100+ Free ABR IR/DR Practice Questions

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Question 1

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According to the SIR 2019 peri-procedural coagulation guidelines, what is the recommended INR threshold for a high-bleeding-risk procedure such as TIPS or transhepatic biliary drainage?

INR ≤3.0

INR ≤2.5

INR ≤1.5-1.8

INR is not relevant if platelets are normal

to track

2026 Statistics

Key Facts: ABR IR/DR Exam

~500

Total MCQ Items

ABR IR/DR Certifying Examination

1-2 day

Exam Duration

Computer-based test at Pearson VUE

~14-16%

Embolization/Oncology Weight

Largest content domain on 2026 content outline

$1,950

2026 Certifying Fee

ABR IR/DR Certifying Exam

6 yr

Required Training

Integrated IR/DR residency (ACGME) or ESIR + IR year

Pearson VUE

Test Delivery

Computer-based testing at authorized ABR centers

The ABR IR/DR Certifying Exam is a 1-2 day computer-based test administered at Pearson VUE with ~500 single-best-answer MCQs. The 2026 content outline covers IR clinical principles (~8-10%), vascular access (~6-8%), arterial interventions (~12-14%), venous interventions (~10-12%), embolization/oncology (~14-16%), hemodialysis access (~4-6%), GU/GI drains (~8-10%), neuro IR (~6-8%), pediatric/women's health/trauma (~8-10%), and renal/lymphatic/DR overview (~10-12%). IR/DR Certifying fee is ~$1,950; requires ACGME Integrated IR/DR Residency or ESIR + IR year.

Sample ABR IR/DR Practice Questions

Try these sample questions to test your ABR IR/DR exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1According to the SIR 2019 peri-procedural coagulation guidelines, what is the recommended INR threshold for a high-bleeding-risk procedure such as TIPS or transhepatic biliary drainage?

A.INR ≤3.0

B.INR ≤2.5

C.INR ≤1.5-1.8

D.INR is not relevant if platelets are normal

Explanation: SIR 2019 Category 2 (high-bleeding-risk) procedures — TIPS, PTBD, RFA, visceral biopsy, PCN — require INR ≤1.5-1.8 and platelets ≥50,000/µL. Category 1 (low-bleeding-risk, e.g., dialysis access, drain exchange, PICC) allow INR ≤2.0-3.0 and platelets ≥20-30K.

2How many days before a high-bleeding-risk IR procedure should warfarin generally be held?

A.2 days

B.1 day

C.5 days

D.10 days

Explanation: Warfarin is held 5 days before high-bleeding-risk procedures, with INR confirmation to ≤1.5-1.8 the day of the procedure. DOACs are held 24-48 hours (longer with reduced CrCl). Clopidogrel is held 5 days; prasugrel 7 days; ticagrelor 5 days. Aspirin may usually be continued.

3Apixaban (a DOAC) should be held for how long before a high-bleeding-risk procedure in a patient with normal renal function?

A.7 days

B.2 hours

C.5 days

D.24-48 hours

Explanation: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are held 24-48 hours before high-bleeding-risk procedures with normal renal function; longer intervals (48-96 hours) are required when CrCl is reduced, especially for dabigatran which is predominantly renally cleared.

4A patient on daily aspirin 81 mg is scheduled for a percutaneous nephrostomy. Per SIR 2019 guidelines, the most appropriate management is:

A.Bridge with LMWH

B.Hold aspirin for 7 days prior

C.Hold aspirin for 10 days prior

D.Continue aspirin through the procedure

Explanation: Aspirin may be continued through most IR procedures, including PCN, per SIR 2019. Holding aspirin is generally not required and may increase cardiovascular risk. Dual antiplatelet therapy, clopidogrel, and therapeutic anticoagulation require individualized assessment.

5The minimum platelet count recommended by SIR 2019 for most high-bleeding-risk IR procedures is:

A.≥50,000/µL

B.≥20,000/µL

C.≥100,000/µL

D.≥150,000/µL

Explanation: For Category 2 (high-bleeding-risk) procedures, platelets ≥50,000/µL is recommended. Category 1 (low-bleeding-risk) procedures require ≥20,000/µL (or ≥30,000/µL for some intermediate procedures). Platelet transfusion can be used to reach target prior to procedure.

6A patient on therapeutic LMWH (enoxaparin 1 mg/kg BID) needs a PCN. When should the last dose be administered prior to the procedure?

A.4 hours before

B.24 hours before (one full dose held)

C.12 hours before

D.48 hours before

Explanation: Therapeutic LMWH: hold 24 hours (one full dose) before high-bleeding-risk procedures. Prophylactic-dose LMWH can be held 12 hours before. Unfractionated IV heparin is held 4-6 hours before with normalization of aPTT.

7During moderate sedation for a tunneled dialysis catheter placement, the patient becomes apneic after midazolam and fentanyl administration. Which reversal combination is most appropriate?

A.Naloxone only

B.Flumazenil only

C.Flumazenil and naloxone

D.Physostigmine

Explanation: Respiratory depression from combined benzodiazepine-opioid sedation is reversed with flumazenil (for midazolam, 0.2 mg IV up to 1 mg) and naloxone (for fentanyl, 0.04-0.4 mg IV titrated). Caution: flumazenil may precipitate seizures in chronic benzodiazepine users and naloxone causes acute withdrawal in chronic opioid users.

8Antibiotic prophylaxis with a first-generation cephalosporin is routinely indicated for which IR procedure?

A.Uncomplicated PICC placement

B.Diagnostic angiography

C.Tunneled central venous catheter placement

D.Ultrasound-guided paracentesis

Explanation: Routine prophylactic antibiotics are indicated for procedures with high infection risk: tunneled catheters/ports, biliary interventions, PCN in obstructed systems, genitourinary instrumentation with stones/stasis, uterine artery embolization, and embolization with necrosis risk. Diagnostic angiography and standard PICC placement do not routinely require prophylaxis.

9During ultrasound-guided right internal jugular vein cannulation, the operator accidentally punctures the carotid artery with the 18-gauge needle. What is the most appropriate next step?

A.Administer IV protamine

B.Advance a dilator to tamponade the site

C.Place a CVC in the carotid artery and consult vascular surgery

D.Withdraw the needle and hold focal pressure for at least 10 minutes

Explanation: For an 18-gauge needle stick, withdraw and hold focal pressure for ≥10 minutes. If a dilator or catheter has been placed in the carotid, do NOT remove it at the bedside — consult vascular surgery for open or endovascular closure because uncontrolled hemorrhage can occur. Ultrasound guidance is standard to avoid this complication.

10Which access site has the HIGHEST risk of pneumothorax during central venous catheter placement?

A.Subclavian vein

B.Internal jugular vein

C.Common femoral vein

D.Basilic vein (PICC)

Explanation: Subclavian access carries the highest pneumothorax risk (~1-3%) because the pleural dome is in close proximity. Internal jugular access has lower pneumothorax risk, especially with ultrasound guidance. Femoral access has no pneumothorax risk but has higher infection and DVT rates. Ultrasound has reduced complication rates across all sites.

About the ABR IR/DR Exam

The ABR IR/DR Certifying Examination is the final board certification for Interventional Radiologists who have completed the ACGME-accredited Integrated IR/DR Residency (6 years) or the ESIR (Early Specialization in IR) pathway plus an Independent IR Residency. The computer-based test contains approximately 500 single-best-answer MCQs assessing competence across IR clinical principles and SIR 2019 peri-procedural coagulation guidelines, vascular access and ultrasound-guided procedures, arterial interventions (PAD, renal, mesenteric, carotid, UAE, PAE, bronchial), venous interventions (IVC filters, May-Thurner, TIPS with VIATORR, BRTO), embolization materials and techniques, oncology interventions (TACE/TARE, ablation — RFA/MWA/cryo/IRE), GU/GI drains (PCN, PTBD, G-tubes, abscess drainage), hemodialysis access, neuro IR (stroke thrombectomy, aneurysm, AVM), pediatric IR, trauma embolization, women's health IR, and selected diagnostic radiology topics relevant to IR practice.

Questions

500 scored questions

Time Limit

1-2 day computer-based exam (IR-DR Certifying combined)

Passing Score

Criterion-referenced scaled score set by ABR (modified Angoff)

Exam Fee

~$1,950 IR/DR Certifying Exam fee (ABR 2026) (American Board of Radiology (ABR) / Pearson VUE)

ABR IR/DR Exam Content Outline

~8-10%

IR Clinical Principles & Peri-procedural Care

Pre-procedure evaluation and consent, SIR 2019 peri-procedural coagulation guidelines (hold warfarin to INR <1.8, DOACs 24-48h, clopidogrel 5 days, ASA usually continue; LMWH last dose 12h; platelets ≥50K most procedures, ≥30K for low-bleeding-risk). Moderate/deep sedation vs GA, antibiotic prophylaxis, periprocedural pain management, contrast reactions, gadolinium-based agent group risk.

~6-8%

Vascular Access & US-Guided Procedures

CVC placement (subclavian, IJ, femoral — Trendelenburg, micropuncture, US guidance), tunneled catheters, ports, PICC lines, complications (pneumothorax on right subclavian, arterial puncture, cardiac arrhythmia with guidewire), catheter malposition, chronic hemodialysis fistulogram and mechanical declotting.

~12-14%

Arterial Interventions

PAD — Rutherford 1-3 intermittent claudication vs 4-6 critical limb ischemia, ABI, duplex, CTA/MRA. Iliac kissing stents, fem-pop DCB, tibial CTO crossing. Renal artery stenosis — FMD balloon angioplasty vs atherosclerotic (CORAL trial negative). Acute vs chronic mesenteric ischemia (SMA embolectomy, stent). Carotid stent CAS vs CEA (CREST). UAE, PAE for BPH, bronchial artery embolization for hemoptysis (ID anterior spinal artery origin to avoid SCI), genicular artery embolization.

~10-12%

Venous Interventions

DVT treatment, IVC filter indications (PE with anticoagulation CI, recurrent PE on anticoagulation; PRESERVE trial, retrievable filters preferred). May-Thurner (L CIV compressed by R CIA — stenting). Paradoxical embolism, IVC reconstruction, pelvic congestion (gonadal vein embolization), varicocele, SVC syndrome. Mechanical thrombectomy — AngioJet, JETi, Inari FlowTriever/ClotTriever, EkoSonic CDT. TIPS indications (refractory variceal bleeding, refractory ascites), CI (severe CHF, severe pulmonary HTN), VIATORR covered stent, MELD >18 higher mortality, HE post-TIPS. BRTO for gastric varices.

~14-16%

Embolization & Oncology Interventions

Embolic materials — coils (push/detachable/HydroCoil), particles (PVA, Embosphere, Embozene), liquid (Onyx, NBCA glue, absolute alcohol, lipiodol), plugs (Amplatzer AVP, MVP). HCC — conventional TACE vs DEB-TACE with doxorubicin; TARE Y-90 resin vs glass. BCLC A/B downstaging to Milan transplant criteria. Partial splenic embolization for hypersplenism/trauma. PVE pre-hepatectomy to induce contralateral hypertrophy (FLR 30-40%). Ablation — RFA, MWA (larger zones), cryoablation (ice-ball monitoring), IRE (near vessels/bile ducts). Liver HCC/CRC mets <3 cm, RCC <4 cm, lung <3 cm primary.

~4-6%

Hemodialysis & AV Access Interventions

AV fistula types — radiocephalic Brescia-Cimino, brachiocephalic, brachiobasilic transposition. AV grafts. Fistulogram, angioplasty of venous outflow stenosis, stent grafts for cephalic arch. Steal syndrome management (DRIL — distal revascularization with interval ligation). Dialysis catheter dysfunction and exchange.

~8-10%

GU/GI Drains & Biliary

Percutaneous nephrostomy (hydronephrosis, obstructing stones, fistulas), nephroureteric stent, suprapubic cystostomy. PTBD/PTC, covered vs uncovered biliary stents, intraductal brachytherapy, lithotripsy. Gastrostomy — push vs pull technique, GJ conversion, cecostomy. Abdominal abscess drainage, empyema, small- vs large-bore chest tubes.

~6-8%

Neuro IR

Acute ischemic stroke thrombectomy (ASPECTS ≥6, LVO, 0-24h extended window per DAWN and DEFUSE-3). Ruptured aneurysm coiling vs clipping (ISAT favored coiling). AVM embolization neoadjuvant to surgery/SRS with Onyx/NBCA. Dural AVF, carotid-cavernous fistula treatment. Spinal cord anterior spinal artery origin awareness during bronchial or thoracic embolization. IIH venous sinus stenting.

~8-10%

Pediatric, Women's Health & Trauma IR

Pediatric vascular anomalies — infantile hemangioma (propranolol first-line), venous malformation (sclerotherapy), lymphatic macro/microcystic (bleomycin, doxycycline), AVM. Pediatric central access. UAE for fibroids, post-partum hemorrhage embolization, fallopian tube recanalization for infertility, pelvic congestion gonadal vein coiling. Blunt liver/spleen/kidney AAST high-grade injury embolization vs surgery, pelvic trauma with IIA embolization, solid-organ preservation.

~10-12%

Renal, Lymphatic & Diagnostic Radiology Overview

Renal biopsy, transplant complications (biopsy, PTA for transplant RAS/RVT, AVF post-biopsy). Renovascular HTN evaluation. Lymphangiogram, thoracic duct embolization for chylothorax. IR-adjacent diagnostic imaging — CT perfusion for stroke triage, CTA for GI bleed and mesenteric ischemia, MRI LI-RADS for HCC, pancreatic cancer staging, trauma FAST, pediatric appendicitis ultrasound.

How to Pass the ABR IR/DR Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABR (modified Angoff)
Exam length: 500 questions
Time limit: 1-2 day computer-based exam (IR-DR Certifying combined)
Exam fee: ~$1,950 IR/DR Certifying Exam fee (ABR 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABR IR/DR Study Tips from Top Performers

1SIR 2019 Coagulation Guidelines — high-yield thresholds to memorize: Low-bleeding-risk procedures (dialysis access, drain exchange, PICC/port, simple biopsy): INR ≤2.0-3.0, platelets ≥20-30K. High-bleeding-risk (TIPS, visceral biopsy, RFA, PCN, PTBD, transcatheter interventions): INR ≤1.5-1.8, platelets ≥50K. Hold warfarin 5 days, DOACs 24-48h (longer if CrCl reduced), clopidogrel 5 days, prasugrel 7 days, ticagrelor 5 days. ASA may usually be continued. LMHW last dose 12h before.

2TIPS indications and complications — INDICATIONS: refractory variceal bleeding, refractory ascites, Budd-Chiari, hepatic hydrothorax, portal vein thrombosis (selected). CONTRAINDICATIONS: severe CHF, severe pulmonary HTN, severe HE, biliary obstruction. VIATORR covered stent is standard. MELD >18 predicts higher 30-day mortality. Post-TIPS hepatic encephalopathy occurs in 20-30%. BRTO (Balloon-occluded Retrograde Transvenous Obliteration) for gastric varices with gastrorenal shunt.

3IVC Filter indications (PRESERVE trial framework): Acute PE/DVT AND contraindication to anticoagulation, recurrent PE despite therapeutic anticoagulation, or complication of anticoagulation. Always prefer RETRIEVABLE filters and plan for removal. Filter retrieval ideally within 3-6 months. Not routinely indicated for prophylaxis. May-Thurner syndrome: left common iliac vein compressed by right common iliac artery against L5 — treat with stenting (not just thrombolysis alone).

4HCC treatment by BCLC stage: BCLC 0 (very early, single <2 cm) — resection or ablation. BCLC A (early, single or up to 3 nodules ≤3 cm) — resection, transplant (Milan criteria: single ≤5 cm or up to 3 ≤3 cm), or ablation. BCLC B (intermediate, multinodular) — TACE (cTACE with doxorubicin + lipiodol or DEB-TACE) or TARE Y-90. BCLC C (advanced, vascular invasion) — systemic atezolizumab + bevacizumab. BCLC D — best supportive care. Y-90 TARE is radiation lobectomy/segmentectomy option and useful in portal vein tumor thrombus.

5Acute ischemic stroke thrombectomy — standard window 0-6h for LVO. Extended window (6-24h): DAWN trial (clinical-core mismatch) and DEFUSE-3 trial (perfusion-core mismatch on CTP/MRI). Require ASPECTS ≥6 on NCCT, LVO on CTA (ICA, M1, proximal M2, basilar), premorbid mRS 0-1, NIHSS ≥6 typically. Door-to-groin-puncture <90 min, TICI 2b/3 reperfusion is goal. Anterior spinal artery arises ~T8-L2 (artery of Adamkiewicz) — critical to identify before bronchial/intercostal embolization to avoid paraplegia.

Frequently Asked Questions

What is the ABR IR/DR Certifying Examination?

The ABR IR/DR Certifying Exam is the final board certification for Interventional Radiologists. It is a computer-based exam taken at Pearson VUE test centers containing approximately 500 single-best-answer MCQs spanning IR clinical principles, vascular access, arterial and venous interventions, embolization, interventional oncology (TACE/TARE/ablation), GU/GI drains, hemodialysis access, neuro IR, pediatric IR, trauma, women's health IR, and selected diagnostic radiology content relevant to IR practice. Candidates must have already passed the ABR DR Core Exam.

Who is eligible to take the ABR IR/DR Certifying Exam?

Candidates must have completed an ACGME-accredited Integrated IR/DR Residency (6 years: 1 clinical year + 4 DR years + 1 IR year) or the ESIR (Early Specialization in IR) pathway within DR residency plus an Independent IR Residency/fellowship. Candidates must hold a valid unrestricted medical license, have program director attestation of satisfactory completion, and have already passed the ABR DR Core Exam.

What is the format of the ABR IR/DR Certifying Exam?

The IR/DR Certifying Exam is a 1-2 day computer-based examination administered at Pearson VUE test centers with approximately 500 single-best-answer MCQs. Questions include clinical vignettes, fluoroscopic/angiographic images, CT/MRI/ultrasound, procedural photographs, and device selection scenarios. Content is distributed across the 2026 ABR IR/DR content outline with emphasis on core IR procedures, peri-procedural management, and evidence-based practice.

How much does the 2026 ABR IR/DR Certifying Exam cost?

The 2026 ABR IR/DR Certifying Exam fee is approximately $1,950. Candidates must also have completed the ABR DR Core Exam (~$1,600). Cancellation and refund policies follow the ABR schedule. Continuing Certification uses OLA (Online Longitudinal Assessment) rather than a traditional MOC exam, with associated annual fees. Retakes within the eligibility window require full re-registration and fee payment.

When is the 2026 exam administered?

The ABR IR/DR Certifying Exam is typically offered in designated annual or semi-annual testing windows. Candidates schedule specific Pearson VUE appointments after application approval. Exact 2026 dates and windows should be confirmed on the ABR Interventional Radiology initial certification page.

How is the exam scored?

ABR uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score rather than on other test-takers. Score reports include subdomain performance. Results are typically released several weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics include: SIR 2019 peri-procedural coagulation thresholds (INR, platelets, DOACs, clopidogrel), TIPS (VIATORR covered stent, indications and CI, MELD, HE risk), HCC treatment (TACE vs TARE Y-90, BCLC staging, Milan criteria for transplant downstaging), ablation modality selection (RFA vs MWA vs cryo vs IRE), IVC filter indications (PRESERVE trial), May-Thurner physiology and stenting, acute stroke thrombectomy criteria (DAWN/DEFUSE-3), ruptured aneurysm management (ISAT), pediatric vascular anomaly treatment (sclerotherapy agents), and embolic material selection.

How should I study for ABR IR/DR?

Use a structured 12-18 month plan during the final 1-2 years of IR training. Map to the ABR IR/DR content outline: lead with IR clinical principles and SIR 2019 coagulation guidelines, then arterial and venous interventions, embolization and oncology, hemodialysis and drains, neuro IR, pediatric/women's health/trauma, and IR-adjacent DR. Core resources include Kaufman and Lee's Vascular and Interventional Radiology (Requisites), Handbook of Interventional Radiologic Procedures (Kandarpa), Image-Guided Interventions (Mauro), SIR practice guidelines, and RFS modules. Drill high-volume MCQs and complete 2-3 full-length timed mocks.