Abstract
The following questions for SVU-CME examination are based on the article entitled “ECG Gating is Not Required for Brachial Artery Flow-Mediated Dilation Measurement” by Usman Jaffer and Mohammed Aslam.
Both true/false and multiple choice questions are included. There is only one (1) correct answer for the multiple choice test items. Answer all the questions as listed below. One (1) SVU-CME will be awarded for successful completion of this test with a grade of 80% or more.
Brachial artery flow mediated dilation (FMD) is a well established technique in the noninvasive assessment of
endothelial function
adventitial disease
venous thrombosis
vasospasm
Endothelial dysfunction is thought to be an offspring event to the development of the overt lesions of atherosclerosis.
True
False
Recently, increasing effort has been made assessing brachial artery vasodilator response in order to establish a correlation with all of the following, except
presence of atherosclerotic disease in coronary arteries
presence of atherosclerotic disease in the carotid vascular bed
predicting ischemia in the leg
predicting the risk of restenosis following coronary artery stenting
In an autopsy study the results showed that all of the following could be predicted by non-invasive studies of endothelial function, except
grade of atherosclerotic lesion in the brachial artery
grade of atherosclerotic lesion in the basilar artery
grade of atherosclerotic lesion in the carotid arteries
grade of atherosclerotic lesion in the coronary arteries
The R wave on the ECG tracing corresponds to the commencement of electrical activity in the ventricle which is followed by ventricular contraction and systole. R-wave gating will ensure that all images are acquired in the end diastole phase of the cardiac cycle.
True
False
The inflated blood pressure cuff to cause dilation was left on for
One minute
Two minutes
Three minutes
Four minutes
Vessel diameter is larger at peak diastole compared to end-diastole, and the degree of this difference may be related to vessel compliance which itself may be related to availability of nitrous oxide. Thus R wave gating may act to mask the effects of endothelial dysfunction, potentially resulting in reduced sensitivity.
True
False
After blood pressure was left on the image of the brachial artery was taken
one minute after deflation
three minutes after deflation
two minutes after deflation
four minutes after deflation
The issue regarding the lack of utility of the R-wave gating using end diastole is that the vessel diameter is larger at peak diastole compared to end-diastole which may be related to the availability of nitrous oxide.
True
False
The authors state that there is no need for automated image analysis and image acquisition throughout the cardiac cycle since it does not help.
True
False
Instructions: Please answer all of the questions and return the answer sheet with the nonrefundable processing fee ($10.00 for SVU members and $20.00 for non-members). All tests must be received by September 30, 2013. Tests received after this deadline will be returned ungraded. When graded, the answer sheet will be returned as proof of earning SVU-CME credit.
If paying by credit card, the answer sheet may be sent via fax: 301-459-5651. Otherwise, mail it with a check, made payable to SVU (in US funds drawn on a US bank net of all charges) to SVU, P.O. Box 75491, Baltimore, MD 21275-5491.
The following questions for SVU-CME examination are based on the article entitled “Risk Focused Screening for Vascular Disease: One University Hospital's Experience” by Joseph P. Hughes, RVT, RVS, FSVU, Rick Dubin, AS, RVT, RDMS, Angela Rodriguez-Wong, MD, RVT, RPVI, and Francis J. Porreca, MD, RPVI.
Both true/false and multiple choice questions are included. There is only one (1) correct answer for the multiple choice test items. Answer all the questions as listed below. One (1) SVU-CME will be awarded for successful completion of this test with a grade of 80% or more.
The United States Preventative Services Task Force (USPSTF) suggests that the risk associated with screening outweighs the benefits when screening for carotid artery stenosis (CAS) and PAD.
True
False
This study was designed to determine all of the following except:
the prevalence of disease when screening exams are performed on those most at risk for developing vascular disease.
the risk associated with screenings
to stratify the amount of vascular disease present in the at-risk population
to establish which individuals might benefit most from vascular screening.
Upon arrival, participants were asked to complete a questionnaire to document any symptoms, family medical history, and whether participants were currently being treated for or were diagnosed with the following controllable cardiovascular risk factors/conditions, except:
Hypertension (HTN)
hyperlipidemia (HLP)
diabetes mellitus (DM)
peripheral arterial disease (PAD)
Ninety-four (94) participants (29%) had mild disease not requiring immediate follow-up and _____ had significant findings, and were recommended for complete non-invasive testing.
23 participants (7%)
32 participants (10%)
46 participants (14%)
64 participants (20%)
A history of current or previous smoking, singly or in combination with other risk factors, did demonstrate statistical significance (p = 0.10) for the presence of disease.
True
False
The United States Preventative Services Task Force (USPSTF) rationale for recommending against CAS screening is that CAS
may miss significant carotid stenosis
has a false negative rate that is inacceptable
the exam itself may cause a stroke
the false positive rate may cause further testing which may cause a stroke
Screening for AAA has been recommended due to “good evidence” that surgical repair of AAA in specific individuals' decreases AAA-specific mortality, and that abdominal ultrasonography is “an accurate screening test for AAA.”
True
False
Individuals with multiple risk factors did have a greater incidence of disease and the number of risk factors that a patient had was a likely predictor of the severity, i.e., mild or significant, of disease alone.
True
False
Stroke, which is the third leading cause of disability in the United States is caused by atherosclerosis in _____ percent of patients.
55
65
75
85
In this wonderful paper there is one fact that might make the results slightly less applicable than hoped for.
males outnumbered females 2 to 1
females outnumbered males 2 to 1
33 participants were excluded
the average age was 71.8
If paying by credit card, the answer sheet may be sent via fax: 301-459-5651. Otherwise, mail it with a check, made payable to SVU (in US funds drawn on a US bank net of all charges) to SVU, P.O. Box 75491, Baltimore, MD 21275-5491.
The following questions for SVU-CME examination are based on the article entitled “Incidental Finding of Asymptomatic Aortic Dissection” by Elaine Y. L. Goh, MBA, BSc, RVT, Shirley C. K. Ng, RVT, Victor T. T. Chao, MBBS, FRCS, FAMS, RPVI, RVT, and Zee P. Ding, MBBS, MMed, FAMS.
Both true/false and multiple choice questions are included. There is only one (1) correct answer for the multiple choice test items. Answer all the questions as listed below. One (1) SVU-CME will be awarded for successful completion of this test with a grade of 80% or more.
Aortic dissection limited to the abdominal aorta is common.
True
False
Aortic dissection occurs when there is
a tear in the adventitia, resulting in longitudinal splitting of arterial wall, producing a double lumen aorta.
a tear in the media, resulting in longitudinal splitting of arterial wall, producing a double lumen aorta.
a tear in the intima, resulting in longitudinal splitting of arterial wall, producing a double lumen aorta.
a tear in the intima, resulting in circumferential splitting of arterial wall, producing a double lumen aorta.
Spontaneous dissection of the aorta mostly originates in the _____ aorta.
ascending
descending
abdominal
transverse
Aortic dissection limited to the abdominal aorta is very rare, accounting for about _____ of all aortic dissections.
6–8%
4–6%
8–10%
2–4%
The most common symptom of abdominal dissections is
back pain
sharp pain radiating between thigh and groin
either asymptomatic or non-specific
indigestion
Abdominal aortic dissection may represent a possible extension of a thoracic aortic dissection.
True
False
Aortography has been, until recently, the gold standard diagnostic study.
True
False
The current gold standard is
angiography
ultrasound
MRI
CTA
Among the limitations of ultrasound are all of the following, except.
thrombosed false lumen may be misinterpreted as intra-luminal thrombus
a lack of bioeffects
accurate diagnosis may not be possible in obese individuals
it is not able to firmly establish the upper extent of the dissection process
MRI limitations include all of the following, except
significant time for image acquisition
may not be able to accurately provide a positive finding if there is a similar blood flow through both the false and true lumina or if thrombus obscures the false lumen
can demonstrate intra-luminal aortic flap and scanning in sagittal, coronal and oblique planes
It may also not be possible if the patient has certain types of metallic implants.
If paying by credit card, the answer sheet may be sent via fax: 301-459-5651. Otherwise, mail it with a check, made payable to SVU (in US funds drawn on a US bank net of all charges) to SVU, P.O. Box 75491, Baltimore, MD 21275-5491.
