CME TEST QUESTIONS: OCTOBER 2015
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learni...
Examination available at http://learn.sirweb.org/. To take the online JVIR CME tests, please log into the SIR Learning Center with your SIR user name and password. Nonmembers: If you do not already have an SIR username and password, please click on “Create an Account” to gain access to the SIR Learning Center. Once in the Learning Center, click on the “Publication” activity type for a listing of all available JVIR CME tests. Each test will be available online for 3 years from the month/date of publication. The CME questions in the October 2015 issue are derived from the article “Root Cause Analysis of Rebleeding Events following Transjugular Intrahepatic Portosystemic Shunt Creation for Variceal Hemorrhage” by Lakhoo et al. 1. In this study the authors performed a root cause analysis (RCA) to determine the factors responsible for recurrent variceal hemorrhage (VH) despite the presence of a functional transjugular portosystemic shunt (TIPS). In their study, approximately what percentage of patients required a TIPS for recurrent VH, despite prior medical or endoscopic management, or both? a. 10% b. 25% c. 50% d. 75% 2. Based on the RCA, what was the approximate 30day incidence of VH? a. 10% b. 30% c. 50% d. 80% 3. True or false? Based on the results of this RCA, gastric varices are at a statistically significant higher risk of rebleeding even after a technically successful TIPS placement.
a. True b. False 4. In this study, the most common primary root cause of variceal rebleeding was a. The patient’s Model for End-Stage Liver Disease score b. TIPS stenosis or occlusion c. The presence of gastric varices, due to its underlying physiology d. The lack of or insufficient variceal embolization 5. The main reasons for a lack of or insufficient variceal embolization included all of the following except a. Omission of embolization despite variceal opacification after TIPS b. Nonvisualization of varices due to suboptimal splenoportography c. Recanalization of varices despite complete variceal obliteration d. Operator choice based on appropriate reduction of the portosystemic gradient following placement of the TIPS