INSTRUCTIONS – 5E016WEB - Valid April 2005-April 2007
INSTRUCTIONS: To receive 10.5 credits in AMA/PRA category 1 you must: Print this page and complete the
answers.
1.
2.
Complete the post-test and evaluation. (Correctly completing 70% of the questions will qualify you for a certificate
of completion, upon request).
Mail or Fax this completed Payment Information and Answer Sheet along with CME fee of $25 to:
The Irwin Brown Office of Continuing Medical Education
(Tax ID73-601-7987)
P.O. Box 26901 – ROB 202
Oklahoma City, OK 73190
Fax:
(405) 271-3087
Phone: (405) 271-2350
(Make checks payable to OUHSC/CME) To pay by credit card, see below. Please allow 7-10 days for grading
and processing. (Next day grading and processing requires an additional $25 fee. Please include this special
handling fee with your test.)
3.
Please CIRCLE your answer to each question/statement below.
Attention DO: For AOA credit you must report this credit on an “Individual Activity Report Form” and submit it with your
certificate of completion to: American Osteopathic Association (AOA), 142 East Ontario Street, Chicago, IL 60611,
Telephone 312-202-8000.
Name
Suffix
Address
City
Social Security Number
Telephone Number
Fax Number
E-mail Address
State
Zip
Specialty
Credit Card Payment for “Creating AV Fistulas in All Eligible Hemodialysis Patients”– 5E016WEB
__MasterCard
__ Visa
__ Discover
__American Express
Card Number
Amount to be charged $
Card Expiration Date
Print Name
Signature of Cardholder
ANSWER SHEET FOR TEST – 5E016WEB
Question 1
A.
B.
C.
Question 15
A.
B.
C.
Question 2
A.
B.
C.
D.
Question 16
A.
B.
C.
Question 3
A.
B.
C.
D.
Question 17
A.
B.
C.
D.
Question 4
A.
B.
C.
D.
Question 18
True
False
Question 5
True
False
Question 19
A.
B.
C.
D.
Question 6
A.
B.
C.
D.
E.
Question 20
A.
B.
C.
D.
Question 7
A.
B.
C.
D.
E.
Question 21
True
False
Question 8
True
False
Question 22
A.
B.
C.
Question 9
True
False
Question 23
A.
B.
C.
D.
Question 10
True
False
Question 24
True
False
Question 11
A.
B.
C.
Question 25
A.
B.
C.
D.
Question 12
A.
B.
C.
D.
Question 26
A.
B.
C.
Question 13
A.
B.
C.
D.
Question 27
True
False
Question 14
A.
B.
C.
D.
Question 28
True
False
E.
D.
E.
EVALUATION – 5E016WEB
Valid April 2005-April 2007
COURSE EVALUATION
Creating AV Fistulas in All Eligible Hemodialysis Patients– 5E016WEB
Please evaluate by circling the corresponding letter as follows:
A. Strongly Agree/Excellent
B. Agree/Good
C. Neutral/Adequate/NA
D. Disagree/Poor
E. Strongly Disagree/Very Poor
1. The overall quality of the entire course.
A.
B.
C.
D.
E.
2. The extent which program met the stated objectives.
A.
B.
C.
D.
E.
3. The course is well organized.
A.
B.
C.
D.
E.
4. The information is presented at the appropriate level.
A.
B.
C.
D.
E.
5. Topics covered will be helpful in my day-to-day practice.
A.
B.
C.
D.
E.
6. I did not perceive any undue commercial bias.
A.
B.
C.
D.
E.
7. This course was free of the discussion of experimental or
off-label therapies that were not previously disclosed.
A.
B.
C.
D.
E.
8. L. Spergel MD – Fistula First Initiative
A.
B.
C.
D.
E.
9. W Jennings MD – Data: Creating AV Fistulas in ….
A.
B.
C.
D.
E.
10. W Jennings MD – Preop Eval & Intro to Ultrasound
A.
B.
C.
D.
E.
11. Drs. Spergel & Jennings – Cimino & Brachial Fistulas
A.
B.
C.
D.
E.
12. W Jennings MD - Proximal Radial Artery AV Fistula
A.
B.
C.
D.
E.
13. W P Arnold MD – Endovascular Preserv of Immature…
A.
B.
C.
D.
E.
14. L Spergel MD – AV Fistula Vein Transpositions
A.
B.
C.
D.
E.
15. W Jennings MD – Difficult AV Fistula Extremities
A.
B.
C.
D.
E.
16. W P Arnold MD – Endovascular Recanalization of …
A.
B.
C.
D.
E.
17. L Spergel MD – Secondary AV Fistulas, Converting..
A.
B.
C.
D.
E.
18. L Spergel MD – Management of Steal Syndrome
A.
B.
C.
D.
E.
19. Movies: Ultrasound: Overview AVF Venous Mapping
A.
B.
C.
D.
E.
20.
Cimino/Distal Radial Artery AVF, Preop Ultrasound
A.
B.
C.
D.
E.
21.
Proximal Radial Artery AVF
A.
B.
C.
D.
E.
22.
Proximal Radial Artery AVF with Angioscopy
A.
B.
C.
D.
E.
23.
Staged Transposition AVF
A.
B.
C.
D.
E.
24.
Proximal Radial Artery AVF, Preop Ultrasound Exam
A.
B.
C.
D.
E.
25. What was the most helpful part of the course?
26. What was the least helpful part of the course?
27. Do you have any suggestions for future continuing education topics?
Creating AV Fistulas in All Eligible Hemodialysis Patients (5E016WEB)
Test Questions
1.
Which is the optimal and safest type of permanent vascular access for most hemodialysis patients?
a) AV Graft
b) Autogenous (native) A-V fistula
c) Cuffed tunneled catheter
2.
Which of the following best describes the objectives of the Fistula First Initiative?
a) Promote the use of autogenous A-V fistulae (AVF) in all eligible hemodialysis patients
b) Increase the use of autogenous A-V fistulae in prevalent hemodialysis patients to a minimum
of 40% by 2006 and 66% by 2009
c) Reduce the use of catheters
d) Promote the use of vessel mapping to optimize identification of candidates for an AVF
e) All of the above
3.
Which of the following is NOT true about the 11 Fistula First Change Concepts (the Change
Package)?
a) These are evidence-based concepts identified as being crucial to maximizing A-V fistula use
b) Although widely accepted, these concepts have not been widely implemented in clinical
practice
c) The Change Package strategies deal exclusively with A-V fistulae
d) The Fistula First Initiative provides tools and resources, including a web site, to assist
practitioners with implementation of these Change Concepts
4.
Which statement is NOT correct?
a) Dialysis by graft or catheter access has up to 8 times greater risk of complications and need for
additional procedures than access by AV fistulas
b) AV fistulas are used in Europe and Japan in 80-90% of dialysis access
c) Relative mortality risk is higher in patients with graft or catheter vascular access as opposed to those
with AV fistula access
d) Less than 5% of hospitalizations are related to vascular access problems
5.
True or False? The U.S. has the lowest AVF prevalence among developed countries.
6.
A-V fistula construction as opposed to placement of grafts will markedly decrease:
a)
b)
c)
d)
e)
7.
Hospital admissions
Infections
Bleeding episodes
Access-related mortality
All of the above
Ultrasound vein mapping prior to dialysis access surgery requires:
a)
b)
c)
d)
e)
Ultrasound probe used is ≥ 7.5 MHz
The study is done with a venous tourniquet in place
Focal depth must be set to a shallow reading
The probe contacts the gel interface only, no pressure is applied over the vein
All of the above
8.
True or False? Determination of whether or not a fistula will mature adequately for
dialysis can usually be made by physical examination alone at one month following AVF
construction.
9.
True or False? If examination following A-V fistula construction is suggestive of a
non-maturing fistula, a fistulogram will almost always detect the problem and frequently
allow immediate correction by balloon angioplasty.
10.
True or False? The radial-cephalic A-V fistula is the NKF-K/DOQI (National Kidney FoundationKidney/Disease Outcomes Quality Initiative)-recommended AVF of choice.
11.
The Cimino radial-cephalic A-V fistula is best constructed by which anastomotic technique?
a) End vein-to-side artery
b) Side-to-side
c) Either end vein-to-side artery or side-to-side
12.
Which statement regarding brachial AV fistulas is NOT correct?
a)
b)
c)
d)
13.
The size of the anastomosis in brachial artery AV Fistulas is an important factor in steal syndrome risk
An attempt should be made to construct the anastomosis distal to the antecubital crease
The upper arm cephalic vein may require transposition in some patients
Risk of steal syndrome is lower than with those fistulas created using the radial artery
When creating a proximal radial artery AV fistula, retrograde (forearm) flow can most often be
achieved by:
a) Simple passage of a probe through the initial retrograde venous valve under direct vision
within the surgical field
b) Angioscopy
c) Valvulotomes
d) None of the above
14.
Which of the following statements regarding proximal radial artery A-V fistula construction
techniques is NOT correct?
a)
b)
c)
d)
15.
The failure rate of immature fistulae can be improved by:
a)
b)
c)
d)
16.
A side-to-side anastomosis to the median antebrachial vein is most commonly used
An end-to-side anastomosis to the deep communicating vein should never be used
Steal syndrome is extremely uncommon with proximal radial artery AV fistulas
Preoperative ultrasound examination is mandatory in selecting best site, feasibility, and predicting success
in these access procedures
Meticulous surgical technique
Pre-operative venous mapping by ultrasound or dilute contrast venography
Endovascular intervention beginning at 4-6 weeks if use for dialysis is not imminent
All of the above
What is the treatment of choice for dysfunctional fistulae?
a) Observation
b) Endovascular balloon dilatation
c) Ultrasound or venography
17.
What basic rules should be followed by the surgeon when positioning a transposed vein?
a)
b)
c)
d)
Superficial
Safe Location
Away from incisions
All of the above
18.
True or False? An imaging study is generally not necessary before embarking on a transposition
A-V fistula.
19.
The surgeon can anticipate potential for a difficult AV fistula based on the presence of the
following:
a)
b)
c)
d)
e)
20.
Diabetes
Female
Obesity
Multiple failed previous access procedures
All of the above
Which of the following options should be the LAST choice for permanent vascular access in the
difficult access patient?
a) Transposition A-V fistula
b) Proximal radial artery A-V fistula
c) Permanent vascular access catheter
d) Translocation A-V fistula
21.
True or False? Ultrasound examination in the difficult access patient will often identify an A-V fistula
opportunity that has been previously overlooked.
22.
What is the optimal time for thrombectomy / recanalization of a native hemodialysis AVF?
a) Within two months
b) Within two weeks (14 days) of thrombosis
c) Any time
23.
What complications of endovascular fistula recanalization must be guarded against when declotting
a fistula?
a)
b)
c)
d)
Pulmonary emboli
Distal arterial emboli
Fistula rupture
All of the above
24.
True or False? Most incident and prevalent patients with A-V grafts are candidates for an A-V fistula.
25.
Which of the following is NOT true?
a) Most patients with a forearm A-V graft have a suitable arterialized outflow vein that is ideal
for conversion to an A-V fistula
b) All patients with recurrent A-V graft failure--regardless of AVG location--should undergo evaluation,
including vessel imaging, for a new A-V fistula
c) Vein transpositions AVFs are not suitable options for secondary AVFs
d) “Sleeves up” is a simple and effective examination that often identifies suitable secondary A-V fistula
candidates in patients with forearm A-V grafts
26.
What is the typical location of the pain of ischemia following an upper extremity access?
a) Neck
b) Hand
c) Chest
27.
True or False? The injury of Ischemic Monomelic Neuropathy (IMN) always involves the nerves but
characteristically spares the soft tissues.
28.
True or False? The treatment of IMN should be immediate sacrifice of the access.