Education Section: Associate Editors Florian Dick and Gert de Borst Eur J Vasc Endovasc Surg (2016) 51,

urg (2016) 51, 310e312

CME MCQ Programme Sub-Editors: Séan Matheiken and Nikolaos Patelis

Multiple Choice Questions

1. Which ONE of the following statements is correct?

A. Clopidogrel is a pro-drug and 85% is metabolized in the liver by a double oxidation process.
B. The active metabolite of clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet
P2Y12 receptor.
C. High-dose clopidogrel achieve a more intense pharmacodynamic effect at 30 days compared with standard dose in
intermediate to poor patients.
D. Non-smoking patients have improved responsiveness to clopidogrel.
E. All of them.

2. Based upon 4-Dimensional analysis of aortic wall biomechanics, which ONE of the following statements is NOT
correct?

A. Mean circumferential wall strain increases with age

B. Aortic wall diameter increases with age
C. Spatial heterogeneity correlates with aneurysmal change
D. Increase in systolic dyssynchrony correlates with increasing age
E. Analysis of circumferential wall strain facilitates determination of temporal dyssynchrony

3. Researchers in Germany have compared the biomechanical properties of three groups of aortas: aneurysmal aortas
vs. non-aneurysmal aortas in young and old patients, using 4-Dimensional ultrasound. Which ONE of the following
indices offered the best distinction between aneurysmal and non-aneurysmal aortas?

A. Ratio of maximum local to mean circumferential wall strain

B. Amplitude of mean circumferential wall strain
C. Spatial homogeneity index
D. Temporal dyssynchrony index
E. Standard deviation of local systolic delay

4. Which ONE of these statements is NOT TRUE regarding the use of endovascular aneurysm repair for abdominal aortic
aneurysms (AAA)?

A. A majority of patients with AAA in the Western hemisphere are now treated with endovascular technology
B. Recent studies reveal an increase in the proportional presentation of ruptured AAA
C. Vascular centres in some countries have been regionalized in the endovascular era
D. Centralisation of AAA repair has been shown to improve patient outcomes
E. Hybrid vascular operating rooms have improved efficiency and safety for endovascular aneurysm repair

5. In a systematic review and meta-analysis of factors influencing outcomes after abdominal aortic aneurysm repair, ALL
of the following factors were independently associated with impaired survival EXCEPT:

A. Age
B. Renal impairment
C. Cerebrovascular disease
D. Gender (Male)
E. COPD

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6. What is the reported average growth rate of small descending thoracic aortic aneurysms?

A. 1mm per year

B. 3mm per year
C. 5mm per year
D. 7mm per year
E. 9mm per year

7. In case of aortic graft infection and aortic reconstruction with autologous femoral veins, the fragile upper anastomosis
between aortic tissue and the thin vein wall can successfully be strengthened using which ONE of the following?

A. Omentum
B. Teflon pledgets
C. A piece of autologous fascia
D. Double sutures
E. An antibiotic-soaked piece of woven prosthesis

8. To calculate the ankle-brachial index (ABI), you should use, by convention, which ONE of the following as
denominator?

A. The highest of the two brachial pressures

B. The lowest of the two brachial pressures
C. The average of the two brachial pressures
D. The ipsilateral brachial pressure
E. The contralateral brachial pressure

9. Typical challenges when using mortality rates following lower limb amputation for the purpose of benchmarking
quality of care include which ONE of the following?

A. Patients may have had more than one amputation

B. Surgeons and hospitals differ regarding indication for amputation and choice of surgical technique
C. Agreement on factors determining ‘amputation-related mortality’ has not been reached
D. All of the above
E. None of the above

10. Which ONE of the following statements is correct regarding the clinical relevance of ectopic bone tissues found in
atherosclerotic arteries (i.e., osteoid metaplasia)?

A. Osteoid metaplasia has the same clinical relevance in all vascular territories
B. Osteoid metaplasia tends to stabilize plaques at the carotid level
C. Osteoid metaplasia only appears at the femoral level
D. Osteoid metaplasia is the result of a well demonstrated pathophysiological process
E. Osteoid metaplasia can usually be assessed by preoperative imaging

11. The psychometric validation of a medical quality of life-questionnaire typically requires which ONE of the following?

A. A multitrait/multi-item analysis (MTMI)

B. A test-retest analysis
C. An analysis of variance (ANOVA)
D. Cronbach’s alpha coefficients
E. All of the above
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12. Which ONE of the following is the primary effect on flow when applying external pressure on a thin walled collapsible
tube?

A. it increases the Reynold’s number towards turbulence

B. it slows velocity
C. it accelerates velocity due to Bernoulli theorem
D. it decreases internal pressure
E. it decreases transmural pressure

13. Which ONE of the following is correct regarding the diagnosis of a ruptured pancreatico-duodenal artery aneurysm?

A. Ruptured pancreatico-duodenal aneurysms should always be suspected in patients with a specific ethnic and a
suggestive history
B. Diagnosis depends on increased lipase levels in the blood
C. A ruptured pancreatico-duodenal aneurysm must be suspected when faced with a periduodenal hematoma in the
absence of a relevant medical history.
D. Diagnosis depends on visualization of the ruptured aneurysm in an abdominal CT-angiogram.
E. Diagnosis almost always linked to the median arcuate ligament.

Answers from previous issue (January 2016)

1C 2C 3C 4B 5B 6C 7B 8D 9C 10C 11C 12D 13D 14C 15D 16D 17D 18C