Post-Test Questions

Article 1 (365–377)

1. A 65‐year‐old man with a history of diabetes mellitus and a 50‐pack‐year smoking history has been recently diagnosed with intermittent claudication. He does not have a history of hypertension or high cholesterol. Which of the following is indicated in the management of this patient?

   • Statin therapy, glycemic control, smoking cessation, clopidogrel, cilostazol.

   • Glycemic control, smoking cessation, cilostazol.

   • Glycemic control, smoking cessation, clopidogrel, cilostazol.

   • Ace inhibitor, glycemic control, smoking cessation, cilostazol.

2. A 68‐year‐old man with a nonhealing ulcer over the first toe of the right foot is suspected to have peripheral arterial disease (PAD). Duplex ultrasound is abnormal. Ankle‐brachial index (ABI) is 0.4. What is the next step?

   • Exercise treadmill ABI.

   • Toe‐brachial index.

   • Angiography with intervention.

   • No further testing is required.

3. A 70‐year‐old man has rest pain and nonhealing ulcer without gangrene, and ABI is 1.10. What is the patient's category of PAD?

   • Symptomatic PAD.

   • Intermittent claudication.

   • Acute limb ischemia.

   • Critical or chronic limb ischemia.

   Article 2 (378–383)

4. Which of the following would represent an acceptable team to treat a patient suffering from critical limb ischemia?

   • Cardiologist, infectious disease specialist, and orthopedic surgeon.

   • Vascular surgeon and podiatrist.

   • Podiatrist, interventional radiologist, and cardiologist.

   • Endocrinologist and wound care nurse.

5. A 1% reduction in hemoglobin A1c results in_%reduction in microvascular complications.

   • 10%.

   • 25%.

   • 50%.

   • 75%.

6. In diabetic foot ulcers, the following would be classified as a “major amputation”:

   • Digital or ray amputation.

   • Transmetatarsal amputation.

   • Syme amputation.

   • Below‐the‐knee amputation.

   • All of the above.

7. Approximate 5‐year survival for patients suffering from critical limb ischemia is:

   • Less than 15%.

   • Less than 40%.

   • Less than 65%.

   • Greater than 90%.

8. The most common medical condition associated with PAD and CLI is:

   • Smoking.

   • Diabetes.

   • Hypertension.

   • Obesity.

   • Renal failure.

   Article 3 (384–392)

9. A major limitation of the diagnostic utility of an ABI is:

   • Poor sensitivity and speciicity.

   • Difficulty performing the exam.

   • Poor compressibility of calciied tibial vessels.

   • Exam cost.

10. A noninvasive test that may be used in conjunction with an ABI to increase diagnostic utility in diabetic patients:

    • Toe‐brachial index.

    • Pulse volume recordings.

    • Color duplex evaluation.

    • All of the above.

11. A peak systolic velocity ratio (PSVR) with high sensitivity and specificity for an arterial stenosis greater than 50%:

    • 2.4.

    • 3.

    • 4.

    • 7.

    Article 4 (393–398)

12. For a patient with a severe lidocaine allergy, if a suitable substitute anesthetic medication is not available, which common drug can be injected subcutaneously for local pain control?

    • Diphenhydramine.

    • Nitroglycerine.

    • Protamine sulfate.

    • Verapamil.

    • Flumazenil.

13. Which of the following is not an indication for prophylactic antibiotic administration during a peripheral arterial intervention?

    • Prolonged procedure.

    • Sheath left in overnight.

    • Stent graft placement.

    • Closure device deployment.

    • Multiple procedures within a 7‐day period.

14. Evidence suggests that a “radial artery cocktail” to prevent radial artery spasm should include each of the following classes of medications except:

    • Calcium channel blocker.

    • Heparin.

    • GP 2a/3b inhibitor.

    • Nitroglycerin.

    Article 5 (399–405)

15. Which of the following statements is false?

    • The 5‐year mortality after a major amputation is twice that of the average 5‐year cancer mortality in the United States.

    • The same numbers of leg revascularization procedures are performed each year as breast augmentations.

    • Evaluation of arterial patency and the level of occlusion or stenoses can be performed utilizing physical examination and a vascular Doppler.

    • Classic features of a venous wound are irregular borders, large amount of fibrinous slough, large volume of exudate, peri‐wound maceration, and location in the sock or medial malleolar distribution.

    • Peri‐wound callus is a classic feature of a neuropathic ulcer.

16. Which one of the following is a classic presentation for the stated wound etiology?

    • A wound with abundant peri‐wound callus, peri‐wound maceration, necrotic eschar, and adjacent sensory loss with hemosiderosis on the lateral leg is classic for a venous ulcer.

    • A wound on the plantar surface of the foot with a “punched‐out” margins, no callous, no sensory loss, no pain, and a large amount of lower extremity edema below the knee is classic for a venous ulcer.

    • A wound on a cold pale forefoot with well‐defined margins, eschar, minimal exudate, and minimal slough, with associated hair loss and shiny thin scaly skin, is classic for an arterial ulcer.

    • A wound on the medial aspect of the foot with a large amount of exudate, ill‐defined borders, beefy red wound bed, telangiectasias, and crusting, is classic for a neuropathic ulcer.

17. Select the history or physical exam finding that is correctly associated with the stated wound type.

    • Dependent rubor is associated with arterial ulcers.

    • Abundant callus involving the peri‐wound tissues is characteristic of an arterial wound.

    • Preceding trauma is common in venous ulcers.

    • Atrophie Blanche is associated with neuropathic ulcers.

    • Eschar is a common feature of venous ulcers.

    Article 7 (427–434)

18. Access site complications in transradial access may provide a specific advantage over transfemoral access in patients being treated for PAD because:

    • They are frequently on antiplatelet and/or anticoagulant medication(s).

    • Most are obese.

    • The procedure times for treatment of PAD are longer.

    • They have a higher incidence of CFA and aortic atherosclerotic disease, aneurysm, and/or prior treatment.

    • All of the above.

    • A and D only.

19. Which of the following is/are limited by the use of a single radial access point to treat PAD:

    • Treatment of bilateral disease.

    • Placement of “kissing” stents.

    • Treatment of a ruptured abdominal aortic aneurysm.

    • All of the above.

    • B and C only.

20. Radial access currently most limits which of the following interventions:

    • Balloon angioplasty of the aorta.

    • Stenting of the common iliac artery.

    • Atherectomy of the superficial femoral artery.

    • Stenting of the anterior tibial artery.

    • Balloon angioplasty of anterior tibial artery.

    Article 8 (435–442)

21. Which of the following is the best recommendation with regard to medical therapy for cardiovascular risk factors in claudicants?

    • Medical therapy should be the last approach after endovascular revascularization for PAD.

    • Medical therapy with cilostazol has no role in relieving claudication symptoms.

    • Medical therapy and diet is the only option in patients with lifestyle‐limiting claudication who cannot exercise.

    • Medical therapy should be the first‐line approach in patients diagnosed with PAD.

22. Which of the following best states results of the CLEVER trial for PAD?

    • Supervised exercise program improved walking performance in patients with critical limb ischemia.

    • Surgical bypass outperformed exercise therapy in improving symptoms of patients with claudication.

    • Supervised exercise program improved walking performance more than endovascular revascularization for patients with aortoiliac disease.

    • Medical management is better than supervised exercise program in patients with femoropopliteal disease.

23. Which of the following statements most accurately characterizes the role of revascularization in patients with PAD?

    • Surgical bypass is the irst‐line approach for patients with recently diagnosed claudication.

    • Revascularization improves cardiovascular morbidity in patients with claudication.

    • Revascularization helps prevent progression to critical limb ischemia and amputations in patients with claudication.

    • Role of revascularization in claudication should be focused at improvement in claudication symptoms and functional status.

    Article 9 (443–452)

24. Paclitaxel, the most commonly utilized antiproliferative agent used for drug coating, works by which of the following actions?

    • Direct endothelial toxicity resulting in cellular death.

    • Binding to microtubule proteins to arrest cellular division.

    • Intercalation into DNA and disruption of topoisomerase‐II‐mediated DNA repair, resulting in cell death.

    • Topoisomerase 1 inhibitor, resulting in cell death.

25. Which of the following is not an important factor when considering the diferences in the current FDA‐approved drug‐coated balloons?

    • Need for heparinization.

    • Excipient.

    • Drug dose.

    • Morphology of the drug coating.

26. A 72‐year‐old male has severe claudication and is found to have a 7‐cm total occlusion of his superficial femoral artery. According to the Zilver PTX trial, which of the following technologies has the highest patency rate at 5 years?

    • Balloon angioplasty.

    • Bare metal stent.

    • Balloon angioplasty with provisional bare metal stent.

    • Drug‐eluting stent.

27. Meta‐analyses have shown all of the following to be benefits of drug‐eluting stents in the infrapopliteal circulation except:

    • Improved freedom from target lesion revascularization (TLR).

    • Improved primary patency.

    • Improved amputation rates.

    • Improved overall survival.

    Article 10 (453–460)

28. Acute limb ischemia, by deinition, is a sudden decrease in limb perfusion that threatens limb viability within what time frame?

    • 7 days.

    • 14 days.

    • 21 days.

    • 30 days.

29. Which of the following classiication systems, which is based on physical examination indings, drives treatment decisions with regard to acute limb ischemia?

    • The Rutherford classiication system.

    • Society of Interventional Radiology Acute Limb Ischemia Practice Guidelines.

    • Surgery vs. Thrombolysis for Ischemia of the Lower Extremity (STILE) classiication system.

    • Thrombolysis or Peripheral Arterial Surgery (TOPAS) classiication system.

30. Which of the following Rutherford classiications of acute limb ischemia is characterized by absent arterial Doppler signals without muscle weakness and may be appropriate for endovascular therapy?

    • Class I.

    • Class IIa.

    • Class IIb.

    • Class III.

    Article 11 (461–468)

31. Rock hard calciied chronic total occlusions (CTOs) are seen most commonly in:

    • Hypertension.

    • Paraneoplastic syndromes.

    • Diabetes mellitus.

    • Chronic renal failure.

    • C and D.

32. True luminal recanalization throughout the calcified CTO is always possible in these patients?

    • Yes, and this is necessary for successful revascularization.

    • Yes, but extra‐adventitial paths are sometimes acceptable.

    • No; however, as long as proximal true lumen to distal true lumen revascularization is achieved, intervening subintimal segments are acceptable.

    • No, it is never possible to maintain true lumen revascularization in CTOs.

33. The main benefit of retrograde pedal (SAFARI) access in these patients is:

    • Smaller device proile access.

    • Less radiation.

    • Increased chances of regaining luminal reentry.

    • Increased procedure time.

    Article 12 (469–476)

34. Which Rutherford classiications are associated with rest pain with or without tissue loss?

    • 1–2.

    • 2–3.

    • 4–6.

    • 7–9.

    • None of the above.

35. The 1‐year amputation rate for patients presenting with critical limb ischemia is:

    • 5%.

    • 10%.

    • 25%.

    • 45%.

    • 70%.

36. True lumen crossing may decrease the risk of losing side branch patency compared to the subintimal approach?

    • True.

    • False.