Nesvs 2013 Annual Meeting Self-assessment Exam

46 Questions | Total Attempts: 86

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Nesvs 2013 Annual Meeting Self-assessment Exam

The 2013 Annual Meeting of the New England Society for Vascular Surgery has been assigned 5. 75 self-assessment credits. In order to receive these self-assessment credits, a minimum performance level of 75% must be attained. Multiple attempts are permitted, but all exams must be completed within 10-days of the conclusion of the Annual Meeting (Friday, October 11, 2013). There are no exceptions to this deadline.


Questions and Answers
  • 1. 
    PRESENTATION #1: All of the following factors were greater for trans-thoracic versus extra thoracic aortic branch reconstructions EXCEPT:
    • A. 

      Thromboembolic complications

    • B. 

      Perioperative stroke

    • C. 

      Blood transfusions

    • D. 

      Length of stay

  • 2. 
    PRESENTATION #1: An 82 year old women with COPD and disabling right arm claudication from proximal subclavian artery occlusion would best be managed by: 
    • A. 

      Aorto-subclavian bypass

    • B. 

      Carotid-subclavian bypass

    • C. 

      Femoro-subclavian bypass

    • D. 

      Cilastozol treatment

  • 3. 
    PRESENTATION #2: During the index admission, the mortality rate for endovascular treatment of acute mesenteric ischemia is approximately:
    • A. 

      10%

    • B. 

      20%

    • C. 

      30%

    • D. 

      40%

  • 4. 
    PRESENTATION #2: For patients undergoing endovascular treatment for chronic mesenteric ischemia, the best post procedural management would be:
    • A. 

      Antiplatelet therapy with aspirin

    • B. 

      Follow up duplex at 3, 6 and 12 months

    • C. 

      Clinical follow up only

    • D. 

      Routine follow up CT angiogram at 6 months

  • 5. 
    PRESENTATION #3: Which of the following is true regarding Medicare patients undergoing thoracic aortic dissection repair in recent years?
    • A. 

      TEVAR now comprises a majority of thoracic aortic dissection repairs

    • B. 

      Patients undergoing TEVAR have higher comorbidity burdens compared to patients undergoing open repair

    • C. 

      Patients undergoing open repair have significantly inferior 3-year mortality rates compared to TEVAR

    • D. 

      Men undergoing TEVAR have inferior 3-year mortality rates compared to women

  • 6. 
    PRESENTATION #3: 53 year old female with HTN brought to ED after collapsing.  Prior to admission, she had stabbing chest pain radiating to left shoulder.  Pulse 110, BP 160/80.  Heart sounds distant, pulsus paradoxus is present.  ECG shows low voltage and ST wave changes.  CXR shows widening of mediastinum.  Dx?
    • A. 

      Aortic dissection with cardiac tamponade

    • B. 

      HTN crisis

    • C. 

      Massive pulmonary thromboembolism

    • D. 

      Myocardial infarct with congestive failure

    • E. 

      Rupture of papillary muscle

  • 7. 
    PRESENTATION #4: When a thoracic stent graft is used to treat a complicated type B aortic dissection, a true finding of late remodeling of the aorta would be:
    • A. 

      False lumen of the stented segment rarely thromboses

    • B. 

      The stented segment true lumen diameter remained stable over time

    • C. 

      The stented segment false lumen diameter remained stable over time

    • D. 

      The non-stented segment false lumen diameter remained stable over time

  • 8. 
    PRESENTATION #4: A 60 year old patient with a type B aortic dissection presents to the EW. Which would not be an indication to use a TEVAR to treat this patient at the present time?
    • A. 

      Impending rupture

    • B. 

      Left renal artery perfused by the false lumen

    • C. 

      Malperfusion of the intestines

    • D. 

      Refractory hypertension

  • 9. 
    PRESENTATION #5: Which types of endoleaks are the most appropriate for transcaval embolization:
    • A. 

      Type I with distal leak (Type Ib)

    • B. 

      Type II emanating from a lumbar branch with an expanding aneurysm sac

    • C. 

      Type II from a patent IMA with a gradually decreasing aneurysm sac size

    • D. 

      Type II of a left common iliac aneurysm with an expanding aneurysm sac E) Type III from component separation with an expanding aneurysm sac

  • 10. 
    PRESENTATION #5: The following are true for patients after endovascular aneurysm repair except:
    • A. 

      Lifelong surveillance is required

    • B. 

      All type II endoleaks require investigation and repair

    • C. 

      All type I endoleaks require investigation and repair

    • D. 

      MR angiography is adequate for all patients after endovascular aneurysm repair

  • 11. 
    PRESENTATION #6: The least concordance of variables identified in the two vascular surgery databases VQI, which is self-reported, and NSQIP, which employs abstractors to obtain data, is greatest in:
    • A. 

      Pre-operative data

    • B. 

      Inpatient stay

    • C. 

      Intraoperative data

    • D. 

      Postoperative data

  • 12. 
    PRESENTATION #6: A 74 year old patient is pre-op for an open AA repair. Which factor would best predict decreased long term survival?
    • A. 

      Aorto-iliac reconstruction

    • B. 

      Age of 74

    • C. 

      Post-operative renal dysfunction

    • D. 

      Moderate CKD disease at baseline

  • 13. 
    PRESENTATION #7: Measurement of psoas muscle area as a marker for frailty demonstrates:
    • A. 

      Patients with low psoas muscle area are more likely to have abdominal aortic aneurysm than arterial occlusive disease

    • B. 

      Frailty as defined by low psoas muscle area is more severe with increased degree of arterial occlusive disease

    • C. 

      Patients with abdominal aortic aneurysm are less frail than patients with arterial occlusive disease based on psoas muscle area

    • D. 

      Low psoas muscle area in patients with arterial occlusive disease is predictive of coronary morbidity and mortality

  • 14. 
    PRESENTATION #8: In patients with end-stage renal disease and peripheral vascular disease with tissue loss, contemporary probabilistic Markov modeling suggests that which of the following is associated with the highest costs and the worst clinical outcomes?
    • A. 

      Local wound care

    • B. 

      Purely endovascular intervention

    • C. 

      Purely open surgical revascularization

    • D. 

      Primary major amputation

  • 15. 
    PRESENTATION #8: A 64 male patient with IDDM and end-stage renal disease has peripheral vascular disease with minor forefoot tissue loss.  Which of the following is associated with the highest costs and the worst clinical outcomes for such a patient?
    • A. 

      Local wound care

    • B. 

      Hybrid revascularization approaches

    • C. 

      Open autogenous surgical revascularization

    • D. 

      Primary major amputation

  • 16. 
    PRESENTATION #9: The incidence of perioperative stroke in patients undergoing early CEA for acute stroke was:
    • A. 

      1%

    • B. 

      2%

    • C. 

      3%

    • D. 

      5%

  • 17. 
    PRESENTATION #9: Patients presenting with stable acute stroke with significant ipsilateral carotid stenosis should undergo CEA:
    • A. 

      Expeditiously during same hospital admission

    • B. 

      At 4 weeks following MRI if no hemorrhage is detected

    • C. 

      After 6 week of anticoagulation with coumadin

    • D. 

      After 4 weeks of treatment with aspirin and clopidigrel

  • 18. 
    PRESENTATION #10: Applying carotid duplex criteria from 10 different vascular laboratories would result in:
    • A. 

      Consistent recommendations for interventions for symptomatic carotid stenosis with variable cost of therapy

    • B. 

      Substantial variation in recommendations for revascularization for patients with both asymptomatic and symptomatic carotid stenosis

    • C. 

      Widely variable costs for revascularization of asymptomatic, but not symptomatic, patients with carotid occlusive disease

    • D. 

      Low costs despite variable interpretation criteria for carotid duplex examinations of symptomatic and asymptomatic patients

  • 19. 
    PRESENTATION #10: A 65 year old otherwise healthy male is referred to you for carotid endarterectomy for an asymptomatic left carotid stenosis. Duplex from another institution has been interpreted as demonstrating a > 80% left internal carotid stenosis. You have a strict policy of reserving carotid intervention in patients without symptoms to stenoses of > 80%.  Based on the findings of this study, you should:
    • A. 

      Recommend endarterectomy based on the patient’s report from the other institution

    • B. 

      Repeat the study in your institution’s vascular lab to confirm the degree of stenosis

    • C. 

      Not proceed with surgery because asymptomatic disease should be treated medically

    • D. 

      Obtain an MRI to look for evidence of prior silent left hemispheric events

  • 20. 
    PRESENTATION #11: The factors that were not identified as independent predictors of worsening the patients postoperative renal dysfunction include:
    • A. 

      Moderate CKD class

    • B. 

      Suprarenal clamp time

    • C. 

      Female gender

    • D. 

      Operative time

  • 21. 
    PRESENTATION #11: An 84 year old patient is scheduled for an EVAR. The insurance calls your office and asks you to determine if there is something you can do to help minimize her post-operative stay. To minimize the hospital stay, you:
    • A. 

      Use epidural anesthesia

    • B. 

      Have a cardiology evaluation pre-operative

    • C. 

      Start statin medication

    • D. 

      Do the case in the fixed angio room

  • 22. 
    PRESENTATION #12: With regards to VSGNE patients treated for carotid disease:
    • A. 

      Carotid stenting was always associated with less adverse complications in all subgroups

    • B. 

      The presence or absence of symptoms was less important than degree of stenosis in predicting adverse events

    • C. 

      Carotid stenting and carotid endarterectomy always had similar outcomes

    • D. 

      If patients were both high risk medically and symptomatic, those treated with CEA had fewer major adverse events post procedure

  • 23. 
    PRESENTATION #12: An 85 year old with left amaurosis fujax and a left–sided 80% stenosis best therapy would be:
    • A. 

      No treatment

    • B. 

      Observation and Plavix

    • C. 

      Stenting

    • D. 

      CEA

  • 24. 
    PRESENTATION #13: Based on data from the US Renal Database System:
    • A. 

      White patients are more likely to initiate dialysis with an arteriovenous fistula than either black or Hispanic patients

    • B. 

      Black patients are more likely to initiate dialysis with a tunneled catheter than white or Hispanic patients

    • C. 

      Hispanic patients have similar rates of arteriovenous grafts as black patients, but more frequently than white patients

    • D. 

      White patients, but not black and Hispanic patients, meet the threshold for arteriovenous fistulas set by the Fistula First Breakthrough

  • 25. 
    PRESENTATION #13: A 40 year old Hispanic patient is referred to establish access in anticipation of hemodialysis for Stage IV kidney disease. You recommend:
    • A. 

      Placement of a tunneled catheter at the initiation of hemodialysis

    • B. 

      Use of an arteriovenous graft since autologous fistulas perform poorly in Hispanics

    • C. 

      Bridging an arteriovenous graft with a tunneled catheter

    • D. 

      Early creation of an autologous arteriovenous fistula