Nesvs 2013 Postgraduate Course Self-assessment Exam

18 Questions | Total Attempts: 39

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Nesvs 2013 Postgraduate Course Self-assessment Exam

The 2013 Postgraduate Course of the New England Society for Vascular Surgery has been assigned 4. 00 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 course (Friday, October 11, 2013). There are no exceptions to this deadline.


Questions and Answers
  • 1. 
    Which of the following trials does not support the use of CEA for the management of asymptomatic carotid artery stenosis?
    • A. 

      ACAS

    • B. 

      ACST

    • C. 

      CREST

    • D. 

      NASCET

  • 2. 
    Under current CMS reimbursement guidelines all of the following treatment scenarios is eligible for reimbursement from Medicare except?
    • A. 

      Carotid angioplasty and stenting for 80% stenosis in an asymptomatic low risk patient outside of a clinical trial

    • B. 

      CEA for symptomatic high risk patients with 80% stenosis

    • C. 

      CEA for asymptomatic patients with 80% stenosis

    • D. 

      Carotid angioplasty and stenting with any approved CAS system for symptomatic high risk patients with 80 % stenosis

  • 3. 
    In the United States which of the statements concerning the management of carotid artery disease is TRUE?
    • A. 

      CEA is performed more frequently for symptomatic carotid artery disease than asymptomatic disease

    • B. 

      CAS is performed more frequently by vascular surgeons than by cardiologists

    • C. 

      Significant regional variation exists in the use of CAS and CEA to manage carotid artery stenosis

    • D. 

      Carotid angioplasty and stenting comprises 50% of the intervention for carotid artery disease in the United States

  • 4. 
    The potential benefits of using a flow reversal system for CAS compared with distal filters include all of the following except:
    • A. 

      Decreased risk of microemboli to the brain

    • B. 

      Lower profile devices and smaller sheath size

    • C. 

      Ability to have cerebral protection in place before crossing the stenosis with a guide wire

    • D. 

      The ability to use any FDA approved carotid stent

    • E. 

      Active aspiration of debris or in line flow reversal to minimize the risk of atheroembolization

  • 5. 
    Upcoming or current carotid stent trials in the United States involving CAS include the following:
    • A. 

      ROADSTER Trial using direct cervical carotid access and flow reversal

    • B. 

      CREST II trial to prospectively evaluate CAS vs. CEA vs. best medical therapy for carotid stenosis

    • C. 

      Bioabsorbable drug eluting stent trial to treat carotid stenosis

    • D. 

      A and B

  • 6. 
    Potential high risk criterion for inclusion in ongoing carotid angioplasty and stenting trials include all of the following except:
    • A. 

      History of previously treated coronary artery disease with normal ejection fraction

    • B. 

      Previous CEA

    • C. 

      Prior neck irradiation

    • D. 

      High bifurcation with difficult to access distal endpoint

    • E. 

      Contralateral ICA occlusion

  • 7. 
    Which of the following criterion are listed as potential requirements when applying to become a CMS approved center to perform and be reimbursed for CAS?
    • A. 

      Participation in an ongoing outcome data collection with regular reporting of outcomes to CMS and recertification every two years

    • B. 

      Evidence of prior participation in carotid stenting clinical trials

    • C. 

      Attestation by the facility that high quality imaging and advanced physiologic monitoring exists to perform CAS in the angio suite

    • D. 

      Attestation that CAS interventionalists undergo a specific credentialing process with ongoing assessment of individual and institutional outcomes

    • E. 

      Attestation that all patients are seen by a vascular surgeon who determines that they are too high risk for an open procedure

  • 8. 
    Which of the following results of the CREST trial are true?
    • A. 

      The rate of stroke/death and MI was not different between CAS and CEA

    • B. 

      The rate of stroke/death for all patients was higher in CAS vs. CEA

    • C. 

      Only asymptomatic patients were treated in the CREST trial

    • D. 

      Only A and B

  • 9. 
    Which of the following statements concerning the 2011 SVS Guidelines concerning the management of extracranial carotid disease is not true?
    • A. 

      CAS is indicated in symptomatic patients who are high risk for CEA

    • B. 

      CEA is the first line treatment for symptomatic patients with 60-99% stenosis

    • C. 

      CAS is indicated in some asymptomatic low risk patients outside of clinical trials

    • D. 

      CEA is indicated in selected asymptomatic patients with 60-99% stenosis

    • E. 

      Statin therapy should be implemented along with antiplatelet therapy in patients undergoing carotid intervention

  • 10. 
    Which of the following statements concerning the ACC/AHA carotid guidelines is not true?
    • A. 

      Simultaneous Carotid revascularization (CEA/CABG) is supported by Level 1 evidence for asymptomatic patients with 80% stenosis undergoing coronary revascularization

    • B. 

      CEA should be considered for high risk symptomatic patients with 80% stenosis

    • C. 

      CAS should be considered for high risk surgical patients with 80% stenosis

    • D. 

      Vascular surgeons, cardiologists and vascular medicine specialists participated in writing these guidelines

  • 11. 
    In patients with non-obstructive atherosclerotic disease and TIA’s preferred on no prior antiplatelet therapy, initial antithrombotic treatment may include all of the following except:
    • A. 

      Aspirin 81 mg

    • B. 

      Plavix 75 mg in aspirin intolerant patients

    • C. 

      Aspirin 325 and Plavix 75 mg

    • D. 

      Aspirin and dipyridamole combination

    • E. 

      Aspirin 325 mg

  • 12. 
    The CREST trial did not demonstrate which of the following:
    • A. 

      Higher incidence of cranial nerve injury for patients undergoing CEA

    • B. 

      Higher incidence of MI in patients undergoing CEA

    • C. 

      The lowest incidence of Stroke in both the CEA and the CAS group of any prospective multicenter randomized carotid trial

    • D. 

      No difference in the outcomes of CAS for Vascular surgeons compared to cardiologists in the Pivotal arm of the trial

    • E. 

      A lower overall incidence of stroke for CAS than with CEA

  • 13. 
    Which of the following statements concerning the use of TCD is true?
    • A. 

      Transcranial Doppler is performed using an ultrasound probe to insonate the intracerebral vessels through the frontal bone window

    • B. 

      Directionality of flow may be assessed in the middle cerebral artery

    • C. 

      Microemboli from either air or plaque may be detected only during CEA and not CAS

    • D. 

      A and C

  • 14. 
    The different types of embolic protection used during carotid angioplasty and stenting trials have included:
    • A. 

      Distal filters or baskets placed in the distal internal carotid artery in the neck

    • B. 

      Distal filters or baskets placed in the intracerebral carotid artery

    • C. 

      Proximal occlusion with flow reversal systems placed in the common carotid artery

    • D. 

      A and C

  • 15. 
    Which of the following statements concerning data supporting medical management of asymptomatic carotid stenosis is not TRUE?
    • A. 

      A recent metaanalyses published in Stroke in 2009 suggested that medical intervention alone was the best method to prevent stroke in asymptomatic patients

    • B. 

      This article suggests that the rate of stroke with medical intervention has fallen over the past 2 decades

    • C. 

      In these studies only patients with severe (70-89%) and critical (> 90%) stenoses were included

    • D. 

      A recent study from the MGH demonstrated that asx patients with severe or critical stenoses on optimal medical therapy had a 25% incidence of neurologic symptoms at 5 years

  • 16. 
    Which of the following statements concerning diffusion weighted MRI after carotid intervention is not true:
    • A. 

      New bright areas on diffusion weighted MRI have been detected after all types of carotid intervention

    • B. 

      It is thought that these areas correlate with new areas of microemboli to the brain

    • C. 

      Long-term decline in neurocognitive functioning has been hypothesized to correlate with new areas of microemboli

    • D. 

      New bright areas on diffusion weighted MRI only occur on the same side of the carotid intervention

  • 17. 
    A 69 year old female in presents with peripheral arterial disease and asymptomatic recurrent carotid stenosis after a previous Right CEA x 2. Optimal medical management for this patient would include all of the following except:
    • A. 

      Aspirin as an antiplatelet agent

    • B. 

      Smoking cessation

    • C. 

      Coumadin for anticoagulation for her PAD and carotid stenosis

    • D. 

      Atorvastatin for management of cholesterol

  • 18. 
    This patient has asymptomatic recurrent stenosis in the RICA with 50-69% stenosis by carotid duplex examination which has been stable for the past two years. The best therapy for treating her carotid stenosis would be optimal medical therapy and:
    • A. 

      Redo carotid endarterectomy

    • B. 

      Carotid Angioplasty and stenting from a transfemoral approach

    • C. 

      Carotid angioplasty and stenting from a direct transcervical approach

    • D. 

      Optimal medical therapy alone and continued surveillance

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