Nesvs 2013 Annual Meeting Self-assessment Exam

46 Questions | Total Attempts: 84

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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

  • 26. 
    PRESENTATION #14: Diabetic patients on the following medical regimen have improved primary patency following isolated primary stenting of the superficial femoral artery:
    • A. 

      Insulin

    • B. 

      Thioglitazone

    • C. 

      Sulfonylureas

    • D. 

      Biguanides

  • 27. 
    PRESENTATION #14: The following patient presents to you in clinic for evaluation, which will have the best outcome with superficial artery stenting:
    • A. 

      Non-diabetic patient with TASC A lesion

    • B. 

      Diabetic patient with TASC D lesion and one vessel runoff

    • C. 

      Non-diabetic patient with popliteal aneurysm

    • D. 

      Diabetic patient with TASC C lesion and peroneal runoff with tissue loss

  • 28. 
    PRESENTATION #15: The use of an ACE inhibitor for patients undergoing endovascular treatment of lower extremity disease improved:
    • A. 

      Primary patency

    • B. 

      Secondary patency

    • C. 

      Primary assisted patency

    • D. 

      Limb salvage

  • 29. 
    PRESENTATION #15: Best medical management for patients undergoing endovascular treatment of infrainguinal occlusive disease likely includes:
    • A. 

      Aspirin and clopidigrel

    • B. 

      A statin agent

    • C. 

      Antiplatelet agent, statin and ACE inhibitor

    • D. 

      Antiplatelet agent and ACE inhibitor

  • 30. 
    PRESENTATION #16: Concurrent venogram during first rib resection for idiopathic venous thoracic outlet syndrome impacts patient care by:
    • A. 

      Provision of information that frequently changes the procedural plan

    • B. 

      Increasing post-operative bleeding complications

    • C. 

      Abrogating the need for any post-procedure anticoagulation

    • D. 

      Excluding requirement for provocative positions during imaging

  • 31. 
    PRESENTATION #16: A 26 year old Red Sox relief pitcher presents to the ER with dominant arm swelling and pain.  Work up reveals venous thoracic outlet syndrome and subclavian vein thrombosis.  The patient undergoes 1st rib resection.  Intraoperative venogram should:
    • A. 

      Never be performed, deferring instead to a dedicated study after 3 months of anticoagulation

    • B. 

      Be performed with the arm in the neutral and hyper-abduction positions

    • C. 

      Be completed with CO2 only

    • D. 

      Delineate vena cava anatomy in view of the high rate of associated anomolies

  • 32. 
    PRESENTATION #17: Which of the following statements about restenosis in the periphery is not correct:
    • A. 

      Biologic mechanisms of restenosis after percutaneous transluminal angioplasty include acute vessel recoil, negative wall remodeling, and intimal hyperplasia

    • B. 

      “Edge restenosis” after vascular brachytherapy (higher-than-expected restenosis rates at the edges of the treated vessel) is due to geographic miss of the lesion, barotrauma secondary to balloon inflation, dose falloff at the edge of the treated vessel, and source movement during the treatment

    • C. 

      A vascular brachytherapy protocol using high-energy gamma sources must take into account the logistics of patient transportation to the department of radiation oncology, including increase in overall catheterization time, anticoagulation, and patient monitoring by trained personnel

    • D. 

      Gamma-emitting sources for vascular brachytherapy have decreased depth penetration compared with beta-emitting sources

  • 33. 
    PRESENTATION #17: Which of the following currently serves as a valid approach to enhance the durability of endovascularly treated femoral occlusive lesions in a 72 year old male under selected circumstances?
    • A. 

      High-energy radio-therapy

    • B. 

      Protamine coated stents

    • C. 

      High-dose rate brachytherapy

    • D. 

      Magnetic resonsance nano-particle infusion

  • 34. 
    PRESENTATION #18: In a human in vitro model of neo-intimal hyperplasia and cellular culture:
    • A. 

      Eph-B4 and ephrin-B2 and osteopontin expression were all significantly decreased in organ culture

    • B. 

      Treatment of vein rings with Ephrin-B2/Fc led to a decrease in neointimal hyperplasia compared to controls

    • C. 

      Activation of Eph-B4 with exogenous Ephrin-B2/Fc increased neointimal hyperplasia in human saphenous veins

    • D. 

      Cultured endothelial cells demonstrated a significant down regulation of Eph-B4 phosphorylation when treated with Ephrin-B2/Fc

  • 35. 
    PRESENTATION #19: For patients with ilio-femoral occlusive disease and claudication, contemporary cost-effectiveness analysis supports which of the following as the least cost-effective?
    • A. 

      Supervised exercise dictated by primary care provider

    • B. 

      Supervised exercise dictated by vascular specialist

    • C. 

      Non-supervised exercise

    • D. 

      Primary stenting

  • 36. 
    PRESENTATION #19: On first presentation for classic unilateral arterial calf claudication at 200 meters with a diminished ipsilateral femoral pulse in a 66 year old female, which of the following is a clinically and cost effective initial management approach?
    • A. 

      Supervised exercise dictated by a vascular specialist

    • B. 

      Axillo-bifemoral bypass

    • C. 

      Neo-aorto iliac system (NAIS) procedure

    • D. 

      Primary stenting

  • 37. 
    PRESENTATION #20: The highest level of evidence by the Oxford Centre for Evidence-based Medicine is:
    • A. 

      Randomized controlled trials

    • B. 

      Cohort single center studies

    • C. 

      Retrospective cohort studies

    • D. 

      Case control studies

  • 38. 
    PRESENTATION #20: The factor which is not an independent predictor for amputation-free survival of critical limb ischemia patients who undergo peripheral vascular intervention is:
    • A. 

      Male gender

    • B. 

      Age > 80

    • C. 

      Smoking

    • D. 

      Tissue loss

  • 39. 
    PRESENTATION #21: The two most important predictors, that combined for more than half of the increased length of stay after Endovascular AAA repair, were:
    • A. 

      Symptomatic CAD and vasopressin use

    • B. 

      Non-home discharge and procedure time

    • C. 

      ICU stay and procedure time

    • D. 

      Patient age and ICU stay

  • 40. 
    PRESENTATION #22: With the decrease in randomized controlled trials in vascular surgery, the number of meta analyses and systematic reviews have increased in number. To help advance the knowledge of vascular surgery in health care decision making, it will be important to:
    • A. 

      Undertake more clinical research from clinical databases

    • B. 

      Make meta-analyses more clear and transparent

    • C. 

      Have systemic reviews and meta-analyses written by independent statisticians

    • D. 

      Answer option 4

  • 41. 
    PRESENTATION #23: In this study, data suggests that:
    • A. 

      Body Mass Index is the most important predictor of post-procedure hematoma formation

    • B. 

      Use of small sheaths was protective of post-procedure hematoma

    • C. 

      Use of ultrasound created more hematomas post-procedure

    • D. 

      Pathology treated was important to predicting post-procedure hematoma

  • 42. 
    PRESENTATION #23: A 62 year old obese claudicant presenting for percutaneous intervention:
    • A. 

      U/S should always be avoided

    • B. 

      Smallest possible sheath should be utilized

    • C. 

      Pt should be instructed to lose 20 lbs and return for therapy

    • D. 

      Start Plavix

  • 43. 
    PRESENTATION #24: In this study, data collected suggested that:
    • A. 

      Routine use of ultra-sound guidance was helpful in reducing post-procedure access site complications

    • B. 

      Vascular closure devices have caused more cardiac complications in PVI patients

    • C. 

      Higher Body Mass Index was associated with lower access site complications

    • D. 

      Older patients on Coumadin had the LOWEST complication rates of all groups studied

  • 44. 
    PRESENTATION #24: A 62 year old obese patient with diabetes:
    • A. 

      Routine use of U/S is important

    • B. 

      Vascular closure devices should be avoided

    • C. 

      Pts should be advised to lose weight and return for a procedure on another date

    • D. 

      Start Plavix

  • 45. 
    PRESENTATION #25: In this study Type I endoleaks developing post-operatively:
    • A. 

      24% of the time resolve spontaneously

    • B. 

      All resulted in rupture of aneurysm sac

    • C. 

      Always necessitate repair with onyx

    • D. 

      Never resolved spontaneously

  • 46. 
    PRESENTATION #26: The new ANCHOR trial reports that in the use of this device:
    • A. 

      Only one device was necessary on all patients

    • B. 

      In using this device 97% of primary cases and 89% of revisions were free of type I leaks at one month

    • C. 

      Suggested use is only on proximal necks of 4cm or greater length

    • D. 

      Similar to sea anchors, two should be used during high winds