CME TEST QUESTIONS: MARCH

2013

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The CME questions in this issue are derived from the article ‘‘Prognostic Capability of Different Liver Disease Scoring

Systems for Prediction of Early Mortality after Transjugular Intrahepatic Portosystemic Shunt Creation’’ by Ron C. Gaba,

et al.

1.

Indications for transjugular intrahepatic portosystemic

shunt (TIPS) creation in this article included

a) Variceal bleeding confirmed with endoscopy.

b) Refractory ascites and hepatic hydrothorax.

c) Portal vein thrombus.

d) Previously transplanted patients.

e) All of the above.

2.

Thirty-day procedure-related adverse events included

a) Mild hepatic encephalopathy managed clinically in

31% of patients.

b) Renal failure in 3% of patients.

c) Liver infarction o 2%.

d) Hepatic insufficiency requiring shunt reduction

o 2%.

e) All of above.

3.

Causes of death in patients following TIPS were

bleeding, liver and multiorgan failure, and septic shock

not specified with

a) 30- and 90-day mortality in the variceal hemor-

rhage of 32% and 36%.

b) 30- and 90-day mortality in the nonemergent TIPS

of 20% and 29%.

c) 30- and 90-day mortality in the ascites cohort of

15% and 21%.

d) No difference found in the 30- and 90-day mortality

between bare metal and covered stent TIPS.

4.

Multivariate analysis of variance showed that

a) The Model for End-Stage Liver Disease (MELD)

scoring system had a higher correlation.

b) Age and right atrial pressure had statistically

significant association with 30-day mortality.

c) Procedure indication, urgency, and stent type used

had statistically significant association with 30-day

mortality.

d) Portosystemic gradient reduction had significant

association with 30-day mortality

e) All of above.

5.

MELD scores for TIPS of 25 and higher associated

with 1- and 3-month mortality rates exceeding 70%

suggest that

a) These patients should not be considered for

intervention.

b) Careful selection of these patients after discussion

with patient and family may be considered in view

of a possible 20% survival at 90 days.

c) The current scoring systems are accurate enough in

the extremes of severe liver disease to make

decisions concerning procedures, and no improve-

ments are needed.

d) Scoring system performance does not vary with

patient circumstance and procedure characteristics.