Cardiovascular

Question 1

ABI interpretation

Answer 1

0.91 - 1.3: normal
0.9 or less: abnormal
more than 1.3: calcified uncompressible vessels, additional vascular studies should be considered

Question 2

ABI vs U/S on the initial diagnosis of PAD

Answer 2

ABI is more sensitive and specific for the initial diagnosis of PAD

Question 3

possible early complications of operation on the abdominal aorta

Answer 3

bowel ischemia + infraction

Question 4

Valvular insuf (incompetence)

Answer 4

the MCC of lower extremity edema –> worsens throughout the day and resolves overnight when the patient is recumbent

Question 5

stasis dermatitis due to venous hypertension - area

Answer 5

medial leg superior to medial malleolus

Question 6

insertion of central venous catheter for infection - next step

Answer 6

chest x-ray prior to catheter use to check it
(visualization of the catheter tip just proximal to the angle between the trachea + R mainstem bronchus confirms appropriate placement

Question 7

Leriche syndrome

Answer 7

aortilicac occlusion:
triad: bilateral hip, thigh and buttock claudication, impotence, absent of femoral pulses (often with symmetric atrophy)
if no impotence –> think alternative diagnosis

Question 8

clinical features of compartment syndrome

Answer 8

common: pain out of proportion injury, pain increased on passive stretch, rapidly increasing + tense swelling, paresthesia (early)
uncommon: decreased sensation, motor weakness (within hours), paralysis (late), decreased distal pulses (very uncommon)

Question 9

PCWP in PE

Answer 9

normal or low

Question 10

acute mediastinitis can follow

Answer 10

cardiac surgery

Question 11

acute mediastinitis - manifestations

Answer 11

fever, chest pain, leukocytosis, mediastinal widening on chest x-ray

Question 12

acute mediastinitis - managemen

Answer 12

drainage, surgical debridement, prolonged antibiotic therapy

Question 13

AF after CABG

Answer 13

occurs within few days after and is usually selflimited, with resolution in less than 24h. Rate control iis best. Anticoagulation and/or cardioversion is reserved for more than 24h

Question 14

extremity vascular trauma - clinical manifestation

Answer 14

hard signs: observed puslatile bleeding, presence of bruit/thrill over injury, expanding hematoma, signs of distal iscemia
soft signs: history of hemorrhage, diminished pulses, bone injury, neurologic abnormalities

Question 15

extremity vascular trauma - evaluation

Answer 15

if hard signs or hemodynamic instability: surgical expolation
otherwise: injured extremity index, CT or conventional angiography, Dupplex Doppler

Question 16

Peripheral artery aneurysms - manifestation

Answer 16

pulsatile mass that can compress adjacent structures (nerves, veins) and can reulst in thrombosis and ischemia
popliteral + femoral artery aneurysms are the MC –> frequently associated with AAA

Question 17

PCWP in tenstion pneumothorax

Answer 17

low or normal

Question 18

Homman’s sign - DDX

Answer 18

DVT

compartment syndrome

Question 19

Abdominal U/S for AAA

Answer 19

routine 1 time screening for AAA with U./S is recommended for men 65-75 with history of smoking