Common Conditions - Cardiovascular

Question 1

Etiology: Abdominal Aortic Aneurysm

Answer 1

2° to atherosclerosis

Question 2

Risk factors: Abdominal Aortic Aneurysm

Answer 2

HTN, hypercholesterolemia, atherosclerosis, FHx, tobacco, M, age, Marfan’s

Question 3

SSx: Abdominal Aortic Aneurysm

Answer 3

Usu asx, pulsatile sensation, back pain, vague epigastric pain

If ruptured: hypotension, severe tearing abd. pain radiating to the back

Question 4

PE: Abdominal Aortic Aneurysm

Answer 4

Pulsatile mass in abdomen, abdominal bruits, evidence of LE arterial insufficiency

Question 5

Work-up: Abdominal Aortic Aneurysm

Answer 5

U/S - dx gold standard
AXR/KUB - mb vascular calcification
CT - anatomy/size
Aortogram - definitive dx

Question 6

DDx: Abdominal Aortic Aneurysm

Answer 6

Pancreatitis, pseudocyst, appendicitis, gb disease, aortic dissection

Question 7

Tx: Abdominal Aortic Aneurysm

Answer 7

Observation (asx, <5 cm, <6 cm + poor surgical candidate)

Surgery (>5.5 cm abd., >6 cm thoracic, smaller lesions rapidly growing)

Question 8

Complications: Abdominal Aortic Aneurysm

Answer 8

MI, thrombosis/post-op emboli, aortoduodenal fistula

Question 9

What is the MC cz of death after elective AAA surgical repair?

Answer 9

MI

Question 10

Thrombosis post-AAA surgery can lead to ___.

Answer 10

Renal failure, GI hemorrhage

Question 11

Screening: Abdominal Aortic Aneurysm

Answer 11

Men 65-75 with hx of smoking

Question 12

Prognosis: Abdominal Aortic Aneurysm

Answer 12

Good-excellent if smaller/ID’d early

Poor if dissection/rupture

Question 13

Grey Turner’s sign

Answer 13

Flank ecchymosis, sometimes seen in retroperitoneal rupture of AAA

Question 14

Mortality: AAA rupture

Answer 14

90%

Question 15

Abdominal Aortic Aneurysm is a local enlargement of the abdominal aorta larger than ___.

Answer 15

3 cm

Question 16

PE: Myenteric ischemia post-AAA surgery

Answer 16

Pain out of proportion to PE

Question 17

Acute onset back pain and severe hypotension is ___ until proven otherwise.

Answer 17

AAA

Question 18

What is the surgical cut-off for asx AAA?

Answer 18

> 5.5 cm

Question 19

Angina: stable vs. unstable

Answer 19

S: predictable, relief w/ NTG

U: new onset or rapidly worsening angina, unpredictable, limited relief w/ NTG

Question 20

SSx: Angina

Answer 20

Chest pain, precipitated by exertion, relieved by rest/nitrates

Radiates to arms/jaw/neck, mb diaphoresis, N, lightheadedness

Question 21

Classic sxs of angina do not always present in which populations?

Answer 21

Elderly, women, diabetics

Question 22

PE: Angina

Answer 22

Usu normal, mb bruits/HTN

Question 23

Work-Up: Angina

Answer 23

EKG (ST depression/elevation, T wave inversion, Q waves), Cardiac enzymes (Troponin, CK, CK-MG), Exercise stress test

Question 24

DDx: Angina

Answer 24

MI, PE, thoracic aortic aneurysm, esophageal rupture, pancreatitis, pseudocyst, neoplasms, MSK, appendicitis, gb dz, GERD

Question 25

Tx: Angina

Answer 25

Morphine, O2, NTG, ASA, ACEIs, BBs

CCB for chronic mgmt of unstable angina

CABG

Question 26

When is CABG indicated for angina?

Answer 26

Failure of tx, 3-vessel dz, 2-vessel dz in diabetics

Question 27

Risk factor reduction: Angina

Answer 27

Diet, exercise, BP control, cholesterol control, smoking

Question 28

What drug class is contraindicated in variant angina?

Answer 28

BBs d/t possibility of unopposed coronary vasospasm