Cardiovascular

Question 1

acute onset back pain and profound hypotension. may have gross hematuria

Dx and Tx

Answer 1

ruptured AAA

emergent surgery

Question 2

why hematuria in a AAA?

Answer 2

gross hematuria from aortocaval fistula with IVC, leading to venous congestion in retroperitoneal structures like that bladder.

Question 3

hypotension and distended beck veins

Answer 3

massive PE

Question 4

MCC of LE edema

Answer 4

venous insufficiency/valvular incompetence

Question 5

After cardiac catheterization, a patient presents with sudden hemodynamic instability and ipsilateral flank/back pain.

Test used to diagnose this condition.

Answer 5

non-contast CT of abd/pelvis or abd US to diagnose a retroperitoneal hematoma

Question 6

treatment of retroperitoneal hematoma

Answer 6

supportive

Question 7

right anterior thigh pain worse with walking. small pulsatile mass in right groin.

Answer 7

femoral artery aneurysm

Question 8

ankle-brachial index definition

Answer 8

(higher dorsalis or posterior tibial systolic in each LE) / (higher brachial artery systolic)

Question 9

0.90 or less ankle-brachial index interpretation

Answer 9

diagnostic of occlusive PAD**

Question 10

0.91 to 1.30 ankle-brachial index interpretation

Answer 10

normal

Question 11

1.31 or higher ankle-brachial index interpretation

Answer 11

suggestive of calcified and uncompressible vessels; additional vascular studies should be considered.

Question 12

Following cardiac surgery, patient presents with fever, chest pain, leukocytosis, mediastinal widening on CXR.

Dx and management

Answer 12

acute mediastinitis. requires surgical drainage, debridement, and antibiotics.

Question 13

describe the triad that follows arterial occlusion at bifurcation of aorta into iliac arteries.

Answer 13

leriche syndrome

triad:
- bilateral hip, thigh, and buttock claudication (aching pain with walking)
- impotence
- symmetric atrophy of bilateral lower extremity due to chronic ischemia

Question 14

high energy, blunt, rapid deceleration MVA trauma. large bruises over entire chest wall. collapsed neck veins bilaterally. decreased breath sounds on the left. Large left hemothorax and widened, right-deviated mediastinum.

Answer 14

aortic injury

Question 15

blunt chest trauma. decreased breath sounds, dullness to percussion and contralateral tracheal deviation.
BP 85/55, HR 120, R 30

Answer 15

large hemothorax with hemorrhagic shock

Question 16

Right atrial pressure (preload) - DECREASED
PCWP (preload) - DECREASED
Cardiac index (pump function) - DECREASED
Systemic vascular resistance (afterload) - INCREASED
Mixed venous oxygen saturation - DECREASED

Answer 16

HYPOVOLEMIC SHOCK

Question 17

Right atrial pressure (preload) - INCREASED
PCWP (preload) - INCREASED
Cardiac index (pump function) - VERY DECREASED
Systemic vascular resistance (afterload) - INCREASED
Mixed venous oxygen saturation - DECREASED

Answer 17

CARDIOGENIC SHOCK

Question 18

Right atrial pressure (preload) - NML TO SLIGHT DECR
PCWP (preload) - NML TO SLIGHT DECR
Cardiac index (pump function) - INCREASED
Systemic vascular resistance (afterload) - DECREASED
Mixed venous oxygen saturation - INCREASED

Answer 18

SEPTIC SHOCK - severely decreased systemic vascular resistance

Question 19

PCWP is elevated and increases significantly after infusion of saline without appreciable change in systemic BP. what is this suggestive of?

Answer 19

elevated intracardiac filling pressures due to left ventricular dysfunction, ML caused by myocardial contusion

Question 20

surgical repair of aneurysm of infrarenal aorta. presents with T 101, BP 110/65, P 110/min, R 22/min. Tenderness in LLQ w/o rebound. WBC 12,000. ML dx?

Answer 20

ischemia of the bowel - complication in 1-7% of AAA repairs

Question 21

severe retrosternal chest pain and mediastinal free air on CXR.

Answer 21

esophageal rupture