Chapter 22: Diseases of the Vascular System Flashcards
A 67yo man is in the ED w/ abdominal and back pain. 2 weeks ago he was dx with an AAA 5.6 cm in diam. The AAA was discovered incidentally when he had a CT scan to confirm the dx of a kidney stone. He has severe COPD. What is the best management for this pt at this time and the rationale?
Endovascular repair since it is assoc with improved survival compared to opne AAA repair for a ruptured AAA.
A 64yo man is referred to your clinic with ischemic rest pain of the left leg and a nonhealing ulcer of his right great toe. His femoral pulses are nonpalpable bilaterally. He does not have DM. His renal function is normal. Which of the following is most appropriate way to assess his vascular anatomy prior to revascularization?
CT angiogram of the pelvis and lower extremities
A 55yo man presents to your clinic b/c he is worried that he may have an abdominal aortic aneurysm. Which of the following factors is associated with the highest risk for development of an AAA?
Personal history of an elective popliteal aneurysm repair
A 60yo woman is referred to your office for evaluation of exercise-induced leg pain. She predictably develops an aching pain in her right calf after walking 1 block. She denies a history of coronary artery disease or diabetes. She takes medication for dyslipidemia and HTN and smokes 1PPD. On exam, she has a normal right femoral pulse and nonpalpable popliteal and pedal pulses. Which of the following would be an indication to intervene for her symptomatic right leg PAD?
Due to her leg pain, she is on medical leave from her job as a letter carrier
A 32yo woman is seen in clinic in follow-up. 2 weeks ago she was dx with HTN and was started on an angiotensin- converting inhibitor. She brings a BP diary and her BP over past 10 days was b/t 150/90 and 180/100. Today her BP is 160/100 and symmetric in all extremities. Her PE is normal except for an upper abdominal bruit. Electrolytes, BUN, and Cr were normal during her last visit. Which of the following is the most likely diagnosis?
Fibromuscular dysplasia of a renal artery
A 65yo man with a gangrenous toe undergoes an arteriogram. Multiple stenoses are present throughout the arterial tree. Which factor is associated with the largest decrease in pressure gradient across a stenosis?
Radius of lesion
A 59yo HTNive man is in the ED with acute onset of severe midscapular “tearing” chest pain. Aortic dissection is suspected. An AKG shows ischemic changes and a chest CT confirms a Stanford Type A dissection. What is the best management for this pt?
Urgent operative repair
A 54yo man was evaluated for bilateral buttock and leg claudication and found to have severe bilateral aorto-iliac occlusive disease. There is no evidence of significant disease distally in his extremities. He is not a diabetic. There is no hx of coronary disease and cardiac stress testing was recently normal. He smokes 1PPD. In addition to smoking cessation, what is the best management for this pt?
Bilateral aortobifemoral bypass
A 43yo woman is seen in clinic b/c of chronic pigmentation and mild pain in her medial left calf. She has a prior hx of deep vein thrombophlebitis at age 20 following an appendectomy. There is mild swelling and brown discoloration of the left pretibial area. The most likely sequelae of this problem, if left untreated, is:
Ankle ulceration
A 52 yo man presents to your office complaining of constant left leg pain. Which of the following associated sxs is most consistent with PAD?
Aching foot pain that is exacerbated with leg elevation (decreased blood supply)
