The Vein Forum: Comprehensive Venous Management For The Practicing Clinician

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About This Quiz


The American College of Surgeons has assigned a maximum of 14 AMA PRA Category 1 Credits™ to the course. Self-assessment credit has been assigned for the entire course. The post-test must be completed by September 18, 2014. A minimum performance level of 75% must be attained in order to earn the self-assessment credit. Multiple attempts are permitted within the 10-day See morespan. Please note that a physician cannot earn the entire self-assessment credit if he/she has not attended the entire course.
CME Scale
September 5
Morning Sessions: 3.5 credit hours
Afternoon Sessions: 3.5 credit hours
September 6
Morning Sessions: 4 credit hours
Afternoon Sessions: 3 credit hours

The Vein Forum: Comprehensive Venous Management For The Practicing Clinician - Quiz

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  • 2. 

    Relevant Venous AnatomyThe intersaphenous vein connects the:

    • Anterior accessory and great saphenous veins.

    • Perforator and great saphenous veins.

    • Great saphenous and small saphenous veins.

    • Small saphenous and superficial femoral veins.

    Correct Answer
    A. Great saphenous and small saphenous veins.
    Explanation
    The correct answer is Great saphenous and small saphenous veins. The question is asking about the connection made by the intersaphenous vein. The intersaphenous vein connects the great saphenous vein and the small saphenous vein.

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  • 3. 

    Clinical Presentation and PathophysiologyAccording to the SVS/AVF 2011 clinical practice guidelines regarding perforators which is correct?

    • All perforators should be ablated

    • Only C5 and C6 should have perforator surgery once the superficial reflux has been corrected

    • Perforator diameter of less than 3.5 mm with reflux should be ablated

    • Symptomatic C2 and C3 patients with perforator insufficiency should have ablation in conjunction with superficial saphenous ablation

    Correct Answer
    A. Symptomatic C2 and C3 patients with perforator insufficiency should have ablation in conjunction with superficial saphenous ablation
    Explanation
    According to the SVS/AVF 2011 clinical practice guidelines, the correct option is that symptomatic C2 and C3 patients with perforator insufficiency should have ablation in conjunction with superficial saphenous ablation. This means that patients with symptoms and insufficiency in perforator veins in the C2 and C3 regions should undergo ablation of these perforator veins along with ablation of the superficial saphenous veins. This approach aims to address both the underlying perforator insufficiency and the superficial reflux, providing comprehensive treatment for the patient.

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  • 4. 

    Venous Ablation RFA/EVLTLaser light is: 

    • Scattered, dissipated, absorbed

    • Reflected, diminished, intensified

    • Attenuated, scattered, reflected

    • Absorbed, reflected, scattered

    Correct Answer
    A. Absorbed, reflected, scattered
    Explanation
    Laser light in venous ablation procedures is absorbed by the targeted tissue, reflected off the surrounding structures, and scattered in different directions. This combination of absorption, reflection, and scattering allows the laser energy to effectively treat the venous condition.

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  • 5. 

    Venous Non-Thermal AblationWhich of the following is a characteristic on US evaluation of iliofemoral vein obstruction?

    • Phasic flow in the common femoral vein

    • Chronic changes in the common femoral vein

    • Pulsatility in the common femoral vein

    • Continous non-phasic flow in the common femoral vein

    Correct Answer
    A. Chronic changes in the common femoral vein
    Explanation
    Chronic changes in the common femoral vein is a characteristic on US evaluation of iliofemoral vein obstruction. This suggests that there are long-standing alterations in the structure and appearance of the vein, which can be indicative of chronic venous insufficiency or previous thrombosis.

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  • 6. 

    Venous Ablation Sclerotherapy/USGFSA 39 year old female patient has reticular veins (3-4 mm veins), and requires a sclerotherapic agent to ablate her veins.  Which of the following agents is most appropriate to achieve effective vein closure, but with minimal side effects (the “minimum effective concentration”)?

    • 3.0% Sodium Tetradecyl Sulfate (STS) liquid

    • 0.5% Polidocanol (PD) liquid

    • Foam sclerotherapy

    • 1.0% Polidocanol (PD)

    Correct Answer
    A. 1.0% Polidocanol (PD)
    Explanation
    The most appropriate agent to achieve effective vein closure with minimal side effects is 1.0% Polidocanol (PD). This concentration of Polidocanol is considered the minimum effective concentration, meaning it is sufficient to effectively close the veins while minimizing the risk of side effects. Sodium Tetradecyl Sulfate (STS) liquid at 3.0% concentration may be too strong and could potentially cause more side effects. Foam sclerotherapy and 0.5% Polidocanol (PD) liquid are not mentioned as being the most appropriate for achieving effective vein closure with minimal side effects.

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  • 7. 

    IVC FiltersA 56 year old female requires an IVC filter due to a failure of anticoagulation for an iliofemoral DVT.  When obtaining consent you can explain that The PREPIC study:

    • Randomized patients with DVT +/- PE to receive or not receive an IVC filter in addition to anticoagulation and the follow up was 18 years.

    • At 8 years patients with IVC filters had a significant decrease in pulmonary embolism

    • At 18 years there was an increase in survival in patients receiving IVC filters

    • At 8 years patients with an IVC filter had significantly less recurrent deep vein thrombosis

    Correct Answer
    A. At 8 years patients with IVC filters had a significant decrease in pulmonary embolism
    Explanation
    The PREPIC study, which randomized patients with DVT +/- PE to receive or not receive an IVC filter in addition to anticoagulation, found that at 8 years, patients with IVC filters had a significant decrease in pulmonary embolism. This suggests that the use of IVC filters can effectively reduce the risk of pulmonary embolism in patients with DVT.

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  • 8. 

    IFDVT/Outflow ObstructionA 64 year old female presents with left leg edema and her CEAP classification is C5. When teaching the medical student, you explain the etiology may include an Iliofemoral venous obstruction and:

    • Rarely contributes to the development of chronic venous insufficiency

    • Is only caused by venous thrombosis

    • May be diagnosed using venography or IVUS

    • Can often by treated by stenting and data supports this approach.

    Correct Answer
    A. Can often by treated by stenting and data supports this approach.
    Explanation
    The given answer suggests that iliofemoral venous obstruction can often be treated by stenting and there is data to support this approach. This implies that stenting is a viable treatment option for this condition and has been proven effective through research and clinical evidence.

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  • 9. 

    Pelvic Venous CongestionWhich of the following statements is CORRECT about Pelvic Venous Congestion Syndrome?

    • In the presence of LEFT ovarian vein reflux, varicose veins always appear on the LEFT labial and leg region

    • If pelvic venous congestion is associated with severe obstruction of the left renal vein or iliac veins, then this obstruction should be treated prior to pelvic venous embolization when possible

    • Pelvic Venous Congestion Syndrome is a disorder common in post menopausal women

    • If internal iliac vein reflux is detected, coils should always be used along with catheter directed sclerotherapy

    Correct Answer
    A. If pelvic venous congestion is associated with severe obstruction of the left renal vein or iliac veins, then this obstruction should be treated prior to pelvic venous embolization when possible
    Explanation
    In cases where there is severe obstruction of the left renal vein or iliac veins, it is important to treat this obstruction before performing pelvic venous embolization. This is because the obstruction can interfere with the effectiveness of the embolization procedure. By treating the obstruction first, the pelvic venous congestion can be better managed and the desired outcome of the embolization can be achieved.

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  • 10. 

    Vascular MalformationsA 14 year old boy has always had a “birthmark” on his left thigh. As a child, prominent veins were noticed, but over the past year, a larger network of distended tortuous veins over thigh has become more evident. He reports that his leg tires easily and it feels heavy after activities. Which of the following would be the most useful initial diagnostic study?

    • Angiogram

    • Venogram

    • CT scan

    • MRI

    • Duplex ultrasound

    Correct Answer
    A. Duplex ultrasound
    Explanation
    The most useful initial diagnostic study in this case would be a duplex ultrasound. This non-invasive imaging technique can provide detailed information about the blood flow in the veins and can help to identify any abnormalities or malformations. In this case, the presence of distended tortuous veins and symptoms of leg fatigue and heaviness suggest a possible vascular malformation. A duplex ultrasound can effectively evaluate the veins and provide valuable information for further diagnosis and management.

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  • 11. 

    DVT and Post-Thrombotic SyndromeAccording to the Clinical Practice Guidelines from the American Venous Forum and Society of Vascular Surgery: A strategy for early thrombus removal is suggested for which patient?

    • 45 year old with femoropopliteal DVT less than 14 days in duration.

    • 55 year old with iliofemoral DVT of less than 14 days in duration.

    • 55 year old with femoropopliteal DVT of less than 21 days in duration.

    • 45 year old with iliofemoral DVT of less than 21 days in duration.

    Correct Answer
    A. 55 year old with iliofemoral DVT of less than 14 days in duration.
    Explanation
    The correct answer is 55 year old with iliofemoral DVT of less than 14 days in duration. This is because the guidelines suggest that early thrombus removal is recommended for iliofemoral DVT, which is a more severe form of DVT involving the iliac and femoral veins. Additionally, the duration of less than 14 days is specified, indicating the importance of early intervention in these cases.

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  • 12. 

    Compression and Wound AdjuvantsA 48 year old male with a history of chronic venous insufficiency has been treated for over a year for a recalcitrant venous leg ulcer. Compression with high strength bandaging has resulted in some improvement in the wound but not complete healing. Reflux duplex studies reveal a normal deep venous system and an incompetent great saphenous vein throughout its length. Which of the following is most likely to result in an increased likelihood of healing of the ulcer in the next 6 months?

    • Continued high strength compression bandaging

    • High ligation and stripping of the great saphenous vein

    • Endovenous laser ablation of the great saphenous vein

    • Application of Apligraf to the wound and continued high strength compression bandaging.

    Correct Answer
    A. Application of Apligraf to the wound and continued high strength compression bandaging.
    Explanation
    Apligraf is a bioengineered skin substitute that contains living cells and proteins that promote wound healing. Applying Apligraf to the wound, along with continued high strength compression bandaging, is likely to result in an increased likelihood of healing the ulcer in the next 6 months. This treatment approach addresses both the underlying venous insufficiency with compression bandaging and provides additional cellular support for wound healing with Apligraf. High ligation and stripping of the great saphenous vein and endovenous laser ablation of the great saphenous vein may be indicated in cases where the reflux of blood is contributing to the ulcer, but in this case, the duplex studies revealed a normal deep venous system and an incompetent great saphenous vein, suggesting that these procedures may not be necessary.

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  • 13. 

    Indication for Treating DVT and RecurrenceRecurrent Deep Vein Thrombosis (DVT) is most likely to occur in patients:

    • On chronic therapeutic anticoagulation

    • After a provoked acute DVT that resolves on anticoagulation

    • After thrombolysis for acute DVT while on therapeutic rivaroxaban (xarelto)

    • With diffuse chronic scar in the iliac and common femoral veins.

    Correct Answer
    A. With diffuse chronic scar in the iliac and common femoral veins.
    Explanation
    Patients with diffuse chronic scar in the iliac and common femoral veins are most likely to experience recurrent Deep Vein Thrombosis (DVT). This is because the scar tissue can disrupt the normal blood flow, leading to the formation of blood clots. Chronic therapeutic anticoagulation and anticoagulation after a provoked acute DVT that resolves are both aimed at preventing DVT recurrence, while thrombolysis for acute DVT while on therapeutic rivaroxaban (xarelto) is a treatment option for acute DVT and not directly related to recurrence. Therefore, the presence of diffuse chronic scar in the iliac and common femoral veins is the most relevant indication for treating DVT and recurrence.

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  • 14. 

    How to Use Anticoagulants Based on current evidence based guidelines, all of the following anticoagulants are indicated for treatment of acute deep venous thrombosis as initial therapy except:

    • Unfractionated heparin

    • Low molecular weigh heparin

    • Fondaprinux

    • Warfarin

    Correct Answer
    A. Warfarin
    Explanation
    Warfarin is not indicated for the initial treatment of acute deep venous thrombosis. Unfractionated heparin, low molecular weight heparin, and fondaparinux are recommended as initial therapy for acute deep venous thrombosis. Warfarin is typically used for long-term treatment and prevention of thromboembolic events, but it takes time to reach therapeutic levels and requires frequent monitoring of the international normalized ratio (INR). Therefore, it is not recommended as the initial therapy for acute deep venous thrombosis.

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  • 15. 

    Pharmacologic Management of CVDMicronized purified flavonoid fraction (MPFF), a mixture of diomin and hesperidin, has been shown to decrease which of the following variables?

    • Diameter of existing varicosities

    • Number of visible varicose veins

    • Time to ulcer healing

    • Rate of new varicosity formation

    Correct Answer
    A. Time to ulcer healing
    Explanation
    MPFF has been shown to decrease the time to ulcer healing in patients with chronic venous disease (CVD). This means that MPFF can help promote the healing of ulcers that are associated with CVD. It is not effective in decreasing the diameter of existing varicosities, reducing the number of visible varicose veins, or preventing the formation of new varicosities.

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  • 16. 

    Horse chestnut extract (HCE) has been shown to reduce leg edema. This compound may be especially beneficial in which population?

    • The morbidly obese

    • Those with previous DVT

    • Women

    • Those with arterial insufficiency

    Correct Answer
    A. Those with arterial insufficiency
    Explanation
    Horse chestnut extract (HCE) has been shown to reduce leg edema, which makes it beneficial for those with arterial insufficiency. Arterial insufficiency refers to a condition where there is inadequate blood flow to the legs, leading to symptoms like leg pain, ulcers, and edema. HCE helps in improving blood circulation and reducing inflammation, which can alleviate the symptoms of arterial insufficiency. Therefore, those with arterial insufficiency would benefit the most from using horse chestnut extract.

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  • 17. 

    Perforator ManagementA 49 year old male patient has venous ulcers, popliteal vein reflux, refluxing medial calf perforating veins and an otherwise normal superficial venous system, and no prior history of DVT.  After maximizing his conservative therapy and wound care, the next appropriate step for treatment of this patient would be?  Choose the best answer.

    • Treatment of the incompetent perforator veins

    • Treatment of the incompetent perforator veins, even if the above patient had extensive history of ileofemoral deep vein thrombosis

    • Treatment of incompetent perforator veins even if the patient had only edema and varicose veins (C3) and no leg ulcers.

    • Treatment of the incompetent perforator veins even if the patient had deep venous reflux in femoral and popliteal veins, GSV reflux, and subacute calf vein DVTs.

    Correct Answer
    A. Treatment of the incompetent perforator veins
    Explanation
    The next appropriate step for treatment of this patient would be the treatment of the incompetent perforator veins. This is because the patient has venous ulcers, popliteal vein reflux, and refluxing medial calf perforating veins. Treating the incompetent perforator veins can help improve the venous circulation and alleviate the symptoms associated with venous insufficiency. It is the most suitable option for this patient, regardless of their history of deep vein thrombosis or the presence of edema and varicose veins.

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  • 18. 

    Live Ultrasound ImagingWhat is the most common pathologic thigh varicosity?

    • Anterior Accessory Saphenous Vein

    • Vein of Giacommini

    • Posterior Saphenous Vein

    • Vein of Stephens

    Correct Answer
    A. Anterior Accessory Saphenous Vein
    Explanation
    The most common pathologic thigh varicosity is the Anterior Accessory Saphenous Vein. This vein is a common site for varicose veins in the thigh area. Varicose veins occur when the veins become enlarged, twisted, and swollen, usually due to weak or damaged valves in the veins. The Anterior Accessory Saphenous Vein is often affected by this condition, leading to the development of varicosities in the thigh.

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  • 19. 

    The image in Duplex ultrasound is:

    • ‘A’ mode

    • 'B’ mode

    • 'M’ mode

    • ‘D’ mode

    Correct Answer
    A. 'B’ mode
    Explanation
    The correct answer is 'B' mode. In duplex ultrasound, 'B' mode refers to the brightness mode which produces a two-dimensional image of the scanned area. It uses grayscale to display the intensity of the reflected ultrasound waves, allowing visualization of the internal structures and organs. This mode is commonly used in diagnostic imaging to examine the anatomy, detect abnormalities, and guide various medical procedures.

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  • 20. 

    Duplex ultrasound combines:

    • Infrared and Doppler

    • Doppler and ‘B’ mode

    • 'A’ mode and ‘B’ mode

    • Doppler and ‘M’ mode

    Correct Answer
    A. Doppler and ‘B’ mode
    Explanation
    Duplex ultrasound combines Doppler and 'B' mode. Doppler ultrasound measures the speed and direction of blood flow, while 'B' mode (brightness mode) produces a two-dimensional image of the scanned area. By combining these two modes, duplex ultrasound can provide both anatomical information and real-time visualization of blood flow, making it a valuable tool in diagnosing and monitoring various vascular conditions.

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  • 21. 

    Great Saphenous Vein Duplication occurs:

    • In the thigh

    • In the calf

    • Never

    • Only in the left leg

    Correct Answer
    A. In the thigh
    Explanation
    Great Saphenous Vein Duplication occurs in the thigh. This means that there can be more than one great saphenous vein present in the thigh region. The great saphenous vein is a large superficial vein in the lower limb, and duplication of this vein can occur due to developmental variations. It is important to note that this duplication does not occur in the calf or only in the left leg, but specifically in the thigh.

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  • 22. 

    Normally, the Great Saphenous Vein

    • Is duplicated

    • Is less than 3 mm in diameter

    • Is within the saphenous fascia

    • Is right beneath the skin

    Correct Answer
    A. Is within the saphenous fascia
    Explanation
    The correct answer is "Is within the saphenous fascia." The saphenous fascia is a layer of connective tissue that surrounds the Great Saphenous Vein. This helps to protect and support the vein, keeping it in place within the body. Being within the saphenous fascia also helps to prevent the vein from bulging or becoming enlarged.

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  • 23. 

    The Small Saphenous Vein

    • Is often duplicated

    • Is deep to the fascia in the upper calf

    • Always enters the popliteal vein at the popliteal crease

    • Is always medial to the Achille’s tendon

    Correct Answer
    A. Is deep to the fascia in the upper calf
    Explanation
    The small saphenous vein is deep to the fascia in the upper calf. This means that it is located beneath the layer of connective tissue known as the fascia in the upper part of the calf muscle. This positioning is important to note as it can affect the accessibility and potential complications during surgical procedures or interventions involving this vein.

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  • 24. 

    The Great Saphenous Vein:

    • Always lies within the saphenous fascia

    • Can exit the fascia

    • Is always singular

    • Is > 3 mm in patients with varicose veins

    Correct Answer
    A. Can exit the fascia
    Explanation
    The Great Saphenous Vein is not always confined within the saphenous fascia and has the ability to exit the fascia. This means that it can sometimes be found outside of the fascia. The other statements are not necessarily true as the vein may not always be singular and its size can vary in patients with varicose veins.

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  • 25. 

    The Great Saphenous Vein:

    • Always contributes to varicose veins

    • Can be normal with varicose veins

    • Has at least 10 valves

    • Is correctly called the Long Saphenous Vein

    Correct Answer
    A. Can be normal with varicose veins
    Explanation
    The Great Saphenous Vein can be normal with varicose veins. This means that even if a person has varicose veins, the Great Saphenous Vein may still be functioning normally. Varicose veins are enlarged and twisted veins that usually occur in the legs and can be caused by weakened valves or increased pressure in the veins. However, the presence of varicose veins does not necessarily mean that the Great Saphenous Vein is always affected or abnormal.

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  • 26. 

    The “Mickey Mouse” Sign:

    • Refers to the saphenofemoral junction

    • Is only present in Florida and California

    • Is at the saphenopopliteal junction

    • Is seen with the probe held longitudinally

    Correct Answer
    A. Refers to the saphenofemoral junction
    Explanation
    The "Mickey Mouse" sign refers to the saphenofemoral junction. This term is used to describe the appearance of the junction between the saphenous vein and the femoral vein when viewed with an ultrasound probe held longitudinally. The junction appears like the ears of Mickey Mouse, with the saphenous vein representing the head and the femoral vein representing the two ears. This sign is commonly used in the field of vascular ultrasound to identify and assess the saphenofemoral junction.

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  • 27. 

    A Baker’s Cyst is:

    • In the popliteal fossa

    • Anywhere in the leg

    • Connected with the joint

    • A and C

    Correct Answer
    A. A and C
    Explanation
    A Baker's Cyst is a fluid-filled sac that forms in the popliteal fossa, which is the hollow space located at the back of the knee. It is also connected with the joint, as it is formed as a result of excess fluid accumulation in the knee joint. Therefore, the correct answer is A and C.

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  • 28. 

    The Femoral Vein:

    • Is always competent with varicose veins

    • Can be absent in certain patients

    • Can be duplicated

    • B and C

    Correct Answer
    A. B and C
    Explanation
    The femoral vein can be absent in certain patients and can also be duplicated. This means that some individuals may not have a femoral vein, while others may have more than one femoral vein. This variability in the presence and number of femoral veins is a normal anatomical variation that can occur in the human body.

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  • 29. 

    The Superficial Femoral Vein

    • Is adjacent to the Superficial Femoral Artery

    • Is a superficial vein

    • Doesn’t exist anymore

    • Is a deep vein

    Correct Answer
    A. Doesn’t exist anymore
    Explanation
    The given answer states that the Superficial Femoral Vein doesn't exist anymore. This suggests that either the vein has been removed or it is no longer present in the body. Without the Superficial Femoral Vein, it cannot be adjacent to the Superficial Femoral Artery, be a superficial vein, or be a deep vein.

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  • 30. 

    Which of the following is a characteristic on US evaluation of iliofemoral vein obstruction?

    • Phasic flow in the common femoral vein

    • Chronic changes in the common femoral vein

    • Pulsatility in the common femoral vein

    • Continous non-phasic flow in the common femoral vein

    Correct Answer
    A. Continous non-phasic flow in the common femoral vein
    Explanation
    Continuous non-phasic flow in the common femoral vein is a characteristic of US evaluation of iliofemoral vein obstruction. This means that there is a constant and steady flow of blood in the common femoral vein, without any variation or pulsatility. This is in contrast to normal phasic flow, which is characterized by variations in flow with respiration. The presence of continuous non-phasic flow suggests a blockage or obstruction in the iliofemoral vein, leading to a disruption in the normal flow patterns.

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  • 31. 

    When assessing the venous system of the lower extremity the great saphenous vein and tibial vein reflux (in seconds) is defined as which of the following (respectively)?

    • 1 and 1

    • 0.5 and 1

    • 0.5 and 0.5

    • 1 and 0.5

    Correct Answer
    A. 0.5 and 0.5
    Explanation
    The correct answer is 0.5 and 0.5. In the assessment of the venous system of the lower extremity, the great saphenous vein and tibial vein reflux are both defined as 0.5 seconds each. This means that there is a backward flow or reflux of blood in both veins for a duration of 0.5 seconds. This measurement is used to evaluate the presence of venous insufficiency or valve dysfunction in these veins.

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  • 32. 

    What is a characteristic on US of acute DVT in the femoral vein?

    • Dilated vein

    • Hyperechoic

    • Compressible

    • Large collaterals around DVT

    Correct Answer
    A. Dilated vein
    Explanation
    In acute deep vein thrombosis (DVT) in the femoral vein, a characteristic finding on ultrasound (US) is a dilated vein. This means that the affected vein appears enlarged compared to its normal size. This dilation occurs due to the presence of the blood clot within the vein, which obstructs the normal flow of blood and causes the vein to expand. This finding is important in diagnosing DVT as it helps differentiate it from other conditions and guides appropriate management.

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  • 33. 

    What is a characteristic on US of chronic DVT in the femoral vein?

    • Dilated vein

    • Partial compressibility

    • Hypoechoic residual thrombus

    • Likely absence of venous reflux

    Correct Answer
    A. Partial compressibility
    Explanation
    Partial compressibility is a characteristic on ultrasound (US) of chronic deep vein thrombosis (DVT) in the femoral vein. Chronic DVT refers to a long-standing blood clot, and on US, the vein may appear dilated. However, the key characteristic is the partial compressibility of the vein, which means that the vein can still be compressed by external pressure. This is in contrast to acute DVT, where the vein is typically non-compressible. The presence of partial compressibility suggests that the thrombus is organized and has undergone some degree of fibrosis, indicating a chronic process.

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  • 34. 

    IVC Filters Case Based WorkshopBased on current evidence based guidelines, which of the following clinical scenarios would use of a permanent filter be most appropriate?

    • 35 y.o. male involved in a motorcycle accident with closed head injury, pelvic fracture, and femur fracture.

    • 35 y.o. male involved in a motorcycle accident with closed head injury, pelvic fracture, and femur fracture. a.45 y.o. female with a body mass index of 55 kg/m2 undergoing elective gastric bypass surgery.

    • 65 y.o. male with a bleeding peptic ulcer and documented acute lower extremity deep venous thrombosis on venous ultrasound.

    • 28 y.o. male with paraplegia from a spinal cord injury with a documented lower extremity deep venous thrombosis who developed a pulmonary embolism while on therapeutic anticoagulation.

    Correct Answer
    A. 28 y.o. male with paraplegia from a spinal cord injury with a documented lower extremity deep venous thrombosis who developed a pulmonary embolism while on therapeutic anticoagulation.
  • 35. 

    Which of the following clinical scenarios would use of an optional / retrievable filter be most appropriate?

    • 48 y.o. male with prior history of venous thromboembolism on chronic therapeutic anticoagulation who presents with shortness of breath and chest pain and is noted to have pulmonary embolism on CT angiogram.

    • 72 y.o. female with metastatic breast cancer who 3 days after modified radical mastectomy presents with acute leg swelling and is found to have deep venous thrombosis on venous ultrasound.

    • 62 y.o. male with a prior history of deep venous thrombosis, known Factor V Leiden mutation, who is on chronic anticoagulation and is scheduled for elective total hip arthroplasty.

    • 48 y.o. male in the medical intensive care unit on pharmacologic thromboprophylaxis with subcutaneous low molecular weight heparin who develops an acute pulmonary embolism.

    Correct Answer
    A. 62 y.o. male with a prior history of deep venous thrombosis, known Factor V Leiden mutation, who is on chronic anticoagulation and is scheduled for elective total hip arthroplasty.
    Explanation
    The use of an optional/retrievable filter would be most appropriate for the 62 y.o. male with a prior history of deep venous thrombosis, known Factor V Leiden mutation, who is on chronic anticoagulation and is scheduled for elective total hip arthroplasty. This patient has multiple risk factors for developing deep venous thrombosis, including a previous history of the condition and a known genetic mutation. The elective surgery further increases the risk of thromboembolism. The use of a retrievable filter can provide temporary protection against pulmonary embolism during the perioperative period and can be removed once the risk has decreased.

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  • 36. 

    Which of the following is not a preparatory step to IVC filter retrieval?

    • Duplex US confirmation of absence of lower extremity DVT by ultrasound in unanticoagulated patients

    • Venographic assessment of the device prior to removal

    • Cessation of anticoagulation

    • Patient discussion to review filtration needs and filter removal implications

    Correct Answer
    A. Cessation of anticoagulation
    Explanation
    Cessation of anticoagulation is not a preparatory step to IVC filter retrieval because anticoagulation should be continued during the retrieval procedure to prevent the formation of blood clots. Anticoagulation helps to keep the blood thin and reduces the risk of clot formation during the removal process. Therefore, stopping anticoagulation would not be a recommended step for IVC filter retrieval.

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  • 37. 

    All of the following features are ideal in IVC filter design except?

    • Low impedance to flow

    • Conical geometry

    • High filtering efficiency

    • Two trapping levels

    Correct Answer
    A. Two trapping levels
    Explanation
    The ideal features in an IVC filter design include low impedance to flow, conical geometry, and high filtering efficiency. However, having two trapping levels is not considered an ideal feature in IVC filter design. This is because having multiple trapping levels can increase the risk of filter migration, fracture, or perforation. Therefore, the presence of two trapping levels is not recommended in an ideal IVC filter design.

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  • 38. 

    Compression and Wound Care Case Based Workshop A 47 YO male develops ulceration of the right leg above the medial maleolus 4 years after a deep vein thrombosis of the popliteal and femoral veins. The wound is debrided and high-strength compression therapy is recommended to support ulcer healing. Which of the following compression methods provides inadequate compression pressures to support venous ulcer healing?

    • Class II knee high compression hosiery

    • Unna’s paste boot and elastic self-adherent wrap (Coban)

    • Multilayer elastic compression system (Profore)

    • Kerlex gauze wrap and long stretch elastic bandage (ACE)

    Correct Answer
    A. Kerlex gauze wrap and long stretch elastic bandage (ACE)
    Explanation
    The correct answer is Kerlex gauze wrap and long stretch elastic bandage (ACE). Kerlex gauze wrap and ACE bandage provide low compression pressures and are not suitable for supporting venous ulcer healing. Compression therapy is essential for venous ulcer healing as it helps improve blood flow, reduce edema, and promote wound healing. Class II knee high compression hosiery, Unna's paste boot and Coban wrap, and Profore multilayer elastic compression system are all effective methods for providing adequate compression pressures to support venous ulcer healing.

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  • 39. 

    A patient presents with a 10 year history of unilateral right lower extremity limb edema and obesity. Her BMI is 37 and she has areas of weeping on the leg but no full thickness ulceration. Prior physicians have attempted to treat her leg with compression hosiery up to 50 mm Hg and bandaging without success. The patient has difficulty applying the stockings and the bandages consistently fall down the leg after application. Which treatment modality is most likely to achieve improved edema control in this situation?

    • Diuretic therapy

    • Inelastic compression therapy

    • Intermittent pneumatic compression therapy

    • Lympho-venous bypass

    Correct Answer
    A. Intermittent pneumatic compression therapy
    Explanation
    Intermittent pneumatic compression therapy is the most likely treatment modality to achieve improved edema control in this situation. This is because the patient has difficulty applying compression hosiery and bandages consistently, which are the standard treatments for edema. Intermittent pneumatic compression therapy uses a device that applies intermittent pressure to the affected limb, helping to improve circulation and reduce edema. This therapy would be more effective for the patient compared to diuretic therapy or inelastic compression therapy. Lympho-venous bypass is not a commonly used treatment for edema and is not the most appropriate option in this case.

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  • 40. 

     Use of four layer compression wraps in the management of venous stasis ulcers has been shown to be:

    • More effective than 3 layer wraps.

    • Safe in patients with ABI

    • Recommended to be changed daily in most patients.

    • An effective antimicrobial treatment.

    Correct Answer
    A. More effective than 3 layer wraps.
    Explanation
    The given statement suggests that the use of four layer compression wraps is more effective than three layer wraps in the management of venous stasis ulcers. This implies that the four layer compression wraps provide better outcomes in terms of wound healing and symptom improvement compared to the three layer wraps. The effectiveness of the four layer wraps may be attributed to their ability to provide more pressure and support to the affected area, leading to improved venous return and reduction in edema.

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  • 41. 

    Use of bilayered skin substitutes are approved for use in:

    • Venous stasis ulcers only

    • Diabetic foot ulcers Only

    • Ischemic ulcers only

    • Venous ulcers and diabetic ulcers

    Correct Answer
    A. Venous stasis ulcers only
    Explanation
    Bilayered skin substitutes are approved for use in venous stasis ulcers only. This means that these substitutes are specifically designed and approved for treating venous stasis ulcers, which are caused by poor circulation in the legs. They may not be suitable or approved for use in other types of ulcers such as diabetic foot ulcers or ischemic ulcers. Therefore, the correct answer is venous stasis ulcers only.

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  • 42. 

    Sclerotherapy Case Based WorkshopWhen managing patient expectations of cosmetic sclerotherapy, one should always mention WHICH ONE of the following?

    • It usually takes only ONE treatment to obliterate veins if the veins are filled quickly

    • It is better to use a larger volume of sclerosant to overfill the veins for better results

    • Sclerotherapy is often associated with trapped blood and pigmentation, and there is no treatment for this other than “tincture of time”

    • A follow up visit is frequently needed (to assess the need for more sclerotherapy, and to assess for intra-luminal thrombus which may benefit from micro-thrombectomy)

    Correct Answer
    A. A follow up visit is frequently needed (to assess the need for more sclerotherapy, and to assess for intra-luminal thrombus which may benefit from micro-thrombectomy)
    Explanation
    When managing patient expectations of cosmetic sclerotherapy, it is important to mention that a follow-up visit is frequently needed. This visit serves two purposes: to assess the need for more sclerotherapy if the veins are not completely obliterated after the initial treatment, and to assess for intra-luminal thrombus, which may require micro-thrombectomy for optimal results. This highlights the importance of ongoing assessment and potential additional treatments to achieve the desired outcome.

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  • 43. 

    With regard to foam sclerotherapy, which of the following statements is CORRECT?

    • Foam is more effective than liquid sclerotherapy for obliteration of venous malformations

    • Foam is very safe in patients with patent foramen ovale as long as it is used with the patient in Trendelenburg position

    • It should be used for treatment of spider veins because it can never embolize from these smaller veins

    • When using foam, there is NEVER any problem with intraluminal thrombus (trapped blood) or pigmentation

    Correct Answer
    A. Foam is more effective than liquid sclerotherapy for obliteration of venous malformations
    Explanation
    Foam sclerotherapy is more effective than liquid sclerotherapy for obliteration of venous malformations. This is because foam has a larger surface area and greater contact with the vein walls, allowing for better distribution and penetration of the sclerosant. The foam also displaces blood in the vein, ensuring that the sclerosant comes into direct contact with the vein wall. This leads to improved efficacy in obliterating the malformations compared to liquid sclerotherapy.

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  • 44. 

    Intravascular Ultrasound (IVUS) Case Based WorkshopThe best method to adequately evaluate the IVC and the iliac venous system for underlying stenosis is with:

    • Venography.

    • Venography with pressure measurements.

    • IVUS with 15 MHz catheter.

    • IVUS with 40 MHz catheter.

    Correct Answer
    A. IVUS with 15 MHz catheter.
    Explanation
    IVUS stands for Intravascular Ultrasound, which is a medical imaging technique that uses sound waves to produce images of blood vessels from inside the body. In this case, the question is asking about the best method to evaluate the IVC (inferior vena cava) and iliac venous system for underlying stenosis (narrowing of the blood vessels). The correct answer is IVUS with a 15 MHz catheter. This is because a 15 MHz catheter provides a good balance between image resolution and depth penetration, making it suitable for visualizing and assessing the blood vessels in this particular scenario.

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  • 45. 

    If a physician uses IVUS to place a bedside IVC filter in the ICU:

    • Visualization of the renals veins is adequate.

    • Overall procedure cost is more expensive since the patient is in the ICU.

    • Although feasible it still requires C-Arm and a small amount of contrast.

    • Visualization of thrombus is not possible with IVUS.

    Correct Answer
    A. Visualization of the renals veins is adequate.
    Explanation
    The correct answer is "Visualization of the renal veins is adequate." This means that using IVUS (Intravascular Ultrasound) to place a bedside IVC (Inferior Vena Cava) filter in the ICU allows for clear visualization of the renal veins. This is important because the renal veins are the blood vessels that carry blood away from the kidneys. By having adequate visualization, the physician can ensure accurate placement of the IVC filter and minimize the risk of complications.

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  • 46. 

    Venous Pathology identified with Intravascular Ultrasound includes all of the following except

    • Vein stenosis due to extrinsic compression

    • Venous webs

    • Non-occlusive “hyperechoic” vein wall changes suggestive of prior DVT

    • Venous atherosclerotic plaque

    Correct Answer
    A. Venous atherosclerotic plaque
    Explanation
    Intravascular ultrasound is a diagnostic tool used to examine the blood vessels. It is particularly useful in identifying venous pathology. Vein stenosis due to extrinsic compression, venous webs, and non-occlusive "hyperechoic" vein wall changes suggestive of prior DVT are all examples of venous pathology that can be identified with intravascular ultrasound. However, venous atherosclerotic plaque is not typically identified with this imaging technique. Atherosclerotic plaque is more commonly associated with arterial disease rather than venous pathology.

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  • 47. 

    Intravascular ultrasound technologies used in treating deep vein disease include

    • Color-enhanced vein wall measurements

    • B-Mode ultrasound imaging

    • Non-contrast venography

    • Multi-Hertz variable ultrasound imaging

    Correct Answer
    A. B-Mode ultrasound imaging
    Explanation
    B-Mode ultrasound imaging is a type of intravascular ultrasound technology used in treating deep vein disease. It involves the use of high-frequency sound waves to create a real-time, two-dimensional image of the blood vessels and surrounding tissues. This imaging technique allows healthcare professionals to visualize the structure and function of the veins, helping in the diagnosis and treatment of deep vein disease. It provides valuable information about the size, shape, and location of blood clots or blockages, allowing for accurate and targeted interventions.

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  • 48. 

    Pharmacomechanical Thrombolysis /Iliofemoral DVT Case Based WorkshopThe most likely presentation that an IVC filter placement should be considered prior to PMT is?

    • A patient with a femoropopliteal DVT

    • A patient with an iliofemoral DVT

    • A patient with an asymptomatic small PE

    • A patient with an iliofemoral DVT with an extension into the IVC

    Correct Answer
    A. A patient with an iliofemoral DVT with an extension into the IVC
    Explanation
    The correct answer is "A patient with an iliofemoral DVT with an extension into the IVC." This is because pharmacomechanical thrombolysis (PMT) is a treatment option for iliofemoral deep vein thrombosis (DVT), especially when it extends into the inferior vena cava (IVC). In this case, an IVC filter placement should be considered prior to PMT to prevent the dislodgement of thrombus during the procedure, which can potentially cause a pulmonary embolism (PE).

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  • 49. 

    For planning treatment with PMT and angioplasty and stenting, for a patient with an entire left limb swelling that is symptomatic and mild tachypnea, the best preoperative imaging would be?

    • CTA

    • MRA

    • CTPA and CTA

    • US

    Correct Answer
    A. US
    Explanation
    Ultrasound (US) would be the best preoperative imaging for a patient with an entire left limb swelling that is symptomatic and mild tachypnea. US is a non-invasive and readily available imaging modality that can provide real-time images of the affected limb, allowing for the assessment of blood flow, blood clots, and any other abnormalities. It is particularly useful for evaluating deep vein thrombosis (DVT) and can help guide the decision-making process for treatment with PMT (pharmacomechanical thrombolysis) and angioplasty and stenting. CTA (computed tomography angiography), MRA (magnetic resonance angiography), and CTPA (computed tomography pulmonary angiography) may also be used in specific cases, but US is generally preferred as the initial imaging modality.

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Quiz Review Timeline (Updated): Feb 22, 2024 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Feb 22, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Aug 21, 2014
    Quiz Created by
    Mia Beans

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