Post-Test Questions

Article 1 (307–312)

1. Proven benefits of communication of severity of disease and the treatments associated with those expectations include all of the following EXCEPT:

   • Patients with advanced cancers who did not expect chemotherapy to cure their disease still received treatment at similar rates to those patients who had higher expectations, but were more likely to enroll in hospice services before death.

   • The majority of patients with Stage IV colorectal cancers who elected to receive systemic treatment had inaccurate expectations for the curative potential of chemotherapy.

   • More accurate illness understanding is NOT associated with patient reports that discussions have occurred on prognosis and life expectancy with their oncologist.

   • Communicating information with varying degrees of optimism correlates with patients' perceptions of physician compassion.

   • All of the above.

2. Regarding meeting the demand for palliative care, all of the following are true EXCEPT:

   • Surveys conducted have demonstrated that most NCI-designated and non-NCI cancer centers have palliative care services, but vary in the extent of their utilization and success of their integration.

   • A 2015 NCCN survey indicated that responding institutions all have inpatient consultation services and majority have outpatient clinics to address symptom management and end-of-life care.

   • Only 23% have home-based palliative care services and that 80% of these institutions still report inadequate capacity to meet demand.

   • While inpatient consultation services have been uniformly available for patients compared to outpatient or home palliative care, few hospitals have appropriate and sufficient staff to comply with national recommendations.

   • All of the above.

3. The minimally invasive palliative procedures conducted by IR greatly improve the quality of life and relieve suffering for cancer patients.

   • True.

   • False.

   Article 2 (313–321)

4. Symptom scales in the EORTC-30 instrument include all of the following except:

   • Fatigue.

   • Dyspnea.

   • Nausea and vomiting.

   • Pain.

5. Common domains measured by quality-of-life instruments include all of the following except:

   • Social/Family.

   • Emotional.

   • Performance status.

   • Physical.

6. A valid quality-of-life questionnaire:

   • Appropriately measures what it is intended to measure.

   • Demonstrates the same results on stable patients over time.

   • Is able to stratify patients according to disease severity.

   • Requires a gold standard.

   Article 3 (322–327)

7. What is the expected likelihood of complete or partial pain relief after an initial course of palliative radiation for a painful osseous metastasis?

   • 20%.

   • 35%.

   • 50%.

   • 80%.

   • 95%.

8. For patients with osseous metastatic disease, assuming equivalent performance status, which of the following primary disease sites predicts for longest expected median survival?

   • Breast.

   • Prostate.

   • Lung.

   • Other.

9. A patient develops recurrent pain in a previously irradiated site. Which of the following is true?

   • A second course of radiation can never be administered to a previously irradiated site.

   • Re-irradiation can be considered, but studies have shown high rates of toxicity, with 30% risk of pathologic fracture.

   • Re-irradiation provides complete or partial pain relief in 10 to 20% of patients.

   • Re-irradiation provides complete or partial pain relief in approximately 50% of patients, and has been shown to significantly improve overall quality of life and functional activity.

   Article 4 (328–336)

10. Which percutaneous ablation technique is governed by an absolutely noninvasive character?

    • Radiofrequency ablation.

    • Microwave ablation.

    • Laser.

    • Cryoablation.

    • High-intensity focused ultrasound.

11. Poly(methyl methacrylate) (PMMA) is an ideal material for:

    • Axial and craniocaudal compression forces.

    • Rotational forces.

    • Shearing forces.

    • Rotational and shearing forces.

    • Axial and rotational forces.

12. The Mirels' score is used for:

    • Recommending prophylactic fixation in acetabular bony defects.

    • Recommending prophylactic augmentation in vertebral fractures.

    • Recommending prophylactic fixation in long bone lesions.

    • Recommending prophylactic fixation in sacral lesions.

    • Recommending prophylactic fixation in pelvic lesions.

    Article 5 (337–342)

13. Based on cost analysis to the payers, after how many large volume paracenteses (LVP) for a patient does a tunneled catheter start to become the more cost-effective management for malignant ascites?

    • 5.

    • 10.

    • 15.

    • 20.

    • 25.

14. Contraindications to tunneled peritoneal drainage catheter placement include all of the following except:

    • Multiloculated ascites with small locules.

    • Severe coagulopathy.

    • Electrolyte imbalances for which diuretic management is preferred.

    • Bacterial peritonitis.

15. Advantages of pleurodesis over tunneled catheters for the symptomatic management of pleural effusions include:

    • Ability to obtain sustained palliation of symptoms.

    • Reduced rates of repeat interventions and hospital length of stay.

    • Reduced costs.

    • None of the above.

    • All of the above.

    Article 6 (343–348)

16. Which of the following is NOT a contraindication for Denver shunt placement?

    • Bloody ascites.

    • History of varicose vein bleeding.

    • Liver failure.

    • Congestive heart failure.

    • Renal failure with patient on dialysis.

17. Which one of the following patients would most benefit from Denver shunt placement?

    • Patient with cirrhosis and esophageal varicose veins.

    • Patient with chylous ascites.

    • Patient with ascites and peritoneal mesothelioma.

    • Patient with loculated ascites.

18. Where is the best location to place the compressible pump?

    • In the left upper abdomen below the rib cage.

    • On a firm, nonmobile lower rib cage.

    • The pump should be placed next to the venous access site.

    • The pump should be placed next to the peritoneal access site in the lower abdomen.

    Article 8 (361–368)

19. Atrophy of a hemi-liver is most likely to occur as a result of occlusion/obstruction of which of the following:

    • Ipsilateral hepatic artery and bile duct.

    • Ipsilateral portal vein and bile duct.

    • Contralateral hepatic artery and bile duct.

    • Contralateral portal vein and bile duct.

20. Regarding the routine use of prophylactic antibiotics for biliary drainage, which of the following is true?

    • Preprocedure prophylaxis is recommended only if there are signs/symptoms of infection.

    • Preprocedure prophylaxis is not required prior to biliary drainage.

    • Preprocedure prophylaxis is recommended for all patients undergoing biliary drainage.

    • Pre- and postprocedure prophylaxis is recommended.

21. Potential advantages of primary suprapapillary compared to transpapillary stent placement include all of the following EXCEPT:

    • Lower risk of cholangitis.

    • Less limitations on patient's lifestyle.

    • Lower risk of pancreatitis.

    • Lower risk of stent occlusion.

    • Lower risk of bleeding complications.

    Article 9 (369–375)

22. A 67-year-old man, who has been healthy and active, presents with a 2-week history of painless jaundice. Physical examination shows the icteric sclera and unremarkable abdomen. Laboratory examination shows an elevated total bilirubin of 8.5 mg/dL (normal range: 0.0–1.2 mg/dL). The computed tomography scan shows a 2-cm mass in the head of the pancreas with the markedly dilated common bile duct. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) confirms pancreatic ductal adenocarcinoma. Your surgical colleague recommends pancreaticoduodenectomy within 2 weeks. What would be the best management for his biliary obstruction?

    • Percutaneous transabdominal biliary drainage before surgery.

    • Endoscopic biliary drainage.

    • No biliary intervention unless the patient is symptomatic.

    • Ursodeoxycholic acid.

23. A 58-year-old woman was diagnosed with adenocarcinoma localized to the head of the pancreas after she presented with itching and jaundice. Following EUS-FNA of the mass, she underwent preoperative biliary decompression by endoscopic retrograde cholangiopancreatography (ERCP) with placement of an uncovered metal biliary stent. She received gemcitabine-based neoadjuvant therapy for 6 weeks, and subsequently underwent a pancreaticoduodenectomy. Six months after the surgical resection, she was admitted to the intensive care unit with fevers, confusion, jaundice, and hypotension. A contrastenhanced CT scan shows a 15-mm mass at the hilum of the liver with marked intrahepatic biliary dilation. What is the next best step in management?

    • Percutaneous transhepatic cholangiopancreatography with biliary drain placement.

    • Single balloon enteroscopy-assisted ERCP.

    • Endoscopic ultrasound-guided biliary access followed by ERCP.

    • Double guidewire cannulation with metal biliary stent placement.

    • Precut sphincterotomy with placement of prophylactic pancreatic duct stent and metal biliary stent.

24. A 74-year-old patient presents with nausea, vomiting, and jaundice. Workups including a cross-sectional imaging study and EUS-FNA confirm a metastatic pancreatic ductal adenocarcinoma. The patient is referred to a gastroenterologist for biliary drainage. However, ERCP attempt is unsuccessful due to a tight obstruction at the second portion of the duodenum, just proximal to the ampulla. At this point, what should be the next step in the management of his biliary obstruction?

    • Abort endoscopic procedure and refer the patient to interventional radiology.

    • Use EUS-guided technique and access the bile duct, and place a metal stent over the guidewire.

    • Arrange hospice care.

    • Terminate the procedure and prescribe a broadspectrum antibiotic.

    Article 10 (376–386)

25. Which of the following is true regarding the anatomy of the upper retroperitoneum?

    • As the largest autonomic plexus, the celiac plexus contains only sympathetic fibers.

    • The most accurate landmark for craniocaudal localization of the celiac plexus is the T12 and L1 vertebral bodies.

    • The diaphragmatic crura separate the antecrural celiac plexus from the retrocrural splanchnic nerves.

    • The celiac plexus provides innervation to the entire peritoneum and all intraperitoneal organs.

26. The most important predictor of response at the time of neurolytic injection is:

    • The type of neurolytic injected.

    • The absolute percentage of ethanol injected.

    • The approach used.

    • Visualization of adequate neurolytic spread.

    • Use of a diagnostic block prior to neurolytic injection.

27. Of the listed complications, the most common experienced with a posterior approach to neurolysis include:

    • Transient hypotension.

    • Paraplegia.

    • Puncture of visceral organs.

    • Constipation.

    • Retroperitoneal hematoma.

    Article 11 (387–397)

28. Which of the following is the most common anatomic arrangement for bronchial arteries?

    • Two left and one right bronchial arteries.

    • Two left and two right bronchial arteries.

    • One left and two right bronchial arteries.

    • One left and one right bronchial arteries.

29. Which of the following statements regarding spontaneous hemorrhage from liver tumors is true?

    • Spontaneous hemorrhage is the most common presentation for patients with hepatocellular carcinoma.

    • Spontaneous hemorrhage from colorectal cancer metastases to the liver is seen in up to 40% of patients.

    • Small, peripheral tumors are more likely to bleed than central, large tumors.

    • Hepatocellular carcinoma is the most common malignancy associated with spontaneous hepatic hemorrhage.

30. Which of the following statements regarding embolization for hematuria due to renal cell carcinoma is true?

    • Embolization has a low (<20%) success rate at improving symptoms of hematuria in this clinical setting.

    • Embolization may provide a survival benefit for patients with advanced renal cell carcinoma.

    • Embolization is contraindicated in patients with tumor thrombus extending into the renal vein.

    Article 12 (398–408)

31. Which of the following is not a potential sign/symptom of superior vena cava syndrome?

    • Altered level of consciousness.

    • Pulsatile tinnitus.

    • Headaches.

    • Papilledema.

    • Amaurosis fugax.

32. Which of the following diagnoses is most likely to result in SVC syndrome?

    • Renal cell carcinoma invading renal veins and extending into the right atrium.

    • Adenocarcinoma of the lung.

    • Small cell lung cancer.

    • Syphilis.

    • Tuberculosis.

33. Which of the following vessels is responsible for the “hot-quadrate” sign seen in the setting of SVC syndrome?

    • Vein of Sappey.

    • Vein of Giacomini.

    • Vein of Labbé.

    • Basal vein of Rosenthal.

    • Left superior intercostal vein.