PAD/Aortic d/o

Question 1

Pt w/ acute chest pain and epigastric chest pain radiating to back with dyspnea and diaphoresis. Skin cool/clammy, HTN, tachycardia and breath sounds decreased in LLL with dullness in percussion.
D-dimer is elevated. Recent cocaine use. Diagnosis?

Answer 1

Aortic Dissection [w/ hemothorax]
(tear in intima)

Cocaine → rapid HTN, sudden-onset, severe chest/back pain and pleural effusion → hemothorax→ aortic dissection

Question 2

pt with recent repair of infrarenal aortic aneurysm POD#1 has abdominal pain, TTP in the LLQ and bloody diarrhea. Femoral pulses are full and symmetric. Dx?

Answer 2

Bowel ischemia and infarction

possible early cx ofoperation on the abdominal aorta/AAA repair

Question 3

Patient with h/o HTN & smoking presents with acute left-sided flank pain & syncope. Pt is anxious, pale, diaphoretic with left CVA tenderness. HD unstable, peripheral pulses decrease, no rigidity/guarding, pulsatile abdominal mass/hematoma at the umbilicus/flank.
Diagnosis?

Answer 3

Ruptured Abdominal Aortic Aneurysm (AAA)

Question 4

[Cardiac cx] occurs ~10% of patients with ankylosing spondylitis.

Answer 4

Aortic regurgitation

Likely results from chronic inflammation of the aortic root and valve cusps

Question 5

Characterized by the triad of:
–Bilateral hip, thigh, and buttock claudication
–Impotence
–Absent/diminished femoral pulses
(often with symmetric atrophy of the BLE s/t chronic ischemia).

Answer 5

Aortoiliac occlusion

Leriche syndrome

Question 6

Aortoiliac occlusion

(Leriche syndrome) 2 greatest risk factors:

Answer 6

Atherosclerosis

Smoking

Question 7

Patient suffering 20 ft fall presents with severe chest and back pain, hypertension tachycardia, and hoarse voice with bruising over the sternum which is tender to palpation. The lower extremities are cool to the touch with diminished femoral pulses bilaterally. What is the diagnosis and next steps in management

Answer 7

Blunt Thoracic Aortic Injury

Get CXR
(then CTA if widened mediastinum)

*TEE if CTA is c/i (contrast allergy, Renal failure)

Question 8

Pts surviving large falls likely have an incomplete aortic rupture which may result in 
Creation of a
– false lumen (like aortic dissection)
– obstructive intimal flap
(2, if  you can)

Treatment:
*pt can be normo or hypertensive

Answer 8

Emergent Surgery

–intramural hematoma impeding distal blood flow (pseudocoarctation) resulting in
BUE HTN &
BLE hypotension– ↓ pulses)

–Expansion of the adventitia compression surrounding structures such as the left recurrent laryngeal nerve (hoarse voice)

Question 9

Myocardial contusion

Has no specific CXR findings (sternal fx raises suspicion)

Typically diagnosed by ___ or ___

Answer 9

ECG
(showing arrhythmia or new bundle branch block)

ECHO (showing wall motion abnormality or decreased contractility)

Question 10

Patients with trauma from rapid deceleration are at risk for blunt thoracic aortic injury (BTAI). All patients with blunt chest trauma require a ___ & ___ after initial trauma survey.

Answer 10

CXR & Fast U/S

• Findings concerning for BTAI include widened mediastinum, abnormal aortic contour, and/or left-sided effusion (hemothorax).

Question 11

Ankle Brachial Index

0. 9 or less =
1. 4 or more =

Answer 11

PAD
Calcified/incompressible vessel

(0. 91 – 1.3 = normal)
0. 4 or less = Revascularization

Question 12

Painful extremity with increased pain on passive stretch suggests

Answer 12

Compartment Syndrome
(urgen fasciotomy)

*DVT can cause pain and swelling, but severe pain and sensory or motor deficits are more consistent with CS.

Question 13

Turner syndrome (45X0). 
Common manifestations 
short height webbed neck, horseshoe kidney, streak ovaries (infertility).

Cardiovascular disease including, 
coarctation of aorta, 
 \_\_\_ valve and \_\_\_ 
placing pt at an increased risk for \_\_\_ 
(risk further increased during pregnancy.)

Answer 13

bicuspid aortic
aortic root dilation
aortic dissection

other cxs:
*diabetes
cataracts
osteoporosis
thyroid problems

Question 14

pulsatile mass in the groin. Dx?

Answer 14

Femoral artery Aneurysm

Question 15

Treatment of acute or acute on chronic limb ischemia (3)

Answer 15

Heparin (IV)

Thrombolysis/fibrinolysis (tPA; Streptokinase), Thrombectomy (Fem–cath)

Question 16

Pt presents with severe and worsening lower extremity pain, legs are hairless and shiny, extremity is mottled and cool to the touch. Pulses are not palpable in either extremity, but unaffected extremity has flow on doppler. Affected extremity has delayed cap refill and decreased movement Diagnosis?

Answer 16

Acute on Chronic limb ischemia

s/t atherosclerotic plaque disruption & collateral circulation no longer able to compensate