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Which statement regarding the treatment of varicose and perforator veins is true?
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A. Surgical and chemical ablations are preferred compared to thermal ablation of the GSV
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B. Selective treatment of incompetent varicose veins is recommended in patients with simple varicose veins
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C. Thermal ablation is an effective approach to the treatment of saphenous veins
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D. Vein reabsorption after thermal ablation occurs over the course of a few days
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C. Thermal ablation is an effective approach to the treatment of saphenous veins. The 2011 consensus opinion recommends thermal ablation to surgical or chemical ablation for GSVs. Selective treatment of incompetent perforating veins is not recommended in patients with simple varicose veins, though is an option for pathologic perforating veins. Vein absorption occurs over the course of months.
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Three months’ anticoagulation is recommended for which of the following?
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A. In patients with PE/an isolated distal DVT of the leg provoked by surgery
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B. In patients with PE/proximal DVT of the leg provoked by a nonsurgical transient risk factor
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D. Three months’ anticoagulation is similarly recommended in patients with (i) PE/proximal DVT of the leg provoked by a nonsurgical transient risk factor, (ii) in patients with PE/an isolated distal DVT of the leg provoked by surgery or by a nonsurgical transient risk factor. This is recommended over a longer or shorter duration of anticoagulation. Not all patients with DVT require anticoagulation for this period of time.
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Which imaging study is an appropriate initial evaluation in patients with suspected axillary-subclavian vein thrombosis?
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D. Upper extremity venous duplex ultrasound
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D. Upper extremity venous duplex ultrasound. Upper extremity venous duplex ultrasound is both sensitive and reliable in the diagnosis of axillary-subclavian vein thrombosis. A chest x-ray is obtained to exclude the presence of cervical ribs which can contribute to the compression of the subclavian vein, but cannot be used solely in diagnosis. A CT venogram is not an appropriate initial evaluation modality. A CT angiogram will not properly image the subclavian vein.
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Which of the following regarding superficial thrombophlebitis is true?
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A. Generalized edema is almost always present
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B. Up to 40% of presentations have associated acute DVT
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C. Ambulation is discouraged due to the painful, inflammatory process
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D. Most episodes of septic thrombophlebitis require surgical excision
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B. Up to 40% of presentations have associated acute DVT. Less than 10% and up to 40% of patients with superficial thrombophlebitis have been reported to have associated acute DVT. Generalized edema is present only if the deep veins are involved. Ambulation is encouraged along with NSAIDs, local heat, elevation, and support stockings. Most episodes of septic thrombophlebitis respond to conservative management and do not require operative treatment.
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Lymphedema is a chronic condition for which no definitive cure is currently available. Which of the following is true?
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A. The distribution of edema is exactly the same as that of venous stasis disease
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B. The gold standard for evaluation of lymph function is CT
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C. Venous duplex scans aid in ruling out venous insufficiency and venous obstruction
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D. Diuretics are a mainstay of treatment of minimizing the edema
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C. Venous duplex scans aid in ruling out venous insufficiency and venous obstruction. distribution of edema from lymphedema is centered around the ankle and is most pronounced on the dorsum of the foot. It often involves the toes, a characteristic not seen in venous stasis disease. Venous duplex scans are helpful in ruling out venous causes of edema, especially in patients with unilateral edema. Due to its minimal risk and ability to provide information on lymph transport and reflux, lymphoscintigraphy is the gold standard for evaluation of lymphatic function. Diuretics are not effective in the long-term treatment of lymphedema, though may be useful for acute exacerbations.