Post-Test Questions

Article 1 (225–232)

1. A 9-month-old Caucasian female presents with a 3 × 4 cm bluish nodule with surface telangiectasia involving the left lateral cheek. The differential diagnosis includes deep infantile hemangioma and congenital hemangioma, which you intend to distinguish based on clinical history; however, a reliable history cannot be obtained. Which of the following would be most likely to differentiate between these two entities?

   • Appearance on magnetic resonance imaging.

   • Glucose transporter-1 (GLUT-1) staining.

   • Persistence of the lesion.

   • D2–40 staining.

2. Which of the following is/are considered a capillary malformation?

   • Spider angioma.

   • Nevus simplex (salmon patch).

   • Nevus flammeus (port-wine stain).

   • All of the above.

3. A 27-year-old pregnant woman develops a subcentimeter pedunculated mass on the oral mucosa, which is suspected to be pyogenic granuloma. How is this entity classified according to the most current ISSVA classification system?

   • Provisionally unclassified vascular anomaly.

   • Simple capillary malformation.

   • Combined vascular malformation.

   • Benign vascular tumor.

   • Borderline/locally destructive vascular tumor.

   Article 2 (233–238)

4. Which vascular anomaly clearly implies increased PI3K/AKT signal transduction?

   • Arteriovenous malformation.

   • Capillary malformation.

   • Noninvoluting congenital hemangioma.

   • Pyogenic granuloma.

   • Venous malformation.

5. In which inherited vascular anomaly a somatic second hit has NOT been demonstrated?

   • CCM.

   • CM-AVM.

   • GVM.

   • HHT.

   • VMCM.

6. Which vascular anomaly has NOT been shown to be associated with a somatic mutation?

   • Blue rubber bleb nevus syndrome.

   • CM.

   • Infantile hemangioma.

   • LM.

   • VM.

   Article 3 (239–249)

7. Which vascular tumor is considered locally aggressive?

   • Kaposiform hemangioendothelioma.

   • Infantile hemangioma.

   • Noninvoluting congenital hemangioma.

   • Rapidly involuting congenital hemangioma.

   • Pyogenic granuloma.

8. Systemic sirolimus has been shown to be beneficial in which of the following disorders?

   • Blue rubber bleb nevus syndrome.

   • Kaposiform hemangioendothelioma.

   • Lymphatic malformation.

   • PTEN hamartoma syndromes.

   • All of the above.

9. Which of the following is an important component of a vascular anomalies center?

   • Multidisciplinary team of providers.

   • Collaboration between specialties and other institutions.

   • Support services (physical therapy, genetic counseling, etc.).

   • Advocacy and education.

   • All of the above are important.

   Article 4 (250–257)

10. Which of the following hereditary AVMs has associated cutaneous vascular malformations?

    • CM-AVM.

    • HHT.

    • PTHS.

    • All of the above.

    • None of the above.

11. Which of the following hereditary AVM syndromes has been found to be responsive to pharmacotherapy?

    • HHT.

    • CM-AVM.

    • PTHS.

    • HHT and CM-AVM.

    • HHT and PTHS.

12. Visceral AVMs are associated with which of the following three hereditary AVMs?

    • HHT.

    • CM-AVM.

    • PTHS.

    • All of the above.

    • HHT and CM-AVM.

    Article 5 (258–271)

13. What is the most important noninvasive imaging modality when first evaluating patients with arteriovenous malformations?

    • MRI.

    • CTA.

    • Doppler ultrasound.

    • PET scan.

14. Which is the best embolic agent to treat arteriovenous malformations?

    • Coils.

    • Ethanol.

    • Glue.

    • Onyx.

15. Which of these lesions will be treated with a mechanical agent (coils or plugs)?

    • Yakes type I.

    • Yakes type IV.

    • Cho type III A.

    • Yakes type II/Cho type IIIb.

    Article 6 (272–279)

16. Among those patients treated for intraosseous arteriovenous malformations (AVMs),

    • Pure intraosseous AVMs are more common than mixed AVMs of soft-tissue and intraosseous AVMs.

    • Surgical resection is the primary mode of therapy for intraosseous AVMs.

    • When intraosseous AVMs are associated with soft-tissue AVMs, we should try to treat intraosseous AVMs first.

    • Pain and pulsating mass are unique clinical manifestation of intraosseous AVMs.

17. Among imaging findings of intraosseous AVMs,

    • Osteolytic lesion with typical periosteal reaction is one of the common findings of simple radiography.

    • For evaluation of the cortical changes by intraosseous AVMs, CT is better than MRI.

    • MR image cannot distinguish between high-flow and low-flow vascular malformations.

    • Type I intraosseous AVMs by angiographic classification are common intraosseous AVMs.

18. In the current endovascular treatment of intraosseous AVMs,

    • Ethanol, coils, and n-butyl cyanoacrylate are essential therapeutic tools for the management of intraosseous AVMs.

    • For type II intraosseous AVMs, transarterial approach is the best therapeutic access for the malformation.

    • For type III intraosseous AVMs, transvenous embolotherapy shows good treatment results.

    • Skin necrosis and peripheral nerve injury are rare complications of ethanol embolotherapy.

    Article 7 (280–287)

19. Which magnetic resonance imaging (MRI) sequence is most helpful when planning cryoablation treatment for vascular anomalies?

    • T1-weighted without fat suppression.

    • T1-weighted with gadolinium.

    • T2-weighted with fat suppression.

    • Dynamic MR angiography.

20. Patients with vascular anomalies considered less suitable for cryoablation have all the following except:

    • Malformation involving major nerves.

    • Nonfocal areas of pain.

    • Significant muscle contracture.

    • Juxta-articular location of the lesion.

21. During cryoablsation the critical temperature required for cell death is between

    • −10 and 20°C.

    • −20 and 40°C.

    • −40 and 60°C.

    • −60 and 80°C.

22. The mechanism of ice ball formation in cryoablation is primarily:

    • Electrical.

    • Mechanical.

    • Electromechanical.

23. Which particular complication associated with cryoablation is most concerning?

    • Skin necrosis.

    • Vascular injury.

    • Cryoshock.

    • Nerve injury.

    Article 8 (288–293)

24. Which sclerosant is the most effective with lowest recurrence rate for the treatment of venous malformation?

    • Ethanol.

    • Sodium tetradecyl sulfate.

    • Bleomycin A5.

    • Sodium morrhuate.

    • Ethanolamine oleate.

25. Which statement is false regarding diffuse venous malformations?

    • They are low-flow malformations.

    • They tend to grow with age and may become symptomatic later.

    • Sclerotherapy is considered curative.

    • Often, multiple sessions are required to treat the lesion.

26. Which of the following is considered the current acceptable indication for the treatment of venous malformation with sclerotherapy?

    • Treat asymptomatic lesions to prevent future growth.

    • Treat the symptomatic lesions and aim for symptom relief.

    • Treat the lesion until it shows considerable volume reduction on MRI.

    • Treat the lesion until it shows considerable volume reduction on angiography.

    Article 9 (294–300)

27. What is the best imaging method of the abnormal pulmonary lymphatic flow?

    • Pedal lymphangiography.

    • Lymphoscintigraphy.

    • Intranodal lymphangiography.

    • Dynamic contrast-enhanced MR lymphangiography (DCMRL).

28. What is PLPS?

    • Pulmonary lymphatic perfusion syndrome.

    • Pulmonary lipid perfusion syndrome.

    • Peripheral lymphatic perfusion sign.

    • Prostate lymphatic percolation system.

29. What part of the body generates most of the lymph?

    • Lower extremities

    • Chest.

    • Abdomen.

    • Upper extremities.