Cardiovascular (9%)

Question 1

Leriche’s Syndrome

Answer 1

Seen with claudication
Aortic bifurcation/common iliac involvement
1. Claudication (buttock, thigh pain)
2. Impotence
3. Decreased femoral pulses

Question 2

In order to be considered aneurysmal, an AAA must be at least > ________

Answer 2

3 cm

Question 3

Risk Factors for AAA

Answer 3

Atherosclerosis (MC)
Age > 60 y/o
Smoking
Males, Caucasians

Question 4

Classic presentation of AAA (when not asymptomatic):

Answer 4

Older male > 60 y/o
Severe back or abdominal pain
Presents with hypotension/syncope
Tender, pulsatile abd mass
May complain of unilateral groin/hip pain

Question 5

Diagnosis of AAA

Answer 5

1. Abdominal Ultrasound - initial test of choice
2. CT Scan - especially for thoracic aneurysm
3. Angiography - gold standard
4. MRI/MRA
5. Abdominal radiograph

Question 6

Management of an AAA >5.5 cm

Answer 6

Immediate surgical repair even if asymptomatic

Question 7

Management of an AAA with expansion of > 0.5 cm in 6 months

Answer 7

Immediate surgical repair even if asymptomatic

Question 8

Management of AAA > 4.5 cm

Answer 8

Vascular surgeon referral

Question 9

Management of AAA 4-4.5 cm

Answer 9

Monitor by US every 6 months

Question 10

Management of AAA 3-4 cm

Answer 10

Monitor by US every year

Question 11

Medicational management of AAA

Answer 11

Beta blockers

Also decrease risk factors

Question 12

65% of aortic dissections are ________

Answer 12

Ascending

Question 13

__________ aortic dissections are associated with a high mortality

Answer 13

Ascending

Question 14

Most important risk factor for aortic dissection

Answer 14

HTN

Question 15

Risk factors for aortic dissection

Answer 15

HTN
Marfan Syndrome
Age 50+
Men
Cocaine use

Question 16

Signs/symptoms of aortic dissection

Answer 16

Chest pain - severe, tearing, ripping, knife-like
N/V
Diaphoresis

Question 17

Physical exam sign of aortic dissection

Answer 17

Decreased peripheral pulses –> radial, carotid or femoral

Question 18

Diagnosis of aortic dissection

Answer 18

1. CT Scan w/ contrast - TOC
2. MRI angiography - gold standard
3. TEE
4. CXR

Question 19

What will show on CXR with aortic dissection?

Answer 19

Widening of the mediastinum

Question 20

Management of Stanford A / DeBakey I and II aortic dissections, or type III with complications

Answer 20

Involve the ascending aorta / aortic arch

Surgery!

Question 21

Management of Stanford / DeBakey III aortic dissections

Answer 21

Are limited to descending aorta
Esmolol, Labetalol - 1st line
Sodium nitroprusside, nicardipine if needed

Question 22

How often should aortic dissection be imaged if not surgically fixed?

Answer 22

3, 6, and 12 mo to look for progression, redissection and/or new aneurysm formation

Question 23

Atherosclerotic disease of the lower extremities

Answer 23

Peripheral arterial disease

Question 24

Stages of peripheral arterial disease

Answer 24

1. Intermittent Claudication (MC)
2. Resting leg pain - advanced dz
3. Acute arterial embolism
4. Gangrene

Question 25

The 6 P's of acute arterial embolism

Answer 25

Caused by sudden occlusion 1. Pain 2. Pallor 3. Pulselessness 4. Poikilothermia 5. Paralysis 6. Paresthesias

Question 26

Signs on physical exam of peripheral arterial disease

Answer 26

1. Decreased pulses, bruits, capillary refill 2. Atrophic skin changes 3. Dependent rubor

Question 27

Diagnosis of peripheral arterial disease

Answer 27

1. ABI (<0,90) 2. Arteriography - gold standard 3. Duplex B mode ultrasound 4. Hand held doppler

Question 28

Management for peripheral arterial disease - revascularization

Answer 28

1. Percutaneous Transluminal angioplasty 2. Bypass grafts fem-pop bypass 3. Endarterectomy

Question 29

Management of acute arterial occlusion in peripheral arterial disease

Answer 29

Heparin for acute embolism Thrombolytics for thrombus Embolectomy

Question 30

Supportive management of peripheral arterial disease

Answer 30

Exercise, foot care, lower risk factors (DM, HTN, HLD)

Question 31

Livedo reticularis

Answer 31

Mottled appearance of leg | Seen with arterial ulcer disease

Question 32

Stasis dermatitis

Answer 32

Eczematous rash, thickening of skin | Seen with venous ulcer disease

Question 33

Varicose veins usually involve the ________ _________ veins

Answer 33

Superficial saphenous

Question 34

Management of varicose veins

Answer 34

1. Conservative - leg elevation, compression stockings, avoid prolonged standing/sitting 2. Sclerotherapy, radiofrequency or laser ablation and ambulatory phlebectomy commonly used