CT angiogram was performed, and the patient underwent endovascular coiling. The image shows a follow-up angiogram post-procedure. Despite the intervention, the patient's left homonymous hemianopia persists, and her right hemiparesis has not improved. What is the MOST appropriate next step in the management of this patient?

A. Repeat angiography to assess for recanalization or further aneurysm growth
B. Start rehabilitation therapy and monitor for improvement
C. Order an MRI of the brain to evaluate for ischemic changes
D. Prescribe a course of high-dose corticosteroids to reduce peri-aneurysmal edema
E. Initiate dual antiplatelet therapy with aspirin and clopidogrel
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal subarachnoid hemorrhage is confirmed. The aneurysm was coiled. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A. Rebleeding
B. Hyponatremia
C. Meningitis
D. Hydrocephalus
E. Vasospasm
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A 68-year-old man with a history of diverticulosis presents with recurrent, large volume rectal bleeding. Initial colonoscopy failed to identify or control the source. He remains haemodynamically stable after resuscitation. What is the most appropriate next step in management?

A. Repeat colonoscopy with epinephrine injection
B. Administration of intravenous octreotide
C. Initiation of high-dose proton pump inhibitor therapy
D. Urgent surgical colectomy
E. Angiography with embolization
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