Learning Strike

The first-choice procedure due to its excellent patency rates and minimal complications is:

• Radio-cephalic primary fistula

• Brachio-cephalic primary fistula

• Transposed brachial-basiclic vein fistula

• Snuff-box

Select the statement/s that describe the AVF physiology of maturation.

• Change in thickness of intima media

• Vasodilation and vascular remodelling

• Reduction of mean shear stress which returns to normal after 3 months

• Increased arterial diameter

Engorgement of vessels distal to the anastomosis, cyanotic vein bed, edema of the hand, engorgement of thumb vein, and swelling of arm, chest, & face- are signs & symptoms of:

• Non-maturing outflow vein

• Non-arterialization of the venous side of the AVF

• Disturbance in flow dynamics

• None of the above

Clinical monitoring of AVG includes physical examination to detect signs suggesting pathological problem. What is the recommended test included?

• Allen's Test

• Augmentation Test

• Arm Elevation Test

• Any of the above

What is/are the characteristic of a 'normal thrill'?

• Strong, localised

• Thrill appears at the anastomosis and diminishes along the length of the vessel

• Thrill appears at the anastomosis and increases along the length of the vessel

• Weak, not localised

What is/are the characteristic of the pulse with AVF outflow stenosis?

• Pulse is feeble

• Pulse is hypopulsatile

• Pulse is water-hammer

• Pulse is soft and compressible

A bruit with a whooshing sound that is low pitched and quiet indicates:

• Normal

• Outflow stenosis

• Inflow stenosis

• AVG failure

The VENOUS needle must always be placed: RETROGRADE direction.

• True

• False

• It does not matter

• Personal (clinician's) preference

For AVG, antegrade, bevel down (arterial) orientation is recommended because:

• The risk of extraluminal haematoma formation is increased

• It increases the risk of perforating the underside of the vessel

• The risk of needle injury is lower

• The risk of extraluminal haematoma formation is reduced

During arm elevation test, with lower arm AVF:

Under normal circumstances, the AVF outflow vein will (a)   when the arm is raised above the level of the heart.