Disorders of Arterial / Venous Circulation

Question 1

Idiopathic cause of PAD more commonsly seen in the Middle & Far East; occurs mostly in smokers and young males

Answer 1

Buerger disease (thromboangiitis obliterans)

Question 2

Fatigue, pain or weakness in involved extremity or digit

Answer 2

Claudication

Question 3

Triad of bilat hip claudication, erectile dysfunction, absent femoral pulses

Answer 3

Leriche syndrome (aortoiliac occlusive dse)

Question 4

ABI <___ is diagnostic of PAD

Answer 4

0.9

Question 5

Definitive test for PAD

Answer 5

Arteriography

Question 6

Only effective tx for Buerger disease

Answer 6

Smoking cessation

Question 7

Most common site of aneurysm

Answer 7

Abdominal aorta (for peripheral, popliteal)

Question 8

Diameter that defines abdominal aortic anuerysm (AAA)

Answer 8

> 3 cm

Question 9

Most common location of rupture of AAA

Answer 9

retroperitoneum

Question 10

Triad of AAA

Answer 10

Pulsatile mass
Hypotension
Abdominal pain

Question 11

Rupture in the IVC may manifest as…

Answer 11

painless hematuria

Question 12

Periumbilical ecchymoses

Answer 12

Cullen sign

Question 13

Flank ecchymoses

Answer 13

Grey-Turner sign

Question 14

MRI and aortography have no place in the emergent evaluation of possible ruptured AAA. TRUE or FALSE?

Answer 14

TRUE

Question 15

Thoracic aortic aneurysm is defined by a thoracic aorta dm > ___cm

Answer 15

> 4.5 cm

Question 16

Most appropriate dx test for unstable TAA patients

Answer 16

Transesophageal echocardiography (TEE)

Question 17

Most common predisposing risk factor for aortic dissection

Answer 17

Uncontrolled HTN

Question 18

Ddx in patients w/ new AR murmur & acute chest pain

Answer 18

Proximal aortic dissection

Question 19

Type __ dissections usually present as ripping chest pain. Hypotension is possible d/t tamponade

Answer 19

Type A

Question 20

Type __ dissections usually present as back pain. They result in asymmetric blood pressure in the LE, refractory HTN d/t renin secretion or paraparesis

Answer 20

Type B

Question 21

Test with sn but poor sp, hence helpful in ruling out dissection

Answer 21

D-dimer

Question 22

Diagnostic test of choice for aortic dissection

Answer 22

CT angiogram

Question 23

Goals of tx for aortic dissection

Answer 23

SBP 100-120 & HR <60 bpm
(esmolol used)

Question 24

Most common site of acute arterial embolism

Answer 24

bifurcation of common femoral artery

Question 25

6 Ps of acute arterial occlusion

Answer 25

Pain Pallor Paresthesias Pulselessness Paralysis Poikilothermia

Question 26

Finding seen in doppler UTZ for acute arterial occlusion

Answer 26

uni/ biphasic (N: triphasic)

Question 27

Test used to differentiate thromboembolism vs thrombosis

Answer 27

Arteriography

Question 28

Treatment for acute thromboembolism

Answer 28

Heparin + Fogarty Catheter embolism

Question 29

Tx for thrombosis-in-situ with limb-threatening ischemia

Answer 29

Heparin + embolectomy + bypass grafting

Question 30

Tx for arterial thrombosis w/o limb-threatening ischemia

Answer 30

Heparin +/- thrombolysis

Question 31

Clinical dx made in px presenting w acute pain in a pulseless extremity

Answer 31

Limb-threatening ischemia

Question 32

Virchow triad in DVT

Answer 32

vessel wall damage venostasis hypercoagulable state

Question 33

Pain in calf or posterior knee with passive dorsiflexion of foot

Answer 33

Homans sign

Question 34

Massive iliofemoral thrombosis causing acute, massive edema d/t venous insufficiency, severe pain & cyanosis

Answer 34

Phlegmasia cerulean dolens (painful blue leg)

Question 35

Massive iliofemoral thrombosis causing arterial spasm and a swollen, pale leg

Answer 35

Phlgemasia alba dolens (painful white leg)

Question 36

Criteria used to establish dx of DVT (score >3 indicates high pretest risk)

Answer 36

Wells

Question 37

Study of choice in DVT

Answer 37

Duplex ultrasound (95% sp/sn)

Question 38

Test that indicated presence of a clot within the past 72 hours

Answer 38

D-dimer

Question 39

Gold standard for dx of DVT

Answer 39

Venography

Question 40

Tx for DVT

Answer 40

Immediate anticoagulation (LMW heparin needs dose adjustment in renal failure)

Question 41

Most common source of pulmonary embolism

Answer 41

thrombus in the LE deep venous system

Question 42

In PE, the MC complaint is dyspnea but the symptom w strongest association is:

Answer 42

Hemoptysis

Question 43

ECG changes in PE involves any evidence of R heart strain

Answer 43

S1 Q3 T3 pattern (S in lead I + Q wave in lead III + T wave inversion in lead III)

Question 44

CXR finding in PE where there is pleural-based, wedeg-shaped density indicating infarcted lung

Answer 44

Hampton hump

Question 45

CXR finding with dec vessel markings distal to embolus (oligemia)

Answer 45

Westermark sign