- Email: [email protected]
CME Test for Safety of Transesophageal Echocardiography
-Cut - - - -here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Cut - - - -here ----
CONTINUING MEDICAL EDUCATION CME Test for Safety of Transesophageal Echocardiography Volume 23 Issue 11 INSTRUCTIONS – PLEASE READ CAREFULLY ASE Members can visit www.aseuniversity.org to complete the evaluation and exam online. Upon successful completion of the exam (score of 70% or higher) your test score and contact information will be automatically sent to ASE and you will be able to immediately print out your certificate. OR 1. Completely fill out both sides of this form (exam, evaluation, and CME request form).*An exam score below 70% is unsatisfactory and CME credits will not be granted.*Incomplete forms will be returned to sender for completion. 2. Processing Fees: ASE Members: FREE, Non-Members: $25. Please fill out payment area below. 3. Fax or Mail this form to: FAX: (919) 882-9900 American Society of Echocardiography Attn: JASE CME
2100 Gateway Centre Boulevard, Suite #310 Morrisville, NC 27560 All submissions must be postmarked by November 30, 2011.
Last Name: ______________________________________________ First Name: ______________________________________________
Name on Credit Card _____________________________________ Credit Card Number ______________________________________ Expiration Date___________________________________________ Credit Card Verification Code ______________________________ Signature ________________________________________________________
CME EVALUATION Help us out by answering the following questions. Please rate questions on a scale of 1 to 4. 4 = Excellent, 3 = Good, 2 = Fair, 1 = Poor 1. How would you rate the overall educational quality of this activity? 4 3 21
Credential(s): ____________________________________________ ASE Member ID: _________________________________________ Address _________________________________________________ City _________________________ State ______________________ Zip ____________________________________________________ Phone __________________________________________________ Fax_____________________________________________________
2. How well did this activity succeed in meeting the learning objectives? 4 3 21 3. What is the likelihood that you will make gradual or long-term changes in your practice as a result of this article? 4 3 21 4. What is the likelihood that you will participate in future CME activities offered in the JASE? 4 3 21 5. What, if anything, will you change in your practice as a result of this activity? ________________________________________________________
Email ___________________________________________________ ________________________________________________________
NON ASE MEMBERS – PLEASE SEE BELOW
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Payment Method:
6. Please give us your suggestions for future JASE CME topics:
Check (US Funds drawn on US bank only. International money order is accepted)
________________________________________________________
MasterCard , VISA , AMEX ,
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1219
1220
EXAM 1. Overall rates of TEE-morbidity between intraoperative and non-operative patients are similar. Compared to TEE in a non-operative setting however, intraoperative TEE poses a slightly different risk profile. These risks are represented by all but which of the following: a. Probe placement and manipulation is generally performed in intubated patients under general anesthesia. b. Patients cannot swallow. c. Patients are more likely to have allergic reactions to topical anesthetic agents. d. Patients cannot respond to potentially injurious probe manipulation. e. Prolonged or consecutive TEE procedures may be required.
2. The incidence of dental injury (dislodged or loosened tooth) with TEE ranges from .03 – 0.1%. Which of the following statements regarding dental injury is true? a. This incidence has no correlation to the patients’ overall dental health. b. There is no need to assess the patient for loose teeth prior to insertion of the probe. c. Loose teeth are a contraindication to TEE probe insertion. d. Dentures can be dislodged by the TEE probe. e. A bite block may increase the risk of dental injury.
3. Upper gastrointestinal/esophageal perforation can be associated with severe morbidity, with an incidence of .01– .04% (approximately 1–3/10,000 TEEs). Delayed recognition of perforation may result from which of the following reasons? a. Heavy sedation in non-operative settings or general anesthesia and endotracheal intubation in the OR/post-operative sedation and intubation. b. Meckler’s triad (vomiting, pain, subcutaneous emphysema) is common. c. Symptoms of dyspnea, agitation, fever, and bloody nasogastric aspirates are non-specific, and >30% of chest x-rays are normal. d. a and c. e. a and b.
4. During TEE probe placement injury of the orogastric tract can occur. Which of the following are anatomic risk factors for injury? a. Osteophytic disease of the cervical spine. b. Gastroesophageal pathology (ie: Zenker’s diverticulum, esophageal stricture or obstructing mass, fibrosis secondary to chest radiation). c. Distorted anatomy (ie: massive cardiomegaly or tracheoesophageal fistula). d. Spasm or hypertrophy of the cricopharyngeal muscle. e. All of the above.
5. As cited in Table 5, which of the following is not considered an absolute contraindication to TEE? a. Primary esophageal pathology (stricture, trauma, tumor, Mallory-Weiss tear). b. Active upper GI bleeding. c. Recent upper GI surgery. d. Recent upper GI bleeding. e. Perforated viscous.
6. Various non-anatomic risk factors have been associated with TEE morbidity. These risk factors include all but which one of the following? a. Older age. b. Resistance to probe insertion. c. Anticoagulation. d. Thrombolysis. e. Manipulation of the probe while locked in extreme anteflexion or retroflexion.
7. Thermal injury from the TEE probe has been proposed as a potential source of injury. Which of the following measures would not be useful in limiting the risk of thermal damage to esophageal mucosa? a. Setting the probe at the minimal gain and acoustic power necessary for adequate image acquisition. b. Storing the probe in a refrigerated room. c. Turning power to the probe off during bypass and leaving the probe unlocked and the tip unflexed. d. Facilitate automatic shutdown of the probe at a preset threshold temperature.
8. Sources of TEE related injuries include probe placement, probe manipulation, and possibly pressure at the mucosal-probe interface. Proposed mechanisms of injury include which of the following? a. The probe is not centered in the posterior pharynx and is placed in the piriform sinus, causing the probe to buckle. b. Manipulation or rapid advancement/withdrawal of the probe while locked in extreme anteflexion can distort the esophagus and cause mucosal tears or perforation. c. Anteflexion of the TEE probe tip at the GE junction can put tension on tissues, causing mucosal disruption or MalloryWeiss tears. d. a and c only. e. a, b, and c.
9. Which of the following respiratory complications may occur during TEE? a. Accidental tracheal intubation with the probe. b. Airway compression. c. Methemoglobinemia from topical anesthetics. d. a and c only. e. a, b, and c.
-Cut - - - -here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Cut - - - -here ----
After reading Safety of Transesophageal Echocardiography please respond to the following questions.
Journal of the American Society of Echocardiography November 2010
-Cut - - - -here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Cut - - - -here ----
Journal of the American Society of Echocardiography Volume 23 Number 11
10. Reported complication rates in pediatric patients range from 1.8–20.4% but may be as high as 64% in infants. Which of the following statements regarding TEE in the pediatric population is true? a. General anesthesia is rarely required. b. When performed on intubated patients, the TEE probe rarely causes endotracheal tube dislodgement. c. If an appropriately sized probe is carefully inserted and manipulated, TEE in pediatric patients appears to be relatively safe. d. Compression of mediastinal structures does not occur in the absence of abnormal vascular anatomy. e. Esophageal injury is a common finding. 11. In infants, hypotension and increased peak inspiratory pressures have been noted with transgastric views. This is likely due to: a. Aortic arch anomalies. b. Extracardiac pulmonary venous confluences. c. Interrupted inferior cava. d. Anteflexion of the probe against the diaphragm. e. Compression of the airway.
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12. Prevention of orogastric and respiratory complications during TEE should include which of the following: a. Push with greater force if resistance is encountered upon probe insertion, keeping the probe in the locked position. b. Avoid using a bite block as it may result in dental injury, and apply additional oropharyngeal topical anesthesia. c. Avoid forceful placement of the probe, using a bite block for midline placement along with adequate probe lubrication, assuring that the probe is not in the locked position. d. If appropriate, head flexion or extension with chin lift may facilitate the passage of the probe. e. c and d.
CONTINUING MEDICAL EDUCATION CME Test for Safety of Transesophageal Echocardiography Volume 23 Issue 11 INSTRUCTIONS – PLEASE READ CAREFULLY ASE Members can visit www.aseuniversity.org to complete the evaluation and exam online. Upon successful completion of the exam (score of 70% or higher) your test score and contact information will be automatically sent to ASE and you will be able to immediately print out your certificate. OR 1. Completely fill out both sides of this form (exam, evaluation, and CME request form).*An exam score below 70% is unsatisfactory and CME credits will not be granted.*Incomplete forms will be returned to sender for completion. 2. Processing Fees: ASE Members: FREE, Non-Members: $25. Please fill out payment area below. 3. Fax or Mail this form to: FAX: (919) 882-9900 American Society of Echocardiography Attn: JASE CME
2100 Gateway Centre Boulevard, Suite #310 Morrisville, NC 27560 All submissions must be postmarked by November 30, 2011.
Last Name: ______________________________________________ First Name: ______________________________________________
Name on Credit Card _____________________________________ Credit Card Number ______________________________________ Expiration Date___________________________________________ Credit Card Verification Code ______________________________ Signature ________________________________________________________
CME EVALUATION Help us out by answering the following questions. Please rate questions on a scale of 1 to 4. 4 = Excellent, 3 = Good, 2 = Fair, 1 = Poor 1. How would you rate the overall educational quality of this activity? 4 3 21
Credential(s): ____________________________________________ ASE Member ID: _________________________________________ Address _________________________________________________ City _________________________ State ______________________ Zip ____________________________________________________ Phone __________________________________________________ Fax_____________________________________________________
2. How well did this activity succeed in meeting the learning objectives? 4 3 21 3. What is the likelihood that you will make gradual or long-term changes in your practice as a result of this article? 4 3 21 4. What is the likelihood that you will participate in future CME activities offered in the JASE? 4 3 21 5. What, if anything, will you change in your practice as a result of this activity? ________________________________________________________
Email ___________________________________________________ ________________________________________________________
NON ASE MEMBERS – PLEASE SEE BELOW
________________________________________________________
Payment Method:
6. Please give us your suggestions for future JASE CME topics:
Check (US Funds drawn on US bank only. International money order is accepted)
________________________________________________________
MasterCard , VISA , AMEX ,
________________________________________________________
________________________________________________________
1219
1220
EXAM 1. Overall rates of TEE-morbidity between intraoperative and non-operative patients are similar. Compared to TEE in a non-operative setting however, intraoperative TEE poses a slightly different risk profile. These risks are represented by all but which of the following: a. Probe placement and manipulation is generally performed in intubated patients under general anesthesia. b. Patients cannot swallow. c. Patients are more likely to have allergic reactions to topical anesthetic agents. d. Patients cannot respond to potentially injurious probe manipulation. e. Prolonged or consecutive TEE procedures may be required.
2. The incidence of dental injury (dislodged or loosened tooth) with TEE ranges from .03 – 0.1%. Which of the following statements regarding dental injury is true? a. This incidence has no correlation to the patients’ overall dental health. b. There is no need to assess the patient for loose teeth prior to insertion of the probe. c. Loose teeth are a contraindication to TEE probe insertion. d. Dentures can be dislodged by the TEE probe. e. A bite block may increase the risk of dental injury.
3. Upper gastrointestinal/esophageal perforation can be associated with severe morbidity, with an incidence of .01– .04% (approximately 1–3/10,000 TEEs). Delayed recognition of perforation may result from which of the following reasons? a. Heavy sedation in non-operative settings or general anesthesia and endotracheal intubation in the OR/post-operative sedation and intubation. b. Meckler’s triad (vomiting, pain, subcutaneous emphysema) is common. c. Symptoms of dyspnea, agitation, fever, and bloody nasogastric aspirates are non-specific, and >30% of chest x-rays are normal. d. a and c. e. a and b.
4. During TEE probe placement injury of the orogastric tract can occur. Which of the following are anatomic risk factors for injury? a. Osteophytic disease of the cervical spine. b. Gastroesophageal pathology (ie: Zenker’s diverticulum, esophageal stricture or obstructing mass, fibrosis secondary to chest radiation). c. Distorted anatomy (ie: massive cardiomegaly or tracheoesophageal fistula). d. Spasm or hypertrophy of the cricopharyngeal muscle. e. All of the above.
5. As cited in Table 5, which of the following is not considered an absolute contraindication to TEE? a. Primary esophageal pathology (stricture, trauma, tumor, Mallory-Weiss tear). b. Active upper GI bleeding. c. Recent upper GI surgery. d. Recent upper GI bleeding. e. Perforated viscous.
6. Various non-anatomic risk factors have been associated with TEE morbidity. These risk factors include all but which one of the following? a. Older age. b. Resistance to probe insertion. c. Anticoagulation. d. Thrombolysis. e. Manipulation of the probe while locked in extreme anteflexion or retroflexion.
7. Thermal injury from the TEE probe has been proposed as a potential source of injury. Which of the following measures would not be useful in limiting the risk of thermal damage to esophageal mucosa? a. Setting the probe at the minimal gain and acoustic power necessary for adequate image acquisition. b. Storing the probe in a refrigerated room. c. Turning power to the probe off during bypass and leaving the probe unlocked and the tip unflexed. d. Facilitate automatic shutdown of the probe at a preset threshold temperature.
8. Sources of TEE related injuries include probe placement, probe manipulation, and possibly pressure at the mucosal-probe interface. Proposed mechanisms of injury include which of the following? a. The probe is not centered in the posterior pharynx and is placed in the piriform sinus, causing the probe to buckle. b. Manipulation or rapid advancement/withdrawal of the probe while locked in extreme anteflexion can distort the esophagus and cause mucosal tears or perforation. c. Anteflexion of the TEE probe tip at the GE junction can put tension on tissues, causing mucosal disruption or MalloryWeiss tears. d. a and c only. e. a, b, and c.
9. Which of the following respiratory complications may occur during TEE? a. Accidental tracheal intubation with the probe. b. Airway compression. c. Methemoglobinemia from topical anesthetics. d. a and c only. e. a, b, and c.
-Cut - - - -here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Cut - - - -here ----
After reading Safety of Transesophageal Echocardiography please respond to the following questions.
Journal of the American Society of Echocardiography November 2010
-Cut - - - -here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Cut - - - -here ----
Journal of the American Society of Echocardiography Volume 23 Number 11
10. Reported complication rates in pediatric patients range from 1.8–20.4% but may be as high as 64% in infants. Which of the following statements regarding TEE in the pediatric population is true? a. General anesthesia is rarely required. b. When performed on intubated patients, the TEE probe rarely causes endotracheal tube dislodgement. c. If an appropriately sized probe is carefully inserted and manipulated, TEE in pediatric patients appears to be relatively safe. d. Compression of mediastinal structures does not occur in the absence of abnormal vascular anatomy. e. Esophageal injury is a common finding. 11. In infants, hypotension and increased peak inspiratory pressures have been noted with transgastric views. This is likely due to: a. Aortic arch anomalies. b. Extracardiac pulmonary venous confluences. c. Interrupted inferior cava. d. Anteflexion of the probe against the diaphragm. e. Compression of the airway.
1221
12. Prevention of orogastric and respiratory complications during TEE should include which of the following: a. Push with greater force if resistance is encountered upon probe insertion, keeping the probe in the locked position. b. Avoid using a bite block as it may result in dental injury, and apply additional oropharyngeal topical anesthesia. c. Avoid forceful placement of the probe, using a bite block for midline placement along with adequate probe lubrication, assuring that the probe is not in the locked position. d. If appropriate, head flexion or extension with chin lift may facilitate the passage of the probe. e. c and d.